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Kocoglu Barlas U, Akcay N, Menentoglu ME, Sevketoglu E, Duyu M, Telhan L, Kangin M, Tugrul HC, Erdogan S, Durak C, Guney Sahin E, Umur O, Sik SG, Citak A, Yaman A. Assessment of the Clinical Course of Human Rhinovirus/Enterovirus Infections in Pediatric Intensive Care. Pediatr Infect Dis J 2023; 42:e454-e460. [PMID: 37820286 DOI: 10.1097/inf.0000000000004127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND This study aims to evaluate the clinical course of human rhinovirus/enterovirus (HRV/EV) infections in the pediatric intensive care unit. METHODS The study was conducted as a multicenter, prospective observational study from September 2022 to December 2022. Cases with positive polymerase chain reaction testing for HRV/EV of nasopharyngeal swab samples within the first 24 hours of pediatric intensive care unit admission were recorded. There were 2 groups: 1-24 months and >24 months. RESULTS A total of 75 cases (39 male) were included in the study. The median age for all cases was 21 months. The highest polymerase chain reaction positivity rates were observed in October (37.33%). Among the cases, 32 (42.67%) presented with bronchopneumonia/pneumonia, 24 (32%) presented with acute bronchiolitis/bronchitis and 7 (9.33%) presented with sepsis/septic shock. The frequency of pediatric acute respiratory distress syndrome was found to be 6.67%. In the age group of 1-24 months, mean lymphocyte and liver enzyme levels were higher, while in the age group of >24 months, mean hemoglobin and mean kidney function test levels were higher ( P ≤ 0.05). Continuous oxygen therapy was provided to 65.3% of the cases, noninvasive ventilation to 33.3%, high-flow nasal cannula-oxygen therapy to 32% and invasive mechanical ventilation to 16%. CONCLUSIONS HRV/EV infections primarily affect the respiratory system and generally exhibit a clinical course with low mortality rates (1, 1.3%). In cases with underlying chronic diseases, more severe clinical conditions such as pediatric acute respiratory distress syndrome and septic shock may occur.
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Affiliation(s)
- Ulkem Kocoglu Barlas
- From the Pediatric Intensive Care Unit, Department of Pediatrics, Istanbul Medeniyet University, Goztepe Prof Dr Süleyman Yalcin City Hospital, Istanbul, Turkey
| | - Nihal Akcay
- Pediatric Intensive Care Unit, Department of Pediatrics, University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Emin Menentoglu
- Pediatric Intensive Care Unit, Department of Pediatrics, University of Health Sciences Turkey, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Esra Sevketoglu
- Pediatric Intensive Care Unit, Department of Pediatrics, University of Health Sciences Turkey, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Muhterem Duyu
- From the Pediatric Intensive Care Unit, Department of Pediatrics, Istanbul Medeniyet University, Goztepe Prof Dr Süleyman Yalcin City Hospital, Istanbul, Turkey
| | - Leyla Telhan
- Pediatric Intensive Care Unit, Department of Pediatrics, Istanbul Medipol University, Bagcilar Mega Hospital, Istanbul, Turkey
| | - Murat Kangin
- Pediatric Intensive Care Unit, Department of Pediatrics, Istanbul Medipol University, Bagcilar Mega Hospital, Istanbul, Turkey
| | - Hazal Ceren Tugrul
- Pediatric Intensive Care Unit, Department of Pediatrics, University of Health Sciences Turkey, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Seher Erdogan
- Pediatric Intensive Care Unit, Department of Pediatrics, University of Health Sciences Turkey, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Cansu Durak
- Pediatric Intensive Care Unit, Department of Pediatrics, University of Health Sciences Turkey, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Ebru Guney Sahin
- Pediatric Intensive Care Unit, Department of Pediatrics, University of Health Sciences Turkey, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Ozge Umur
- Pediatric Intensive Care Unit, Department of Pediatrics, Acibadem Mehmet Ali Aydinlar University, Atakent Hospital, Istanbul, Turkey
| | - Sare Guntulu Sik
- Pediatric Intensive Care Unit, Department of Pediatrics, Acibadem Mehmet Ali Aydinlar University, Atakent Hospital, Istanbul, Turkey
| | - Agop Citak
- Pediatric Intensive Care Unit, Department of Pediatrics, Acibadem Mehmet Ali Aydinlar University, Atakent Hospital, Istanbul, Turkey
| | - Ayhan Yaman
- Pediatric Intensive Care Unit, Department of Pediatrics, Istinye University, Bahcesehir Liv Hospital, Istanbul, Turkey
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2
