Viral Aetiology of Severe Acute Lower Respiratory Tract Infection in Children from the Paediatric Intensive Care Unit at a Tertiary Care Hospital, Eastern India- A Retrospective Study

Abstract

Introduction: Viral infections are the common source of lower respiratory tract infection worldwide. Rapid and accurate detection of viral infections is important that can prevent antibiotic abuse. However, there are few studies determining viral etiologies in paediatric subjects in Eastern India. Aim: To study viral aetiology in children hospitalised with severe Acute Lower Respiratory Tract Infection (ALRTI) over a period of two years and to detect the impact of co-infection on severity and duration of hospitalization. Materials and Methods: This was a retrospective study based on electronic database in a tertiary care Paediatric Intensive Care Unit (PICU) of Bhagirathi Neotia Women and Child Care Hospital, Kolkata, West Bengal, India. Data were collected for all the patients who fulfilled the selection criteria and were admitted to PICU with ALRTI from March 2018 to March 2020. The medical records were reviewed in 51 patients with positive viral Reverse Transcription Polymerase Chain Reaction (RT-PCR). Data was collected for the type of viruses infecting the subjects and whether there were single infection or co-infection. Co-infection is simultaneous infection with more than one virus. Statistical analysis was done using the IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, version 24.0 (Armonk, NY: IBM Corp). Student’s t-test and Chi-square test were used to compare single infection and co-infection. A p-value <0.05 was considered significant assuming the confidence interval of 95% as the level of significance. Results: The highest positivity rate was 66.6% (34/51) observed in children in the age group 1-12 months. The common viruses detected were adenovirus seen in 51% of samples, Respiratory Syncytial Virus (RSV) in 31.3% and rhinovirus in 11.8%. Clustering of cases was observed for RSV and influenza A in the colder months of the year. Single infection was seen in 74.5% of samples and co-infection in 25.5%. Comparison between single and co-infection with two viruses in terms of complications (p-value=0.163), average duration of PICU stay (p-value=0.70), C-reactive protein (p-value=0.952), procalcitonin (p-value=0.198), white blood cell count (p-value=0.737), absolute neutrophil count (p-value=0.612) were not significant. Conclusion: This present study found that adenovirus and RSV were the leading viral pathogens for ALRTI in the PICU. Co-infection with multiple viruses compared with a single viral infection in a patient did not impact severity.

Keywords

• adenovirus
• co-infection
• respiratory syncytial virus
• reverse transcription polymerase chain reaction
• viral infection