Clinical characteristics of respiratory viral infection in children during spring/summer: focus on human bocavirus

Kwang Jin Kwak; Yeo Hyang Kim; Hee Joung Choi

doi:10.4168/aard.2015.3.6.410

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Kwak, Kim, and Choi: Clinical characteristics of respiratory viral infection in children during spring/summer: focus on human bocavirus

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(6): 410-416.

Published online: 30 November 2015

DOI: https://doi.org/10.4168/aard.2015.3.6.410

Clinical characteristics of respiratory viral infection in children during spring/summer: focus on human bocavirus

Kwang Jin Kwak¹, Yeo Hyang Kim², Hee Joung Choi¹

¹Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.

²Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea.

Correspondence to: Hee Joung Choi. Department of Pediatrics, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea. Tel: +82-53-250-7524, Fax: +82-53-250-7783, joung756@dsmc.or.kr

Received 1 July 2015 Revised 30 August 2015 Accepted 2 September 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

We evaluated the clinical characteristics of respiratory viruses that were frequently found in children during spring/summer, namely, human bocavirus (hBoV), human metapneumovirus (hMPV), parainfluenza virus (PIV), and human rhinovirus (hRV).

Methods

This study enrolled patients with acute lower respiratory infection in whom respiratory virus reverse transcriptase polymerase chain reaction was performed between March 2013 and August of 2013. We retrospectively reviewed the medical records to collect the patients' data.

Results

A total of 96 patients were enrolled and divided into 5 categories: hBoV in 19 patients (19.8%), hMPV in 18 patients (18.8%), PIV in 16 patients (16.7%), hRV in 20 patients (20.8%), and negative result in 23 patients (24.0%). The mean age of the patients was 8.2±5.9 months (median, 7.5 months; range, 1-24 months), and the male-to-female ratio was 1.1:1. The most common diagnoses were acute bronchiolitis (62.5%) and pneumonia (30.2%). Compared to other patients, those with hBoV were older (12.3±4.9 months, P=0.001) and more frequently diagnosed with acute bronchiolitis (P=0.005). In addition, they showed higher incidences of tachypnea and rales (P=0.039 and P=0.035, respectively), and were more frequently treated with oxygen and systemic steroids (P=0.044 and P=0.001, respectively) than the other patients.

Conclusion

We compared respiratory viruses in children during spring/summer and found that hBoV may have more severe clinical manifestations than other viruses.

Keywords: Respiratory infection, Human bocavirus, Child

Figures and Tables

Fig. 1

Diagnosis of the patients according to causing virus. The most common clinical diagnosis was acute bronchiolitis, and the other diagnoses were pneumonia, bronchitis and croup. hBoV, human bocavirus; hMPV, human metapneumonvirus; PIV, parainfluenza virus; hRV, human rhinovirus.

Fig. 2

Age (A) and gender (B) of the patients with human bocavirus (hBoV) and the others. The patients with human bocavirus were older than other patients (P=0.001) (A), but there was no gender difference (B).

Fig. 3

The percentage of the patients with human bocavirus (hBoV) and the other patients according to clinical manifestations. The patients with human bocavirus showed more incidence of tachypnea and rale than other patients (P=0.039, P=0.035).

Fig. 4

The percentage of the patients with human bocavirus (hBoV) and the other patients according to management. The patients with human bocavirus were more commonly treated with oxygen and systemic steroid than other patients (P=0.044, P=0.001).

