Clinical considerations of febrile infants with respiratory symptoms according to the respiratory viral detection

Nury Bag; Jin-A Jung; Kyoung Ah Kwon

doi:10.4168/aard.2016.4.1.38

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Bag, Jung, and Kwon: Clinical considerations of febrile infants with respiratory symptoms according to the respiratory viral detection

Original Article

Allergy, Asthma & Respiratory Disease 2016; 4(1): 38-43.

Published online: 29 January 2016

DOI: https://doi.org/10.4168/aard.2016.4.1.38

Clinical considerations of febrile infants with respiratory symptoms according to the respiratory viral detection

Nury Bag, Jin-A Jung, Kyoung Ah Kwon

Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea.

Correspondence to: Kyoung Ah Kwon. Department of Pediatrics, Dong-A University College of Medicine, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 50612, Korea. Tel: +82-51-240-5124, Fax: +82-51-242-2765, hap99@naver.com

Received 21 July 2015 Revised 27 October 2015 Accepted 2 November 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/4.0/).

Abstract

Purpose

Respiratory viral infection is one of the most common diseases in febrile infants. This study evaluates the clinical characteristics of febrile infants who were hospitalized for respiratory symptoms, with or without respiratory viral detection.

Methods

Seventy-six hospitalized infants aged 28–90 days with fever and respiratory symptoms from January 2011 to December 2012 were enrolled in this study. We performed reverse transcriptase polymerase chain reaction to identify 7 respiratory viruses from nasopharyngeal swabs. Also, we retrospectively reviewed the medical records to analyze the clinical features.

Results

Respiratory viruses were detected in 45 patients (RVP group). Respiratory syncytial virus (n=16) was most frequently detected, followed by human rhinovirus (n=10). Age, sex, past illness, and sibling's respiratory symptoms showed no differences between the 2 groups. Infants in the RVP group had a significantly higher incidence of tachypnea (22.2%) and abnormal breathing sounds (wheezing and rales, 57.8%) than those in the negative group (P=0.021, P=0.002 each). There were no significant differences in laboratory findings between the 2 groups.

Conclusion

In our study, RSV was the most common virus in febrile infants aged 28–90 days with respiratory symptoms. Tachypnea and abnormal breathing sounds were more reliable clinical features to guess the detection of respiratory viruses. Further studies are required to confirm the values of these clinical features in febrile infants who have lower respiratory tract infections.

Keywords: Fever, Respiratory symptoms, Infants, Respiratory viruses

Figures and Tables

Fig. 1

Numbers of detected viruses in respiratory virus positive group. Parainfluenza virus and adenovirus (n=1), parainfluenza virus and influenza A virus (n=1), parainfluenza virus and metapneumovirus (n=1), respiratory syncytial virus and rhinovirus (n=1). RSV, respiratory syncytial virus; hRV, human rhinovirus; PIV, parainfluenza virus; hMPV, human metapneumovirus; Flu A, influenza virus type A; ADV, adenovirus; Co-inf., co-infection.

Fig. 2

Monthly incidence of detected viruses from 2011 to 2012. RSV, respiratory syncytial virus; hRV, human rhinovirus; PIV, parainfluenza virus; hMPV, human metapneumovirus; Flu A, influenza virus type A; ADV, adenovirus.

Fig. 3

Distribution of clinical diagnosis according to the groups. RVP, respiratory virus positive; RVN, respiratory virus negative; URI, upper respiratory tract infection.

Fig. 4

Distribution of detected viruses according to the clinical diagnosis in respiratory virus positive group. RSV, respiratory syncytial virus; hRV, human rhinovirus; PIV, parainfluenza virus; hMPV, human metapneumovirus; Flu A, influenza virus type A; ADV, adenovirus; URI, upper respiratory tract infection.

Table 1

Demographic characteristics of enrolled patients

Characteristic	RVP (n = 45)	RVN (n = 31)	P-value
Age (mo)	1.6 ± 0.7	1.7 ± 0.7	0.470
Male sex	28 (62.2)	19 (61.3)	0.934
Past illness	6 (13.3)	11 (35.5)	0.023
Prematurity	2	1
Fever	1	5
Jaundice	1	0
Congenital disease	1	1
TTN	0	1
Pneumonia	0	1
Gastroenteritis	1	2
Delivery type			0.480
NSVD	28 (62.2)	16 (51.6)
C-sec	17 (37.8)	15 (48.4)
Feeding type			0.212
Breast feeding	14 (31.1)	11 (35.5)
Formula feeding	5 (11.1)	8 (25.8)
Mixed	26 (57.8)	12 (38.7)
Having siblings	35 (77.8)	23 (74.2)	0.718
Respiratory symptoms of siblings	23 (51.1)	13 (41.9)	0.431

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

RVP, respiratory virus positive; RVN, respiratory virus negative; TTN, transient tachypnea of newborn; NSVD, normal spontaneous vaginal delivery; C-sec, cesarean section.

Table 2

Comparison of clinical manifestations between RVP and RVN groups

Variable	RVP (n = 45)	RVN (n = 31)	P-value
Season of admission			0.160
Spring	14 (31.1)	10 (32.3)
Summer	11 (24.4)	12 (38.7)
Fall	6 (13.3)	5 (16.1)
Winter	14 (31.1)	4 (12.9)
Duration of admission (day)	6.5 ± 2.0	6.0 ± 1.8	0.279
Fever duration (day)	1.9 ± 1.1	1.7 ± 1.2	0.394
Decreased activity	8 (17.7)	4 (12.9)	0.567
Irritability	6 (13.3)	8 (25.8)	0.168
Poor oral intake	12 (26.7)	8 (25.8)	0.933
Ill looking	17 (37.8)	13 (41.9)	0.716
Gastrointestinal symptoms (vomiting, diarrhea)	2 (4.4)	1 (5.6)	0.789
Skin rash	2 (4.4)	3 (16.7)	0.366
Tachypnea	10 (22.2)	1 (5.6)	0.021
Abnormal lung sound (rales or wheezing)	26 (57.8)	7 (38.9)	0.002

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

RVP, respiratory virus positive; RVN, respiratory virus negative.

Table 3

Comparison of laboratory data between RVP and RVN groups

	RVP (n = 45)	RVN (n = 31)	P-value
WBC	11,221.6±3,313.5	11,642.6±4,390.4	0.637
Segment neutrophil (%)	37.6±12.5	39.8±15.1	0.514
ANC	4,315.1±2,306.3	4,789.2±3,093.1	0.471
CRP	1.6±2.1	2.0±2.2	0.417

Values are presented as mean±standard deviation.

RVP, respiratory virus positive; RVN, respiratory virus negative; WBC, white blood cell; ANC, absolute neutrophil count; CRP, C-reactive protein.

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ORCID iDs: Kyoung Ah Kwon
https://orcid.org/http://orcid.org/0000-0003-4578-5393
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