title: Viruses as Sole Causative Agents of Severe Acute Respiratory Tract Infections in Children.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) and influenza A viruses are known to cause severe acute respiratory tract infections (SARIs) in children. For other viruses like human rhinoviruses (HRVs) this is less well established. Viral or bacterial co-infections are often considered essential for severe manifestations of these virus infections.
  
  
  OBJECTIVE
  The study aims at identifying viruses that may cause SARI in children in the absence of viral and bacterial co-infections, at identifying disease characteristics associated with these single virus infections, and at identifying a possible correlation between viral loads and disease severities.
  
  
  METHODS
  Between April 2007 and March 2012, we identified children (<18 year) with or without a medical history, admitted to our paediatric intensive care unit (PICU) with SARI or to the medium care (MC) with an acute respiratory tract infection (ARTI) (controls). Data were extracted from the clinical and laboratory databases of our tertiary care paediatric hospital. Patient specimens were tested for fifteen respiratory viruses with real-time reverse transcriptase PCR assays and we selected patients with a single virus infection only. Typical bacterial co-infections were considered unlikely to have contributed to the PICU or MC admission based on C-reactive protein-levels or bacteriological test results if performed.
  
  
  RESULTS
  We identified 44 patients admitted to PICU with SARI and 40 patients admitted to MC with ARTI. Twelve viruses were associated with SARI, ten of which were also associated with ARTI in the absence of typical bacterial and viral co-infections, with RSV and HRV being the most frequent causes. Viral loads were not different between PICU-SARI patients and MC-ARTI patients.
  
  
  CONCLUSIONS
  Both SARI and ARTI may be caused by single viral pathogens in previously healthy children as well as in children with a medical history. No relationship between viral load and disease severity was identified.
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Fleur M
authors.initials: FM
authors.lastname: Moesker
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Jeroen J A
authors.initials: JJ
authors.lastname: van Kampen
authors.affiliation: Department of Paediatrics, Erasmus MC - Sophia, Rotterdam, the Netherlands.
authors.forename: Annemarie M C
authors.initials: AM
authors.lastname: van Rossum
authors.affiliation: Department of Paediatrics, Paediatric Intensive Care Unit, Erasmus MC - Sophia, Rotterdam, the Netherlands.
authors.forename: Matthijs
authors.initials: M
authors.lastname: de Hoog
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Marion P G
authors.initials: MP
authors.lastname: Koopmans
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands.|Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine, Hannover, Germany.
authors.forename: Albert D M E
authors.initials: AD
authors.lastname: Osterhaus
authors.affiliation: Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands.|Department of Paediatrics, Erasmus MC - Sophia, Rotterdam, the Netherlands.
authors.forename: Pieter L A
authors.initials: PL
authors.lastname: Fraaij
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D009980:Influenza A virus; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology*; D012136:Respiratory Syncytial Viruses; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000821:virology; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D019562:Viral Load