title: Viral coinfection in acute respiratory infection in Mexican children treated by the emergency service: A cross-sectional study.
abstract: BACKGROUND
  Acute respiratory infections (ARIs) cause illness. Children under five years of age are highly vulnerable to these infections. Viral coinfection or multiple viral infection is a variable that can have a significant impact on the evolution of these diseases.
  
  
  METHODS
  This cross-sectional study was carried out in Mexican children (under five years of age) who had an ARI and who were treated by an emergency service in a hospital in Guadalajara, Jalisco, Mexico. The viral etiology, as well as the presence of multiple viral infections, was determined. A structured questionnaire was used to obtain demographic and clinical information. Odds ratio (OR) was calculated, and univariate and multivariate analyses using logistic regression were performed.
  
  
  RESULTS
  In the study population, metapneumovirus (hMPV) was the most frequent virus (22%), followed by adenovirus (hAD) (16%), respiratory syncytial virus (RSV) (14%), rhinovirus (hRV) (12%), bocavirus (hBoV) (9%), influenza virus (IF) (7%), and parainfluenza (PIF) (4%). The frequency of viral coinfections was 31.62%, and multiple logistic regression analysis revealed that hMPV, RSV, PIF, and hBoV were independently associated with multiple viral infection. No difference was found in the clinical manifestation of children with simple and multiple infections. Simple hMPV infection was associated with patients who presented with severe ARI. Using a multivariate analysis, we found that overcrowding is associated with coinfection when the viral etiology was hRV (OR = 2.56, 95% confidence interval (CI) 1.07 to 6.13), IF (OR = 2.56, 95% CI 1.07 to 6.13), PIF (OR = 2.96, 95% CI 1.15 to 7.65), hAD (OR = 2.56, 95% CI 1.07 to 6.13), and hBoV (OR = 2.9, 95% CI 1.14 to 7.34).
  
  
  CONCLUSIONS
  Viral coinfections are frequent in children requiring treatment by an emergency service. However, the severity of ARI is similar to that of children with a simple infection. The hMPV is common and may confer a significant disease burden in the Mexican population. Finally, overcrowding is a housing characteristic that favors the development of coinfections.
authors.affiliation: Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México. jahazieldv@hotmail.com.
authors.forename: Jahaziel
authors.initials: J
authors.lastname: Diaz
authors.affiliation: Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México. jaimemrom@gmail.com.
authors.forename: Jaime
authors.initials: J
authors.lastname: Morales-Romero
authors.affiliation: Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México. gustavo_000@hotmail.com.|Centro de Ciencias Biomédicas, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México. gustavo_000@hotmail.com.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pérez-Gil
authors.affiliation: Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Salvador Quevedo y Zubieta 750, Col. La Perla, 44100, Guadalajara, Jalisco, México. drmbedbar@gmail.com.
authors.forename: Martín
authors.initials: M
authors.lastname: Bedolla-Barajas
authors.affiliation: Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Salvador Quevedo y Zubieta 750, Col. La Perla, 44100, Guadalajara, Jalisco, México. netscience89@gmail.com.
authors.forename: Netzahualpilli
authors.initials: N
authors.lastname: Delgado-Figueroa
authors.affiliation: Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México. rebgarcia@uv.mx.
authors.forename: Rebeca
authors.initials: R
authors.lastname: García-Román
authors.affiliation: Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México. oll_1531@hotmail.com.|Facultad de Química Farmacéutica Biológica, Universidad Veracruzana, Lomas del Estadio s/n, Col. Zona Universitaria, 91000, Xalapa, Veracruz, México. oll_1531@hotmail.com.
authors.forename: Omar
authors.initials: O
authors.lastname: López-López
authors.affiliation: Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México. gaby8y10@hotmail.com.|Facultad de Química Farmacéutica Biológica, Universidad Veracruzana, Lomas del Estadio s/n, Col. Zona Universitaria, 91000, Xalapa, Veracruz, México. gaby8y10@hotmail.com.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Bañuelos
authors.affiliation: Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México. aidin1303@hotmail.com.
authors.forename: Cristal
authors.initials: C
authors.lastname: Rizada-Antel
authors.affiliation: Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México. rzenteno@uv.mx.
authors.forename: Roberto
authors.initials: R
authors.lastname: Zenteno-Cuevas
authors.affiliation: Facultad de Ciencias Químicas, Universidad Veracruzana, Prolongación de Oriente 6, 1009, Col. Rafael Alvarado, 94340, Orizaba, Veracruz, México. angramos@uv.mx.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Ramos-Ligonio
authors.affiliation: Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México. csampieri@uv.mx.
authors.forename: Clara Luz
authors.initials: CL
authors.lastname: Sampieri
authors.affiliation: Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Salvador Quevedo y Zubieta 750, Col. La Perla, 44100, Guadalajara, Jalisco, México. lgoa@yahoo.com.
authors.forename: Luis Gustavo
authors.initials: LG
authors.lastname: Orozco-Alatorre
authors.affiliation: Unidad de Procedimientos Preparativos y de acceso a servicios de Proteómica, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Av. Universidad, Col. Ciudad Universitaria, 04510, Distrito Federal, México. sivonnemor@biomedicas.unam.mx.
authors.forename: Silvia I
authors.initials: SI
authors.lastname: Mora
authors.affiliation: Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México. hmontero@uv.mx.
authors.forename: Hilda
authors.initials: H
authors.lastname: Montero
mesh_terms: D000208:Acute Disease; D000258:Adenovirus Infections, Human / Q000453:epidemiology; D060085:Coinfection; D003430:Cross-Sectional Studies; D003441:Crowding; D004636:Emergency Service, Hospital; D006801:Humans; D016015:Logistic Models; D029121:Metapneumovirus; D008800:Mexico / Q000453:epidemiology; D018184:Paramyxoviridae Infections / Q000453:epidemiology; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D014777:Virus Diseases / Q000453:epidemiology*