Single or Dual Infection with Respiratory Syncytial Virus and Human Rhinovirus: Epidemiology and Clinical Characteristics in Hospitalized Children in a Rural Area of South Korea

Yerim Kwon; Won Je Cho; Hwang Min Kim; Jeongmin Lee

doi:10.14776/piv.2019.26.2.99

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Kwon, Cho, Kim, and Lee: Single or Dual Infection with Respiratory Syncytial Virus and Human Rhinovirus: Epidemiology and Clinical Characteristics in Hospitalized Children in a Rural Area of South Korea

Original Article

Pediatr Infect Vaccine 2019;26(2):99-111.

Published online: 20 August 2019

DOI: https://doi.org/10.14776/piv.2019.26.2.99

Single or Dual Infection with Respiratory Syncytial Virus and Human Rhinovirus: Epidemiology and Clinical Characteristics in Hospitalized Children in a Rural Area of South Korea

Yerim Kwon, Won Je Cho, Hwang Min Kim, Jeongmin Lee

Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, the Republic of Korea

Correspondence to Jeongmin Lee Department of Pediatrics, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, the Republic of Korea. E-mail: ejeongmin@yonsei.ac.kr

Received 20 September 2018 Revised 9 May 2019 Accepted 27 May 2019

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

Abstract

Purpose

Respiratory syncytial virus (RSV) and human rhinovirus (hRV) are the most common causes of child respiratory viral infections. We aimed to investigate epidemiological and clinical characteristics of RSV and hRV single infections and coinfections.

Methods

Nasopharyngeal aspirates of hospitalized children aged <5 years were tested using multiplex reverse transcription polymerase chain reaction (RT-PCR) from October 2014 to April 2017. Their medical records were retrospectively reviewed.

Results

RSV or hRV was detected in 384 patients who divided into 3 groups: patients with RSV (R group, n=258); patients with hRV (H group, n=99); and patients with both (RH group, n=27). The R group (median age, 6 months) consisted of 248 (96.1%) patients with lower respiratory tract infection (LRTI), and 14 (5.4%) needed oxygen inhalation. Infants aged <12 months (63.2%) had respiratory difficulty and were supplied oxygen more often. The H group (median age, 16 months) consisted of 56 (56.6%) patients with LRTI, 4 (4%) required oxygen inhalation, and 1 (1.0%) required mechanical ventilation. Infants (40.4%) showed longer hospitalization compared to patients aged ≥12 months (5 vs. 4 days, P<0.05). The RH group consisted of 24 (88.9%) patients with LRTI, and 2 (7.4%) needed oxygen inhalation. Hospitalization days and oxygen inhalation and mechanical ventilation rates did not differ between single infections (R and H groups) and coinfections (RH group).

Conclusions

RSV was detected more often in younger patients and showed higher LRTI rates compared to hRV. Single infections and coinfections of RSV and hRV showed no difference in severity.

Keywords: Respiratory syncytial virus, Rhinovirus, Multiplex polymerase chain reaction

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Fig. 1.

Monthly incidence of total RSV, RSV A, RSV B and hRV Infections from 2014 to 2017. Abbreviations: RSV, respiratory syncytial virus; hRV, human rhinovirus.

Fig. 2.

Age distribution in R, H, and RH group. Abbreviations: R, single infection of respiratory syncytial virus; H, single infection of human rhinovirus; RH, dual infection of respiratory syncytial virus and human rhinovirus.

Table 1.

Demographic findings of subjects

Variables	R (n=258)	H (n=99)	RH (n=27)	P-value^∗	Adjusted OR (95% CI)^†
Age (mon)	6 (0–59)	16 (0–54)	4 (0–51)	<0.05
				R<H (<0.05)
				RH<H (<0.05)
Sex (M:F)	1.4:1	1.3:1	2.4:1	0.41
Past history
Chronic disease^‡	12 (4.7)	6 (6.1)	2 (7.4)	0.64
Allergic disease	8 (3.1)	12 (12.1)	1 (3.7)	<0.05
				R<H (<0.05)	0.32 (0.12–0.84)
Gestational age (<37 wk)	37 (14.3)	21 (21.2)	3 (11.1)	0.22
Birth weight (<2,500 g)	24 (9.3)	16 (16.2)	3 (11.1)	0.18
Siblings	152 (59.1)	58 (58.6)	19 (70.4)	0.51
Daycare center	62 (25.0)	33 (34.4)	5 (19.2)	0.14

Values are presented as median (range) or number (%). Bold values are statistically significant.

Abbreviations: R, single infection of respiratory syncytial virus; H, single Infection of human rhinovirus; RH, dual infection of respiratory syncytial virus and human rhinovirus; OR, odds ratio; CI, confidence interval.

^∗ Post hoc analysis was performed by Dunn procedure, χ² test and Fisher's exact test with Bonferroni correction;

^† Adjusted with age and sex by multivariable logistic regression;

^‡ Congenital heart diseases, chronic lung diseases, neurologic disorders.