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Mammas IN, Drysdale SB, Charalampous C, Koletsi P, Papatheodoropoulou A, Koutsaftiki C, Sergentanis T, Merakou K, Kornarou H, Papaioannou G, Kramvis A, Greenough A, Theodoridou M, Spandidos DA. Navigating paediatric virology through the COVID‑19 era (Review). Int J Mol Med 2023; 52:83. [PMID: 37503745 PMCID: PMC10555476 DOI: 10.3892/ijmm.2023.5286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
The present review article presents the key messages of the 8th Workshop on Paediatric Virology organised virtually by the Institute of Paediatric Virology based on the island of Euboea in Greece. The major topics covered during the workshop were the following: i) New advances in antiviral agents and vaccines against cytomegalovirus; ii) hantavirus nephropathy in children; iii) human rhinovirus infections in children requiring paediatric intensive care; iv) complications and management of human adenovirus infections; v) challenges of post‑coronavirus disease 2019 (COVID‑19) syndrome in children and adolescents; and vi) foetal magnetic resonance imaging in viral infections involving the central nervous system. The COVID‑19 era requires a more intensive, strategic, global scientific effort in the clinic and in the laboratory, focusing on the diagnosis, management and prevention of viral infections in neonates and children.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion
- First Department of Paediatrics, School of Medicine, University of Athens, 11527 Athens
- Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece
| | - Simon B. Drysdale
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London SW17 0RE
- Department of Paediatrics, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | | | - Patra Koletsi
- Department of Paediatrics, 'Penteli' Children's Hospital, 15236 Palaia Penteli
- Paediatric Intensive Care Unit (PICU), 'Penteli' Children's Hospital, 15236 Palaia Penteli
| | | | - Chryssie Koutsaftiki
- COVID-19 Reference Centre, 'Rafina' Health Care Centre, 19009 Rafina
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Theodoros Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Kyriakoula Merakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Helen Kornarou
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Georgia Papaioannou
- Department of Paediatric Radiology, 'Mitera' Children's Hospital, 15123 Athens, Greece
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, 2193 Johannesburg, South Africa
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, King's College London, London SE5 9RS, UK
| | - Maria Theodoridou
- First Department of Paediatrics, School of Medicine, University of Athens, 11527 Athens
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion
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Al-Eyadhy A, Almazyad M, Hasan G, Almuhaideb Q, AbuDujain N, Alhaboob AAN, Alfawaz F, Alshenaifi S, Alfayez F, Aljebrin Y, Alsohime F, Alabdulhafid M, Temsah MH. The burden of viral infections in pediatric intensive care unit between endemic and pandemic coronavirus infections: A tertiary care center experience. J Infect Chemother 2022; 29:20-25. [PMID: 36103948 PMCID: PMC9464359 DOI: 10.1016/j.jiac.2022.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022]
Abstract
Objectives To measure the prevalence of viral infections, length of stay (LOS), and outcome in children admitted to the pediatric intensive care unit (PICU) during the period preceding the COVID-19 pandemic in a MERS-CoV endemic country. Methods A retrospective chart review of children 0–14 years old admitted to PICU with a viral infection. Results Of 1736 patients, 164 patients (9.45%) had a positive viral infection. The annual prevalence trended downward over a three-year period, from 11.7% to 7.3%. The median PICU LOS was 11.6 days. Viral infections were responsible for 1904.4 (21.94%) PICU patient-days. Mechanical ventilation was used in 91.5% of patients, including noninvasive and invasive modes. Comorbidities were significantly associated with intubation (P-value = 0.025). Patients infected with multiple viruses had median pediatric index of mortality 2 (PIM 2) scores of 4, as compared to 1 for patients with single virus infections (p < 0.001), and a median PICU LOS of 12 days, compared to 4 in the single-virus group (p < 0.001). Overall, mortality associated with viral infections in PICU was 7 (4.3%). Patients with viral infections having multiple organ failure were significantly more likely to die in the PICU (p = 0.001). Conclusion Viral infections are responsible for one-fifth of PICU patient-days, with a high demand for mechanical ventilation. Patients with multiple viral infections had longer LOS, and higher PIM 2 scores. The downward trend in the yearly rate of PICU admissions for viral infections between the end of the MERS-CoV outbreak and the start of the COVID-19 pandemic may suggest viral interference that warrants further investigations.
