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Park, Chu, Shin, Ryu, Tang, Choi, Kim, and Kim: Comparison of clinical severity between single- and coinfections of respiratory syncytial virus and influenza virus with common respiratory viruses
Original Article

Allergy Asthma Respir Dis 2019;7(2):86-91.

Published online: 12 April 2019

DOI: https://doi.org/10.4168/aard.2019.7.2.86

Comparison of clinical severity between single- and coinfections of respiratory syncytial virus and influenza virus with common respiratory viruses

Jin-Sung Park1, 2, Shou-Yu Chu2, Yi-Yeon Shin2, In-Kyung Ryu2, Chih-Lung Tang2, Jungi Choi2, 3, Hyo-Bin Kim2, Chang-Keun Kim2

1Department of Pediatrics, Kangwon University Hospital, Chuncheon

2Department of Pediatrics, Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul Korea

3First 365 Pediatric Clinic, Daejeon, Korea

Correspondence to: Chang-Keun Kim https://orcid.org/0000-0001-8292-3455 Department of Pediatrics, Asthma and Allergy Center, Inje University Sanggye Paik Hospital, 1342 dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-8832, Fax: +82-2-950-1662, E-mail: kimck@paik.ac.kr

Received 10 October 2018       Revised 2 January 2019       Accepted 9 January 2019

Copyright © 2019 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology

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/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Multiple virus infections may affect clinical severity. We investigated the effect of coinfection of respiratory syncytial virus (RSV) and influenza virus with other respiratory viruses on clinical severity.

Methods

Data from 634 samples of a single tertiary hospital between September 2014 and April 2015 were analyzed for clinical characteristics (fever duration and O2 need, steroid use, and ICU care) between single infection and coinfection of RSV (n=290) and influenza virus (n=74) with 16 common respiratory viruses from hospitalized children.

Results

The RSV coinfection group (n=109) (3.1±2.7 days) showed significantly longer fever duration than the RSV single infection group (n=181) (2.6±2.6 days) (P=0.04), while there was no difference in O2 need, steroid use or ICU care in the 2 groups. The influenza coinfection group (n=38) showed significantly higher O2 need than the influenza single infection group (n=36) (21.1% vs. 5.6%, P=0.05), while there was no difference in fever duration between the 2 groups.

Conclusion

The results indicate that RSV and Influenza coinfections can increase clinical severity and that the severity may be influenced by the nature of coinfecting viruses.

Keywords: Respiratory syncytial viruses, Influenza, Fever, Dyspnea, Coinfection

References

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Fig. 1.
Comparison of serum eosinophil-derived neurotoxin (s-EDN) (A) and serum eosinophil cationic protein (s-ECP) (B) between respiratory syncytial virus (RSV) and Influenza groups.
aard-7-86f1.tif
Table 1.
Baseline characteristics of study subjects
Variable Single infection (n=181) Coinfection (n=109) P-value
RSV group      
Age (mo) 19.64±22.09 17.78±17.34 0.89
Sex, male:female 106:75 62:47 0.78
Diagnosis      
Bronchiolitis 90 (49.7) 40 (36.7)  
Pneumonia 47 (26.0) 35 (32.1)  
Others 44 (24.3) 34 (31.2) 0.09
WBC (cells/mm3) 10,309.84±9,094.24 11,605.69±4,405.57 <0.01
ALT (IU) 23.07±25.39 31.04±54.29 0.77
Cr (mg/dL) 0.30±0.44 0.27±0.07 0.54
CRP (mg/dL) 1.78±4.12 1.55±1.83 0.84
Influenza group      
Age (mo) 57.33±51.08 40.89±43.89 0.17
Sex, male:female 24:12 21:17 0.31
Diagnosis      
Bronchiolitis 4 (11.1) 10 (26.3)  
Pneumonia 11 (30.6) 13 (34.2)  
Others 21 (58.3) 15 (39.5) 0.15
WBC (cells/mm3) 9,856.67±6,548.24 8,387.63±3,277.30 0.61
ALT (IU) 41.11±16.70 25.68±30.12 <0.01
Cr (mg/dL) 0.37±0.15 0.30±0.09 0.03
CRP (mg/dL) 1.73±1.72 1.35±1.54 0.32

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

RSV, respiratory syncytial virus; WBC, white blood cell; ALT, alanine aminotransferase; Cr, creatinine; CRP, C-reactive protein.

Table 2.
Duration of fever and respiratory difficulties in single infection and coinfection groups
Variable Single infection Coinfection P-value
RSV group (n=181) (n=109)  
Duration of fever (day) 2.58±2.56 3.10±2.68 0.04
O2 supply 41 (23.0) 21 (19.3) 0.32
Steroid use 7 (3.9) 5 (4.6) 0.22
ICU care 3 (1.7) 2 (1.8) 0.24
Influenza group (n=36) (n=38)  
Duration of fever (day) 4.63±3.82 4.00±2.19 0.85
O2 supply 2 (5.6) 8 (21.1) 0.05
Steroid use 8 (22.2) 3 (7.9) 0.13
ICU care 0 (0) 0 (0) –

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

RSV, respiratory syncytial virus; ICU, intensive care unit.

Table 3.
Duration of fever and respiratory difficulties according to level of viral load
Level of viral load 1+ 2+ 3+ P-value
RSV (n=290) (n=12) (n=47) (n=231)  
Duration of fever (day) 3.17±2.25 2.96±2.93 2.71±2.56 0.68
O2 supply 2 (16.7) 7 (14.9) 51 (22.1) 0.51
Steroid use 0 (0) 3 (6.4) 9 (3.9) 0.56
ICU care 1 (8.3) 1 (2.1) 3 (1.3) 0.18
Influenza (n=74) (n=26) (n=20) (n=28)  
Duration of fever* (day) 4.77±4.20 3.00±2.60 4.86±1.92 0.05
O2 supply 5 (19.2) 3 (15.0) 2 (7.1) 0.42
Steroid use 2 (7.7) 0 (0) 1 (3.6) 0.41
ICU care 0 (0) 0 (0) 0 (0) –

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

RSV, respiratory syncytial virus; ICU, intensive care unit.

*2+ vs. 3+: P<0.01 in post hoc analysis.

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