title: Respiratory viruses in exacerbations of non-cystic fibrosis bronchiectasis in children.
abstract: BACKGROUND
  Respiratory viral infections precipitate exacerbations of chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease though similar data in non-cystic fibrosis (CF) bronchiectasis are missing. Our study aimed to determine the point prevalence of viruses associated with exacerbations and evaluate clinical and investigational differences between virus-positive and -negative exacerbations in children with bronchiectasis.
  
  
  METHODS
  A cohort of 69 children (median age 7 years) with non-CF bronchiectasis was prospectively followed for 900 child-months. PCR for 16 respiratory viruses was performed on nasopharyngeal aspirates collected during 77 paediatric pulmonologist-defined exacerbations. Clinical data, systemic (C reactive protein (CRP), IL-6, procalcitonin, amyloid-A, fibrinogen) and lung function parameters were also collected.
  
  
  RESULTS
  Respiratory viruses were detected during 37 (48%) exacerbations: human rhinovirus (HRV) in 20; an enterovirus or bocavirus in four each; adenoviruses, metapneumovirus, influenza A virus, respiratory syncytial virus, parainfluenza virus 3 or 4 in two each; coronavirus or parainfluenza virus 1 and 2 in one each. Viral codetections occurred in 6 (8%) exacerbations. HRV-As (n=9) were more likely to be present than HRV-Cs (n=2). Children with virus-positive exacerbations were more likely to require hospitalisation (59% vs 32.5% (p=0.02)) and have fever (OR 3.1, 95% CI 1.2 to 11.1), hypoxia (OR 25.5, 95% CI 2.0 to 322.6), chest signs (OR 3.3, 95% CI 1.1 to 10.2) and raised CRP (OR 4.7, 95% CI 1.7 to 13.1) when compared with virus-negative exacerbations.
  
  
  CONCLUSIONS
  Respiratory viruses are commonly detected during pulmonary exacerbations of children with bronchiectasis. HRV-As were the most frequently detected viruses with viral codetection being rare. Time-sequenced cohort studies are needed to determine the role of viral-bacterial interactions in exacerbations of bronchiectasis.
authors.affiliation: Department of Respiratory Medicine, Royal Children's Hospital, Queensland, Australia.
authors.forename: Nitin
authors.initials: N
authors.lastname: Kapur
authors.affiliation: Queensland Paediatric Infectious Diseases Laboratory, SASVRC, QCMRI, Herston, Queensland, Australia.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Mackay
authors.affiliation: Queensland Paediatric Infectious Diseases Laboratory, SASVRC, QCMRI, Herston, Queensland, Australia.
authors.forename: Theo P
authors.initials: TP
authors.lastname: Sloots
authors.affiliation: Department of Respiratory Medicine, Royal Children's Hospital, Queensland, Australia.
authors.forename: Ian B
authors.initials: IB
authors.lastname: Masters
authors.affiliation: Department of Respiratory Medicine, Royal Children's Hospital, Queensland, Australia Child Health Division, Menzies School of Health Research, Darwin, Australia.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Chang
mesh_terms: D001987:Bronchiectasis / Q000175:diagnosis / Q000821:virology*; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000821:virology*; D000685:Serum Amyloid A Protein / Q000378:metabolism; D014777:Virus Diseases / Q000175:diagnosis / Q000821:virology*; D014780:Viruses / Q000235:genetics / Q000302:isolation & purification
chemical_list: C000606589:CALCA protein, human; D004279:DNA, Viral; C508600:IL6 protein, human; D015850:Interleukin-6; D011498:Protein Precursors; D000685:Serum Amyloid A Protein; D005340:Fibrinogen; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: Biomarkers; Bronchiectasis; Children; Exacerbation; Virus