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Affiliation(s)
- Ayman Al-Eyadhy
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Mohammed Almazyad
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Gamal Hasan
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; Assiut Faculty of Medicine, Assiut University, Egypt; Pediatric Critical Care Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | | | - Ali A N Alhaboob
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Fahad Alfayez
- College of Medicine, King Saud University, Saudi Arabia
| | | | - Fahad Alsohime
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Majed Alabdulhafid
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohamad-Hani Temsah
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Halabi KC, Stockwell MS, Alba L, Vargas C, Reed C, Saiman L. Clinical and socioeconomic burden of rhinoviruses/enteroviruses in the community. Influenza Other Respir Viruses 2022; 16:891-896. [PMID: 35485187 PMCID: PMC9343330 DOI: 10.1111/irv.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background The epidemiology, clinical features, and socioeconomic burden associated with detection of rhinoviruses (RV)/enteroviruses (EV) from individuals in the community with acute respiratory infections (ARIs) are not fully understood. Methods To assess the clinical and socioeconomic burden associated with RV/EV, a secondary analysis of data collected during a prospective, community‐based ARI surveillance study was performed. From December 2012 to September 2017, adult and pediatric participants with ARIs had nasopharyngeal specimens obtained and tested by multiplex polymerase chain reaction assay. Characteristics and socioeconomic burden including missed school or work and/or antibiotic use among participants who did and did not seek medical care and among participants with and without co‐detection of another respiratory pathogen with RV/EV were compared. Results Throughout the study period, RV/EV was detected in 54.7% (885/1617) of ARIs with a respiratory pathogen detected. Most ARI episodes associated with RV/EV occurred in females (59.1%) and children ≤17 years old (64.2%). Those ≤17 years were more likely to seek medical care. Compared to those not seeking medical care (n = 686), those seeking medical care (n = 199) had a longer duration of illness (5 vs. 7 days) and were more likely to miss work/school (16.4% vs. 47.7%) and/or use antibiotics (3.6% vs. 34.2%). Co‐detection occurred in 8% of ARIs of which 81% occurred in children. Co‐detection was not associated with longer illness, more missed work/or school, or antibiotic use. Conclusion Non‐medically attended and medically attended ARIs associated with RV/EV resulted in clinical and socioeconomic burden, regardless of co‐detection of other respiratory pathogens.
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Affiliation(s)
| | - Melissa S Stockwell
- Columbia University Irving Medical Center, New York, New York, USA.,Mailman School of Public Health, Columbia University, New York, New York, USA.,New York-Presbyterian Hospital, New York, New York, USA
| | - Luis Alba
- Columbia University Irving Medical Center, New York, New York, USA
| | - Celibell Vargas
- Columbia University Irving Medical Center, New York, New York, USA
| | - Carrie Reed
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Saiman
- Columbia University Irving Medical Center, New York, New York, USA.,New York-Presbyterian Hospital, New York, New York, USA
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Factors Associated with Severe Acute Respiratory Infections Due to Rhinovirus/Enterovirus Complex in Children and Their Comparison with Those of Respiratory Syncytial Virus. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2021. [DOI: 10.5812/pedinfect.115548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Acute respiratory tract infections (ARTIs) are one of the main causes of morbidity and mortality in children under the age of five worldwide. Objectives: The objective of this research was to describe the main characteristics of hospitalized patients with ARTI caused by the rhinovirus/enterovirus (RV/EV) complex and the risk factors associated with severe infection. Methods: This was a retrospective descriptive study in patients from one month to 18-years-old who had been hospitalized for ARTI between October 2015 and December 2019 at Fundación Cardioinfantil in Bogotá, Colombia, and had had an RT-PCR viral panel during their hospitalization. Rhinovirus/enterovirus infection