ESPID Education. Esposito S. 06/07/11; 7685
Assoc. Prof. Susanna Esposito
Assoc. Prof. Susanna Esposito

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Background and aims:
Community-acquired pneumonia (CAP) is an important cause of morbidity and hospitalization in children in developed countries and one of the leading causes of death in children in the less developed countries. Many microorganisms are associated with CAP and now attention is turning to the importance of viruses as etiologic agents. Importantly, the availability of molecular diagnostic multiplex assay has greatly increased the ability to detect and characterise the epidemiology of respiratory viral infections. This study evaluated the impact of respiratory viral infections in children with CAP admitted to hospital during three winter seasons.

Viral RNA or DNA extracted from nasopharyngeal swabs collected in children with CAP attending the Department of Maternal and Pediatric Sciences in Milan, Italy, during winter seasons 2007-2008, 2008-2009 and 2009-2010 were tested using the RVP Fast assay according to the manufacturer's instructions (Luminex Molecular Diagnostics Inc., Toronto, Canada). The RVP Fast assay simultaneously detects influenza A virus (subtyped H1 or H3), influenza B virus, RSV-A and -B, PIV-1, -2, -3, and -4, adenovirus, human metapneumovirus, coronaviruses 229E, NL63, OC43, and HKU1, enterovirus/rhinovirus, and human bocavirus. Samples positive for enterovirus/rhinovirus were retested for the identification of rhinovirus with a real-time RT-PCR.

During 2007-2008, 2008-2009 and 2009-2010 winter seasons, a total of 525 episodes of radiographically-confirmed CAP were observed, 111 (21.1%) in children aged 0-11 months, 260 (49.5%) in children aged 12-47 months and 154 (29.3%) in children aged ≥48 months. Among the total number of CAP, 384 (73.1%) were positive for at least one viral infection, with the highest prevalence in children aged 0-11 months (85.4%). In all the age groups, the most representative viruses were RSV (166/384, 43.2%) and rhinovirus (131/384, 34.1%). Among the total number of CAP in which a virus was identified, 107 episodes (27.9%) were multiple infections with the presence of two or more viruses. No significant differences were observed in clinical and laboratory findings between episodes with single viral infection and multiple viral infections in all age groups.
Conclusions: Viral infections were found in the great majority of children admitted to hospital with CAP, highlighting the main role exerted by these agents in the determination of lower respiratory infections in pediatrics. The importance of co-infections between different viruses deserves attention particularly in the youngest children as possible cause of severe disease.
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