title: Single- and multiple viral respiratory infections in children: disease and management cannot be related to a specific pathogen.
abstract: The number of viral pathogens associated with pediatric acute respiratory tract infection (ARI) has grown since the introduction of reverse transcription real-time polymerase chain reaction (RT-PCR) assays. Multiple viruses are detected during a single ARI episode in approximately a quarter of all cases. The clinical relevance of these multiple detections is unclear, as is the role of the individual virus. We therefore investigated the correlation between clinical data and RT-PCR results in children with single- and multiple viral ARI.
  
  
  
  Data from children with ARI were prospectively collected during two winter seasons. RT-PCR testing for 15 viruses was performed in 560 ARI episodes. In the patients with a single-viral etiology, clinical data, laboratory findings, patient management- and outcome data were compared between the different viruses. With this information, we compared data from children of whom RT-PCR data were negative, with children with single- and multiple viral positive results.
  
  
  
  The viral detection rate was 457/560 (81.6%) of which 331/560 (59.1%) were single infections and 126/560 (22.5%) were multiple infections. In single viral infections, some statistically significant differences in demographics, clinical findings, disease severity and outcome were found between children with different viral etiologies. However, no clinically recognizable pattern was established to be virus-specific. In a multivariate analysis, the only variables that were correlated with longer hospital stay were the use of oxygen and nebulizer therapy, irrespective of the viral pathogen. Children with RT-PCR positive test results had a significant higher disease severity, fever, length of hospital stay, days of extra oxygen supply, and days of antibiotic treatment than children with a negative RT-PCR test result. For children with single- versus children with multiple positive RT-PCR test results, these differences were not significant.
  
  
  
  Disease (severity), management and outcome in pediatric ARI are not associated with a specific virus. Single- and multiple viral ARI do not significantly differ with regard to clinical outcome and patient management. For general pediatrics, RT-PCR assays should be restricted to pathogens for which therapy is available or otherwise may have clinical consequences. Further research with an extended panel of RT-PCR assays and a larger number of inclusions is necessary to further validate our findings.
authors.affiliation: Department of Pediatrics, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands. wishaupt@rdgg.nl.
authors.forename: Jérôme O
authors.initials: JO
authors.lastname: Wishaupt
authors.affiliation: Pieter van Foreest Institute for Education and Research, Medical Centre Alkmaar, Alkmaar, The Netherlands.
authors.forename: Tjeerd
authors.initials: T
authors.lastname: van der Ploeg
authors.affiliation: Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Ronald
authors.initials: R
authors.lastname: de Groot
authors.affiliation: Department of Pediatrics, Groene Hart Ziekenhuis, Gouda, The Netherlands.|Department of Pediatrics, Ghent University Hospital, Ghent, Belgium.
authors.forename: Florens G A
authors.initials: FG
authors.lastname: Versteegh
authors.affiliation: Department of Pediatrics, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands.|Department of Pediatric Infectious Diseases and Immunology, ErasmusMC-Sophia, Rotterdam, The Netherlands.
authors.forename: Nico G
authors.initials: NG
authors.lastname: Hartwig
mesh_terms: D000258:Adenovirus Infections, Human / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D060085:Coinfection / Q000453:epidemiology / Q000821:virology*; D018352:Coronavirus Infections / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D009330:Nebulizers and Vaporizers; D009426:Netherlands / Q000453:epidemiology; D010102:Oxygen Inhalation Therapy; D010850:Picornaviridae Infections / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D011014:Pneumonia / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000628:therapy / Q000821:virology*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012621:Seasons; D012720:Severity of Illness Index; D014777:Virus Diseases / Q000453:epidemiology / Q000628:therapy / Q000821:virology*; D014780:Viruses / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents
keywords: Child; Co-infection; Respiratory Syncytial Virus; Respiratory tract infections; Respiratory viruses