was characterized to identify factors associated with disease severity as compared to respiratory syncytial virus (RSV). A multivariate analysis was performed, controlling for confounding factors, to identify groups at risk of developing associated acute respiratory distress syndrome (ARDS). Results: During the study period, 645 RT-PCRs were performed, with the two main etiological agents identified being RV/EV (n = 224) and RSV (n = 68). The median age of patients with the RV/EV complex was 27 months (IQR: 8 - 70), and seven months for those with RSV (IQR: 2 - 11). Severe RV/EV complex infections required more transfers to intensive care (47% vs. 11%), showed more viral coinfection (OR: 2.13, 95% CI: 1.42 - 4.64), and had less bacterial coinfection (OR: 0.55, 95% CI: 0.31 - 0.98) than RSV infections. The RV/EV group had a higher risk of developing ARDS (OR: 3.6, 95% CI: 1.07 - 12:18), especially in premature infants (P: 0.05; exp(B), 2.99; 95% CI = 1.01 - 8.82), those with heart disease (P: 0.047; exp(B), 2.99; 95% CI = 1.01 - 8.82), and those with inborn errors of metabolism (P: 0.032; exp(B), 5 - 01; 95% CI = 1.15 - 21.81). A total of 13 patients from both study groups died (4.5%), with no differences found between the groups (RV/EV 54% vs. RSV 46%; P = 0.3). Conclusions: Respiratory infection due to RV/EV in children can frequently be severe, requiring management with intensive care therapy. When compared to RSV, this complex is more frequently associated with the development of ARDS, especially in risk groups such as those with prematurity, heart disease, or inborn errors of metabolism.
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6
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Lei C, Yang L, Lou CT, Yang F, SiTou KI, Hu H, Io K, Cheok KT, Pan B, Ung COL. Viral etiology and epidemiology of pediatric patients hospitalized for acute respiratory tract infections in Macao: a retrospective study from 2014 to 2017. BMC Infect Dis 2021; 21:306. [PMID: 33771128 PMCID: PMC7995389 DOI: 10.1186/s12879-021-05996-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/17/2021] [Indexed: 01/22/2023] Open
Abstract
Background Acute respiratory infections (ARIs) are among the leading causes of hospitalization in children. Understanding the local dominant viral etiologies is important to inform infection control practices and clinical management. This study aimed to investigate the viral etiology and epidemiology of respiratory infections among pediatric inpatients in Macao. Methods A retrospective study using electronic health records between 2014 and 2017 at Kiang Wu Hospital was performed. Nasopharyngeal swab specimens were obtained from hospitalized children aged 13 years or younger with respiratory tract diseases. xMAP multiplex assays were employed to detect respiratory agents including 10 respiratory viruses. Data were analyzed to describe the frequency and seasonality. Results Of the 4880 children enrolled in the study, 3767 (77.1%) were positive for at least one of the 13 viral pathogens tested, of which 2707 (55.5%) being male and 2635 (70.0%) under 2 years old. Among the positive results, there were 3091 (82.0%) single infections and 676 (18.0%) multiple infections. The predominant viruses included human rhinovirus/enterovirus (HRV/EV 27.4%), adenovirus (ADV, 15.8%), respiratory syncytial virus B (RSVB, 7.8%) and respiratory syncytial virus A (RSVA, 7.8%). The detection of viral infection was the most prevalent in autumn (960/1176, 81.6%), followed by spring (1095/1406, 77.9%), winter (768/992, 77.4%), and summer (944/1306, 72.3%), with HRV/EV and ADV being most commonly detected throughout the 4 years of study period. The detection rate of viral infection was highest among ARI patients presented with croup (123/141, 87.2%), followed by lower respiratory tract infection (1924/2356, 81.7%) and upper respiratory tract infection (1720/2383, 72.2%). FluA, FluB and ADV were positive factors for upper respiratory tract infections. On the other hand, infection with RSVA, RSVB, PIV3, PIV4, HMPV, and EV/RHV were positively associated with lower respiratory tract infections; and PIV1, PIV2, and PIV3 were positively associated with croup. Conclusions This is the first study in Macao to determine the viral etiology and epidemiology of pediatric patients hospitalized for ARIs. The study findings can contribute to the awareness of pathogen, appropriate preventative measure, accurate diagnosis, and proper clinical management of respiratory viral infections among children in Macao.