Table 1

Comparison of clinical manifestations according to causing viruses

Variable	hBoV	hMPV	PIV	hRV	Negative	Total
No. of patients	19 (19.8)	18 (18.8)	16 (16.7)	20 (20.8)	23 (24.0)	96 (100)
Age (mo)	12.3 ± 4.9^†§∥	6.6 ± 6.1	8.8 ± 5.7	7.9 ± 6.1	5.9 ± 5.1	8.2 ± 5.9
Sex
Male:female	9:10	11:7	11:5	11:9	8:15	50:46
Clinical findings
Fever (> 38℃)	10	10	10	9	15	54
Duration of fever prior to admission (day)	1.3 ± 1.4	1.8 ± 1.8	2.1 ± 1.8	1.0 ± 1.6^∥	2.1 ± 2.6	1.7 ± 1.9
Duration until fever subside (day)	0.6 ± 0.8	0.7 ± 0.9	0.8 ± 1.2	0.8 ± 1.2	1.1 ± 1.1	0.8 ± 1.0
Duration of cough (day)	5.4 ± 6.4	6.2 ± 3.2^*‡	3.6 ± 2.2	8.4 ± 9.7	7.0 ± 6.7	6.3 ± 6.5
Tachypnea	9^†∥	2	6	6	4	27
Grunting	4	1	3	2	1	11
Stridor	1	1	2	2	3	9
Rale	15^‡§	12	7	8	14	56
Wheezing	12	8	7	10	9	46
Decreased aeration	11	10	8	7	12	48
Abnormal chest radiography	11	11	12	12	15	61
Treatment
Oxygen supply	7^†‡	1	1	4	6	19
Duration of oxygen use (day)	0.9 ± 1.4^†	0.1 ± 0.5	0.3 ± 0.8	0.7 ± 1.7	1.3 ± 2.5	0.7 ± 1.6
Systemic steroid	14^†‡§∥	5	5	8	7	39
Inhaled steroid	11	13	9	13	12	58
Ventilator use	0	0	0	1	0	1
ICU care	3	1	2	7^†	6	19
Admission duration (day)	5.2 ± 1.3	5.3 ± 1.5	4.6 ± 1.4	5.9 ± 2.8	6.3 ± 5.0	5.5 ± 2.9

Values are presented as number (%), mean±standard deviation or number.

hBoV, human bocavirus; hMPV, humanmetapneumonvirus; PIV, parainfluenza virus; hRV, human rhinovirus; ICU, intensive care unit.

^*P<0.05, compared with hBoV. ^†P<0.05, compared with hMPV. ^‡P<0.05, compared with PIV. ^§P<0.05, compared with hRV. ^∥P<0.05, compared with negative result.

Table 2

Comparison of laboratory findings according to causing viruses

Variable	hBoV	hMPV	PIV	hRV	Negative
No. of patients	19 (19.8)	18 (18.8)	16 (16.7)	20 (20.8)	23 (24.0)
O₂ saturation (SpO₂) (%)	96.3 ± 4.5	92.3 ± 23.1	92.0 ± 24.6	97.9 ± 2.4	78.6 ± 38.3
White blood cell count (/mm³)	12,915 ± 4,765	12,004 ± 3,914	10,459 ± 9,275	12,271 ± 3,588	10,954 ± 4,107
Neutrophil proportion (%)	52.7 ± 19.0^†‡	39.0 ± 16.3	35.6 ± 18.6	43.4 ± 21.5	42.4 ± 14.3
Lymphocyte proportion (%)	31.1 ± 16.2^†‡∥	47.4 ± 15.0	48.7 ± 16.9	42.6 ± 16.8	44.6 ± 12.4
Eosinophil proportion (%)	3.1 ± 2.2^†‡§∥	1.1 ± 1.1	2.0 ± 2.4	1.7 ± 1.5	2.0 ± 1.7
Erythrocyte sedimentation rate (mm/hr)	14.8 ± 9.5	33.9 ± 28.8^*	24.8 ± 20.5	18.2 ± 15.9	19.9 ± 14.1
C-reactive protein (mg/dL)	1.2 ± 2.1	1.0 ± 1.4	2.0 ± 2.2	1.0 ± 1.3	1.1 ± 1.3

Values are presented as number (%) or mean±standard deviation

hBoV, human bocavirus; hMPV, humanmetapneumonvirus; PIV, parainfluenza virus; hRV, human rhinovirus.

^*P<0.05, compared with hBoV. ^†P<0.05, compared with hMPV. ^‡P<0.05, compared with PIV. ^§P<0.05, compared with hRV. ^∥P<0.05, compared with negative result.

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ORCID iDs: Hee Joung Choi
https://orcid.org/http://orcid.org/0000-0002-7119-4194
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