title: Rhinovirus Disease in Children Seeking Care in a Tertiary Pediatric Emergency Department.
abstract: BACKGROUND
  Rhinovirus is the most common cause of viral respiratory tract infections in children. Virologic predictors of lower respiratory tract infection (LRTI), such as viral load and the presence of another respiratory virus (coinfection), are not well characterized in pediatric outpatients.
  
  
  METHODS
  Mid-nasal turbinate samples were collected from children presenting for care to the Seattle Children's Hospital emergency department (ED) or urgent care with a symptomatic respiratory infection between December 2011 and May 2013. A subset of samples was tested for rhinovirus viral load by real-time polymerase chain reaction. Clinical data were collected by chart reviews. Multivariate logistic regression was used to evaluate the relationship between viral load and coinfection and the risk for LRTI.
  
  
  RESULTS
  Rhinovirus was the most frequent respiratory virus detected in children younger than 3 years. Of 445 patients with rhinovirus infection, 262 (58.9%) had LRTIs, 231 (51.9%) required hospital admission and 52 (22.5%) were hospitalized for 3 days or longer. Children with no comorbidities accounted for 142 (54%) of 262 rhinovirus LRTIs. Higher viral load was significantly associated with LRTI among illness episodes with rhinovirus alone (OR, 2.11; 95% confidence interval [CI], 1.24-3.58). Coinfection increased the risk of LRTI (OR, 1.83; 95% CI, 1.01-3.32).
  
  
  CONCLUSIONS
  Rhinovirus was the most common pathogen detected among symptomatic young children in a pediatric ED who had respiratory viral testing performed, with the majority requiring hospitalization. Higher rhinovirus viral load and coinfection increased disease severity. Virologic data may assist clinical decision making for children with rhinovirus infections in the pediatric ED.
authors.affiliation: Department of Medicine, University of Washington.
authors.forename: Helen Y
authors.initials: HY
authors.lastname: Chu
authors.affiliation: Center for Clinical and Translational Research.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
authors.affiliation: Center for Clinical and Translational Research.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Strelitz
authors.affiliation: Center for Clinical and Translational Research.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Lacombe
authors.affiliation: Center for Clinical and Translational Research.
authors.forename: Charla
authors.initials: C
authors.lastname: Jones
authors.affiliation: Center for Clinical and Translational Research.
authors.forename: Kristin
authors.initials: K
authors.lastname: Follmer
authors.affiliation: Center for Clinical and Translational Research.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Martin
authors.affiliation: Center for Clinical and Translational Research.
authors.forename: Miranda
authors.initials: M
authors.lastname: Bradford
authors.affiliation: Department of Microbiology, Seattle Children's Hospital, Washington.
authors.forename: Xuan
authors.initials: X
authors.lastname: Qin
authors.affiliation: Department of Laboratory Medicine, University of Washington.
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.affiliation: Center for Clinical and Translational Research.
authors.forename: Eileen J
authors.initials: EJ
authors.lastname: Klein
mesh_terms: D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology* / Q000821:virology; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010850:Picornaviridae Infections / Q000453:epidemiology*; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012229:Rhinovirus / Q000302:isolation & purification*; D062606:Tertiary Care Centers; D019562:Viral Load
keywords: coinfection; disease severity; emergency department; rhinovirus; viral load