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Affiliation(s)
- Cheng Lei
- Department of Pediatrics, Kiang Wu Hospital, Macao SAR, China
| | - Lisong Yang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Cheong Tat Lou
- Department of Pediatrics, Kiang Wu Hospital, Macao SAR, China
| | - Fan Yang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Kin Ian SiTou
- Department of Pediatrics, Kiang Wu Hospital, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - King Io
- Department of Pediatrics, Kiang Wu Hospital, Macao SAR, China
| | - Kun Tat Cheok
- Department of Pediatrics, Kiang Wu Hospital, Macao SAR, China
| | - Baoquan Pan
- Department of Pediatrics, Kiang Wu Hospital, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China.
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Spaeder MC, Stewart C, Sharron MP, Noether JR, Martinez-Schlurman N, Kavanagh RP, Signoff JK, McCrory MC, Eidman DB, Subbaswamy AV, Shea PL, Harwayne-Gidansky I, Ninmer EK, Sheram ML, Watson CM. Adenoviral Respiratory Infection-Associated Mortality in Children: A Retrospective Case Series. J Pediatr Intensive Care 2020; 11:13-18. [DOI: 10.1055/s-0040-1718868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/19/2020] [Indexed: 12/22/2022] Open
Abstract
AbstractViral respiratory infections are a leading cause of illness and hospitalization in young children worldwide. Case fatality rates in pediatric patients with adenoviral lower respiratory tract infection requiring intensive care unit (ICU) admission have been reported between 7 and 22%. We investigated the demographics and clinical characteristics in pediatric mortalities associated with adenoviral respiratory infection at 12 academic children's hospitals in the United States. There were 107 mortality cases included in our study, 73% of which had a chronic medical condition. The most common chronic medical condition was immunocompromised state in 37 cases (35%). The incidences of pediatric acute respiratory distress syndrome (78%) and multiple organ dysfunction syndrome (94%) were profound. Immunocompetent cases were more likely to receive mechanical ventilation within the first hour of ICU admission (60 vs. 14%, p < 0.001) and extracorporeal membrane oxygenation (27 vs. 5%, p = 0.009), and less likely to receive continuous renal replacement therapy (20 vs. 49%, p = 0.002) or have renal dysfunction (54 vs. 78%, p = 0.014) as compared with immunocompromised cases. Immunocompromised cases were more likely to have bacteremia (57 vs. 16%, p < 0.001) and adenoviremia (51 vs. 17%, p < 0.001) and be treated with antiviral medications (81 vs. 26%, p < 0.001). We observed a high burden of nonrespiratory organ system dysfunction in a cohort of pediatric case fatalities with adenoviral respiratory infection. The majority of cases had a chronic medical condition associated with an increased risk of complications from viral respiratory illness, most notably immunocompromised state. Important treatment differences were noted between immunocompromised and immunocompetent cases.
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Affiliation(s)
- Michael C. Spaeder
- Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
| | - Claire Stewart
- Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Matthew P. Sharron
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, United States
| | - Julia R. Noether
- Division of Pediatric Critical Care, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
| | - Natalia Martinez-Schlurman
- Division of Pediatric Critical Care, University of Florida School of Medicine, Gainesville, Florida, United States
| | - Robert P. Kavanagh
- Division of Pediatric Critical Care, Pennsylvania State University School of Medicine, Hershey, Pennsylvania, United States
| | - Jessica K. Signoff
- Division of Pediatric Critical Care, University of California at Davis School of Medicine, Sacramento, California, United States
| | - Michael C. McCrory
- Pediatric Critical Care, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
| | - Daniel B. Eidman
- Pediatric Critical Care, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Anjali V. Subbaswamy
- Division of Pediatric Critical Care, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
| | - Paul L. Shea
- Division of Pediatric Critical Care, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Ilana Harwayne-Gidansky
- Division of Pediatric Critical Care, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | - Emily K. Ninmer
- Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
| | - Mary Lynn Sheram
- Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
| | - Christopher M. Watson
- Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
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8
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Smith ME, Wilson PT. Human Rhinovirus/Enterovirus in Pediatric Acute Respiratory Distress Syndrome. J Pediatr Intensive Care 2020; 9:81-86. [PMID: 32351760 PMCID: PMC7186013 DOI: 10.1055/s-0039-3400466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/12/2019] [Indexed: 02/04/2023] Open
Abstract
The role of human rhinovirus/enterovirus (HRV/HEV) in severe lower respiratory tract infections remains unclear. We characterized the respiratory status of children admitted to a large academic pediatric intensive care unit (PICU) who tested positive for only HRV/HEV. One hundred and fifty-five children met inclusion criteria with 62% requiring positive pressure respiratory support of 5 cm of water pressure or more within the first 24 hours of admission. Among them, 34% had SaO
2
to FiO
2
ratios of 264 or less with 22 patients (14%) meeting criteria for pediatric acute respiratory distress syndrome. HRV/HEV is associated with significant respiratory disease in children admitted to the PICU.