Table 2.

Clinical findings of subjects

Variables	R (n=258)	H (n=99)	RH (n=27)	P-value^∗	Adjusted OR (95% CI)^†
Days of hospitalization	5 (2–12)	4 (2–15)	4 (3–13)	0.06
LRTI	248 (96.1)	56 (56.6)	24 (88.9)	<0.05
				R>H (<0.05)	19.80 (9.19–42.68)
				RH>H (<0.05)	6.79 (1.87–24.70)
Signs of respiratory difficulty	55 (21.3)	11 (11.1)	9 (33.3)	<0.05
				RH>H (<0.05)	3.22 (1.14–9.10)
Fever	157 (60.9)	70 (70.7)	14 (51.9)	0.11
Treatment
Oxygen inhalation	14 (5.4)	4 (4.0)	2 (7.4)	0.76
Ventilator care	0 (0.0)	1 (1.0)	0 (0.0)	0.24

Values are presented as median (range) or number (%). Bold values are statistically significant.

^∗ Post hoc analysis was performed by Dunn procedure, χ² test and Fisher's exact test with Bonferroni correction;

^† Adjusted with age and sex by multivariable logistic regression.

Table 3.

Laboratory findings of subjects

Variables	R (n=258)	H (n=99)	RH (n=27)	P-value^∗	Adjusted β (SE)^†
WBC (×10⁹/L)	9.2 (3.0–22.6)	11.4 (2.3–32.2)	9.6 (4.8–16.1)	<0.05
				R<H (<0.05)	−2.53 (0.49)^‡
PLT (×10⁹/L)	349.5 (143.0–815.0)	385 (102.0–875.0)	415 (175.0–653.0)	0.13
ANC (×10⁹/L)	3.0 (0.4–17.9)	4.6 (0.5–29.1)	2.8 (0.9–9.6)	<0.05
				R<H (<0.05)	−2.24 (0.37)^‡
				RH<H (<0.05)	−1.80 (0.66)^‡
NEU (%)	34.4 (6.7–80.2)	47.9 (3.4–90.3)	33.1 (14.9–75.0)	<0.05
				R<H (<0.05)	−7.59 (1.72)^‡
LUC (%)	5.1 (1.7–12.9)	3.6 (0.9–8.4)	5.0 (1.9–7.0)	<0.05
				R>H (<0.05)	1.41 (0.20)^‡
				RH>H (<0.05)	0.79 (0.36)^‡
DNI (%)	0.0 (0.0–6.8)	0.0 (0.0–7.3)	0.0 (0.0–2.4)	0.05
CRP (mg/dL)	0.4 (0.0–9.4)	0.7 (0.3–15.5)	0.3 (0.3–4.7)	<0.05
				R<H (<0.05)	−0.65 (0.20)^‡

Values are presented as median (range) or number (%). Bold values are statistically significant.

Abbreviations: R, single infection of respiratory syncytial virus; H, single infection of human rhinovirus; RH, dual infection of respiratory syncytial virus and human rhinovirus; β, regression coefficient; SE, standard error; WBC, white blood cell count; PLT, platelet count; ANC, absolute neutrophil count; NEU, neutrophil; LUC; large unstained cell; DNI, delta neutrophil index; CRP, C-reactive protein.

^∗ Post hoc analysis was performed by Dunn procedure with Bonferroni correction;

^† Adjusted with age and sex by multivariable linear regression;

^‡ Statistically significant (P<0.05).

Table 4.

Comparison of clinical and laboratory findings according to the age

Variables	R (n=258)		P-value	H (n=99)		P-value
Variables	<12 mon (n=163)	≥12 mon (n=95)	P-value	<12 mon (n=40)	≥12 mon (n=59)	P-value
Days of hospitalization	5 (2–12)	4 (3–11)	0.08	5 (2–9)	4 (2–15)	<0.05
LRTI	158 (96.9)	90 (94.7)	0.51	22 (55.0)	34 (57.6)	0.80
Respiratory difficulty	47 (28.8)	8 (8.4)	<0.05	5 (12.5)	6 (10.2)	0.72
Fever	72 (44.2)	85 (89.5)	<0.05	25 (62.5)	45 (76.3)	0.14
Severity
Oxygen inhalation	14 (8.6)	0 (0)	<0.05	1 (2.5)	3 (5.1)	0.65
Ventilator care	0	0		0 (0)	1 (1.7)	1.00
Siblings	107 (66.1)	45 (47.4)	<0.05	29 (72.5)	29 (49.2)	<0.05
Daycare center	9 (5.8)	53 (56.4)	<0.05	0 (0)	33 (57.9)	<0.05

Values are presented as median (range) or number (%). Bold values are statistically significant.

Abbreviations: R, single infection of respiratory syncytial virus; H, single infection of human rhinovirus; LRTI, lower respiratory tract infection.

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