The Impact of Multiple Viral Infection in Children with Severe Lower Respiratory Tract Infections

Abstract

Aim:We aimed to compare the clinical features and outcomes between single and multiple viral pathogens in children with severe lower respiratory tract infections (LRTIs) in a pediatric intensive care unit (PICU).Materials and Methods:This study was conducted retrospectively in patients who were admitted to a PICU between March, 2018 and March, 2020. The subjects were divided into two groups, single viral infection and multiple viral infection. The epidemiologic characteristics, clinical features, disease severity and outcomes were compared between these single and multiple viral infection groups.Results:During this study period, positive polymerase chain reaction (PCR) tests were carried out on 136 (29%) children among the 468 children admitted to the PICU with the diagnosis of LRTI. Rhinovirus and Respiratory Syncytial Virus (RSV) were the most commonly identified viruses (44.1% and 35.2%, respectively). Two viruses were detected in thirty-nine (28.6%) of samples via PCR tests. Rhinovirus and RSV co-infection was the most common combination (10/39, 25.6%) in our cohort. The multiple viral infection group had higher PRISM scores than the single virus infection group (10 vs. 7, respectively, p=0.009). In the multiple viral infection group, the invasive ventilatory support rate (56.4% vs 36.1%, p=0.030) and the non-invasive ventilatory (NIV) support rate (43.5% vs 6.1%, p=0.018) were significantly higher than in the single viral infection group.Conclusion:Lower respiratory multi-viral infections are associated with increased invasive and NIV support requirements. Close monitoring in a unit where support can be provided is essential for those infants with multi-viral LRTIs.

Keywords

• respiratory viruses
• children
• co-infection
• critical care
• lower respiratory tract infections