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Affiliation(s)
- Michele E Smith
- Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Children's Hospital, New York, United States
| | - Patrick T Wilson
- Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Children's Hospital, New York, United States
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9
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Kawaguchi A, Bates A, Lee BE, Drews S, Garros D. Virus detection in critically ill children with acute respiratory disease: a new profile in view of new technology. Acta Paediatr 2018; 107:504-510. [PMID: 29131392 PMCID: PMC7159542 DOI: 10.1111/apa.14148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022]
Abstract
AIM To describe the epidemiology of critically ill children admitted to a paediatric intensive care unit (PICU) with acute respiratory disease. The association with intubation was analysed for the three most prevalent viruses and in those with and without viral co-infection. METHODS Patients admitted to the PICU (2004-2014) with acute respiratory disease were included. Analyses were performed utilising each respiratory viral infection or multiple viral infections as an exposure. RESULTS There were 1766 admissions with acute respiratory disease of which 1372 had respiratory virus testing and 748 had one or more viruses detected. The risk of intubation before or during the PICU stay was higher if parainfluenza virus was detected compared to respiratory syncytial virus (RSV) (OR: 2.20; 95% CI: 1.06-4.56). Sixty-three admissions had two or more viruses detected, and the combination of RSV and Rhinovirus/enterovirus was the most common. No significant difference was observed in the risk of intubation between patients with multiple and single viral infections. CONCLUSION Higher risk of intubation was found in patients with parainfluenza as compared to RSV. The risk of intubation comparing parainfluenza virus to other viruses and for patients with multiple versus single virus needs to be further studied.
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Affiliation(s)
- Atsushi Kawaguchi
- Department of Pediatrics; Pediatric Critical Care Medicine; University of Alberta; Edmonton AB Canada
- School of Public Health; University of Alberta; Edmonton AB Canada
| | - Angela Bates
- Department of Pediatrics; Pediatric Critical Care Medicine; University of Alberta; Edmonton AB Canada
| | - Bonita E. Lee
- Department of Pediatrics; Pediatric Infectious Disease; University of Alberta; Edmonton AB Canada
| | - Steven Drews
- Provincial Laboratory for Public Health; Alberta Health Services; Edmonton AB Canada
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
| | - Daniel Garros
- Department of Pediatrics; Pediatric Critical Care Medicine; University of Alberta; Edmonton AB Canada
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Respiratory Viral Coinfections in the PICU: More Is Not Better...But Is It Worse? Pediatr Crit Care Med 2017; 18:816-817. [PMID: 28796712 DOI: 10.1097/pcc.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Baker T, Schandl C, Presnell SE, Madory J, Nolte FS, Batalis N. Use of an Automated Nested Multiplex Respiratory Pathogen PCR Panel Postmortem in the Pediatric Forensic Setting. J Forensic Sci 2017; 62:1223-1228. [PMID: 28120330 PMCID: PMC7166375 DOI: 10.1111/1556-4029.13415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 10/24/2016] [Accepted: 11/29/2016] [Indexed: 02/04/2023]
Abstract
Respiratory pathogens have been detected in forensic investigations using multiple techniques; however, no study has examined the use of automated, nested, multiplex polymerase chain reaction (ANM-PCR), commonly used in living patients, in the forensic setting. This retrospective study assessed the utility of ANM-PCR in detecting respiratory pathogens in the pediatric forensic setting. Respiratory samples from 35 cases were tested for up to 20 respiratory pathogens. 51.4% of these cases yielded a positive ANM-PCR result, 20% of which were considered the cause of or contributory to death. The most commonly detected pathogens were rhinovirus/enterovirus and respiratory syncytial virus, and these were the only pathogens determined to play a significant role in cause of death. The sampled sites and postmortem intervals tested did not affect the likelihood of a positive or negative test. ANM-PCR panels are effective, affordable, and rapid ancillary tools in evaluating cause of death in the forensic pediatric population.
