title: Respiratory viral coinfection and disease severity in children: A systematic review and meta-analysis.
abstract: With advent of molecular diagnostic technologies, studies have reported detection of two or more respiratory viruses in about 30% of children with respiratory infections. However, prognostic role of coinfection remains unclear.
  
  
  
  Evaluate relation between respiratory viral confection and illness severity in children.
  
  
  
  MEDLINE (through PUBMED), EMBASE, EBSCO, LILACS databases were searched up to March 2015 by two independent reviewers. Studies assessing severity of viral coinfection in patients aged less than 18 years were included. Standardized forms were used for data extraction of population, study design, clinical syndromes, virus combinations compared and severity outcomes. Risk of bias and quality of evidence were assessed through EPHPP and GRADE. Subgroup analysis was performed according to age and viral combinations.
  
  
  
  Of 5218 records screened, 43 were included in analysis. Viral coinfection did not influence risks of all outcomes assessed: length of stay (mean difference in days in coinfection, -0.10 [95% confidence interval: -0.51 to 0.31]), length of supplemental oxygen (-0.42 [-1.05 to 0.20]), need of hospitalization (odds ratio of coinfection, 0.96 [95% confidence interval: 0.61-1.51]), supplemental oxygen (0.94 [0.66 to 1.34]), need of intensive care (0.99 [0.64 to 1.54]), mechanical ventilation (0.81 [0.33 to 2.01]) and death (2.22 [0.83 to 5.95]). Sub-analyses according to age and viral combinations have not shown influence of these factors in outcomes.
  
  
  
  Respiratory viral coinfection did not increase severity in all outcomes assessed. Further studies are necessary to confirm this finding, especially regarding role of specific viral interactions.
authors.affiliation: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Marcelo Comerlato
authors.initials: MC
authors.lastname: Scotta
authors.affiliation: Universidade Federal do Rio Grande do Sul, Department of Pediatrics, Brazil.
authors.forename: Valentina Coutinho Baldoto Gava
authors.initials: VC
authors.lastname: Chakr
authors.affiliation: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Angela
authors.initials: A
authors.lastname: de Moura
authors.affiliation: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Rafaela Garces
authors.initials: RG
authors.lastname: Becker
authors.affiliation: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Ana Paula Duarte
authors.initials: AP
authors.lastname: de Souza
authors.affiliation: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Marcus Herbert
authors.initials: MH
authors.lastname: Jones
authors.affiliation: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Leonardo Araújo
authors.initials: LA
authors.lastname: Pinto
authors.affiliation: Universidade de Santa Cruz do Sul (UNISC). School of Medicine, Department of Biology and Pharmacy, Brazil.
authors.forename: Edgar Enrique
authors.initials: EE
authors.lastname: Sarria
authors.affiliation: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Paulo Marcio
authors.initials: PM
authors.lastname: Pitrez
authors.affiliation: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Renato Tetelbom
authors.initials: RT
authors.lastname: Stein
authors.affiliation: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil. Electronic address: rita.mattiello@pucrs.br.
authors.forename: Rita
authors.initials: R
authors.lastname: Mattiello
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology* / Q000821:virology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D012121:Respiration, Artificial; D012141:Respiratory Tract Infections / Q000821:virology*; D012720:Severity of Illness Index; D016019:Survival Analysis; D014777:Virus Diseases / Q000453:epidemiology*
keywords: Child; Coinfection; Prognosis; Respiratory insufficiency; Respiratory tract infections; Viruses