title: Clinical Impact of Mixed Respiratory Viral Infection in Children with Adenoviral Infection.
abstract: BACKGROUND
  Although adenovirus (ADV) infection occurs steadily all year round in Korea and the identification of respiratory viral coinfections has been increasing following the introduction of multiplex real-time polymerase chain reaction tests, the clinical impact of viral coinfection in children with ADV infection has rarely been reported.
  
  
  METHODS
  Medical records of children diagnosed with ADV infection were retrospectively reviewed. The enrolled children were divided into two groups based on the identified respiratory viruses: ADV group and coinfection group. Clinical and laboratory parameters were compared between the two groups.
  
  
  RESULTS
  In total, 105 children (60 males and 45 females) with a median age of 29 months (range: 0-131 months) diagnosed with an ADV infection were enrolled. Fever (99.0%) was by far the most frequent symptom, followed by respiratory (82.9%), and gastrointestinal (22.9%) symptoms. Upper and lower respiratory tract infections were diagnosed in 56 (53.3%), and 32 (30.5%) children, respectively. Five (4.8%) children received oxygen therapy, and no child died due to ADV infection. Coinfection was diagnosed in 32 (30.5%) children, with rhinovirus (46.9%), and respiratory syncytial virus (21.9%) being the most frequent. The proportions of children younger than 24 months (P <0.001), with underlying medical conditions (P = 0.020), and diagnosed with lower respiratory tract infection (P = 0.011) were significantly higher in the coinfection group than in the ADV group. In a multivariate analysis, only the younger age was significantly associated with coinfection (P <0.001). Although more children in the coinfection group received oxygen therapy (P = 0.029), the duration of fever and hospitalization was not significantly different between the two groups.
  
  
  CONCLUSIONS
  Respiratory viral coinfection with ADV occurred more frequently in children younger than 24 months of age compared with children aged 24 months or older. Respiratory viral coinfection may increase the severity of ADV infection, however, appropriate therapy prevented prolonged hospitalization and poor prognosis due to coinfection.
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hyun Jun
authors.identifier: http://orcid.org/0000-0002-9562-4670
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Seo
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.|The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea. beomsid@catholic.ac.kr.
authors.forename: Seung Beom
authors.identifier: http://orcid.org/0000-0002-1299-2137
authors.initials: SB
authors.lastname: Han
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.|The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Dae Chul
authors.identifier: http://orcid.org/0000-0003-0934-817X
authors.initials: DC
authors.lastname: Jeong
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.|The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jin Han
authors.identifier: http://orcid.org/0000-0003-1610-6742
authors.initials: JH
authors.lastname: Kang
keywords: Adenoviridae; Child; Coinfection; Prognosis