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Affiliation(s)
- Tiffany Baker
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Avenue, MSC 908, Charleston, SC, 29425
| | - Cynthia Schandl
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Avenue, MSC 908, Charleston, SC, 29425
| | - Susan Erin Presnell
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Avenue, MSC 908, Charleston, SC, 29425
| | - James Madory
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Avenue, MSC 908, Charleston, SC, 29425
| | - Frederick S Nolte
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Avenue, MSC 908, Charleston, SC, 29425
| | - Nicholas Batalis
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 171 Ashley Avenue, MSC 908, Charleston, SC, 29425
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12
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Scotta MC, Chakr VCBG, de Moura A, Becker RG, de Souza APD, Jones MH, Pinto LA, Sarria EE, Pitrez PM, Stein RT, Mattiello R. Respiratory viral coinfection and disease severity in children: A systematic review and meta-analysis. J Clin Virol 2016; 80:45-56. [PMID: 27155055 PMCID: PMC7185664 DOI: 10.1016/j.jcv.2016.04.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/16/2016] [Accepted: 04/25/2016] [Indexed: 11/29/2022]
Abstract
Respiratory viral coinfections are common in children. Overall pediatric respiratory viral coinfections have no impact on severity. Prognostic role of specific viral interactions remains unclear.
Background With advent of molecular diagnostic technologies, studies have reported detection of two or more respiratory viruses in about 30% of children with respiratory infections. However, prognostic role of coinfection remains unclear. Objective Evaluate relation between respiratory viral confection and illness severity in children. Study design MEDLINE (through PUBMED), EMBASE, EBSCO, LILACS databases were searched up to March 2015 by two independent reviewers. Studies assessing severity of viral coinfection in patients aged less than 18 years were included. Standardized forms were used for data extraction of population, study design, clinical syndromes, virus combinations compared and severity outcomes. Risk of bias and quality of evidence were assessed through EPHPP and GRADE. Subgroup analysis was performed according to age and viral combinations. Results Of 5218 records screened, 43 were included in analysis. Viral coinfection did not influence risks of all outcomes assessed: length of stay (mean difference in days in coinfection, −0.10 [95% confidence interval: −0.51 to 0.31]), length of supplemental oxygen (−0.42 [−1.05 to 0.20]), need of hospitalization (odds ratio of coinfection, 0.96 [95% confidence interval: 0.61–1.51]), supplemental oxygen (0.94 [0.66 to 1.34]), need of intensive care (0.99 [0.64 to 1.54]), mechanical ventilation (0.81 [0.33 to 2.01]) and death (2.22 [0.83 to 5.95]). Sub-analyses according to age and viral combinations have not shown influence of these factors in outcomes. Conclusions Respiratory viral coinfection did not increase severity in all outcomes assessed. Further studies are necessary to confirm this finding, especially regarding role of specific viral interactions.
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Affiliation(s)
- Marcelo Comerlato Scotta
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Angela de Moura
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafaela Garces Becker
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Paula Duarte de Souza
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcus Herbert Jones
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leonardo Araújo Pinto
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Edgar Enrique Sarria
- Universidade de Santa Cruz do Sul (UNISC). School of Medicine, Department of Biology and Pharmacy, Brazil
| | - Paulo Marcio Pitrez
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renato Tetelbom Stein
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rita Mattiello
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
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Viruses as Sole Causative Agents of Severe Acute Respiratory Tract Infections in Children. PLoS One 2016; 11:e0150776. [PMID: 26964038 PMCID: PMC4786225 DOI: 10.1371/journal.pone.0150776] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/18/2016] [Indexed: 01/02/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) and influenza A viruses are known to cause severe acute respiratory tract infections (SARIs) in children. For other viruses like human rhinoviruses (HRVs) this is less well established. Viral or bacterial co-infections are often considered essential for severe manifestations of these virus infections. Objective The study aims at identifying viruses that may cause SARI in children in the absence of viral and bacterial co-infections, at identifying disease characteristics associated with these single virus infections, and at identifying a possible correlation between viral loads and disease severities. Study Design Between April 2007 and March 2012, we identified children (<18 year) with or without a medical history, admitted to our paediatric intensive care unit (PICU) with SARI or to the medium care (MC) with an acute respiratory tract infection (ARTI) (controls). Data were extracted from the clinical and laboratory databases of our tertiary care paediatric hospital. Patient specimens were tested for fifteen respiratory viruses with real-time reverse transcriptase PCR assays and we selected patients with a single virus infection only. Typical bacterial co-infections were considered unlikely to have contributed to the PICU or MC admission based on C-reactive protein-levels or bacteriological test results if performed. Results We identified 44 patients admitted to PICU with SARI and 40 patients admitted to MC with ARTI. Twelve viruses were associated with SARI, ten of which were also associated with ARTI in the absence of typical bacterial and viral co-infections, with RSV and HRV being the most frequent causes. Viral loads were not different between PICU-SARI patients and MC-ARTI patients. Conclusion Both SARI and ARTI may be caused by single viral pathogens in previously healthy children as well as in children with a medical history. No relationship between viral load and disease severity was identified.
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Holm-Hansen CC, Midgley SE, Fischer TK. Global emergence of enterovirus D68: a systematic review. THE LANCET. INFECTIOUS DISEASES 2016; 16:e64-e75. [PMID: 26929196 DOI: 10.1016/s1473-3099(15)00543-5] [Citation(s) in RCA: 230] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 01/15/2023]
Abstract
Since its discovery in California in 1962, reports of enterovirus D68 have been infrequent. Before 2014, infections were confirmed in only 699 people worldwide. In August, 2014, two paediatric hospitals in the USA reported increases in the number of patients with severe respiratory illness, with an over-representation in children with asthma. Shortly after, the authorities recognised a nationwide outbreak, which then spread to Canada, Europe, and Asia. In 2014, more than 2000 cases of enterovirus D68 were reported in 20 countries. Concurrently, clusters of children with acute flaccid paralysis of unknown cause were reported in several US states and in Europe. Enterovirus D68 infection was confirmed in some of the paralysed children, but not all. Complications in patients who were severely neurologically affected resemble those caused by poliomyelitis. In this paper we systematically review reports on enterovirus D68 to estimate its global epidemiology and its ability to cause respiratory infections and neurological damage in children. We extracted data from 70 papers to report on prevalence, symptoms, hospitalisation and mortality, and complications of enterovirus D68, both before and during the large outbreak of 2014. The magnitude and severity of the enterovirus D68 outbreak underscores a need for improved diagnostic work-up of paediatric respiratory illness, not only to prevent unnecessary use of antibiotics, but also to ensure better surveillance of diseases. Existing surveillance systems should be assessed in terms of capacity and ability to detect and report any upsurge of respiratory viruses such as enterovirus D68 in a timely manner, and focus should be paid to development of preventive measures against these emerging enteroviruses that have potential for severe disease.
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Affiliation(s)
- Charlotte Carina Holm-Hansen
- Virology Surveillance and Research Section, Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark
| | - Sofie Elisabeth Midgley
- Virology Surveillance and Research Section, Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark
| | - Thea Kølsen Fischer
- Virology Surveillance and Research Section, Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark; Center for Global Health and Department of Infectious Diseases, Clinical Institute, University of Southern Denmark, Odense, Denmark.
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Rhino/enteroviral infections in the PICU: the uncertainty of diagnosis and interpretation of clinical significance. Pediatr Crit Care Med 2015; 16:186-8. [PMID: 25647126 DOI: 10.1097/pcc.0000000000000333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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