Allergy Asthma Respir Dis.  2013 Dec;1(4):370-376. 10.4168/aard.2013.1.4.370.

Clinical characteristics of respiratory virus infection in children admitted to an intensive care unit

• Shin YS
• Kang DS
• Lee KS
• Kim JK
• Chung EH

• KMID: 2262596
• DOI: http://doi.org/10.4168/aard.2013.1.4.370

Abstract

PURPOSE
To investigate the clinical characteristics and the risk factors for mechanical ventilator treatment and incidence of complications in children admitted to an intensive care unit (ICU) with detected respiratory viruses.
METHODS
Eighty-two patients who were detected respiratory viruses by multiplex real-time polymerase chain reaction from nasopharyngeal aspirates were enrolled among the 123 children admitted to ICU with acute respiratory manifestations during the study period from January 2006 to December 2012.
RESULTS
Detection rate of respiratory viruses were 66% and 13 patients (16%) had two viruses isolated. The most common respiratory virus isolated was respiratory syncytial virus (RSV) (35%) followed by rhinovirus (19%), adenovirus (13%), parainfluenza virus (11%), influenza virus (11%), human metapneumovirus (6%), and human coronavirus (5%). Pneumonia (70%) was the most common clinical diagnosis. The mean age of patient with RSV infection was the youngest and with influenza virus infection was the oldest among other viruses infection (mean+/-standard deviation, 5.9+/-10.1 months vs. 51.0+/-26.1 months; P=0.01). Forty Patients (49%) who had the underlying diseases were not associated with incidence of mechanical ventilator treatment and complications. Bacterial coinfection with respiratory virus was the significant risk factor of mechanical ventilator care and incidence of complications (odds ratio [OR], 50.003; 95% confidence interval [CI], 3.955-632.144; P=0.003, and OR, 15,569; 95% CI, 1.803-134.452; P=0.013).
CONCLUSION
The significant morbidity of pediatric patient admitted to ICU with respiratory virus infection (RVI) was associated with bacterial coinfection. Furthermore, multicenter study should be performed to investigate the epidemiology of RVI in pediatric patients admitted to ICU in domestic.

Keyword

Respiratory virus; Intensive care units; Child

MeSH Terms

Adenoviridae
Child*
Coinfection
Coronavirus
Diagnosis
Epidemiology
Humans
Incidence
Intensive Care Units*
Critical Care*
Metapneumovirus
Orthomyxoviridae
Paramyxoviridae Infections
Pneumonia
Real-Time Polymerase Chain Reaction
Respiratory Syncytial Viruses
Rhinovirus
Risk Factors
Ventilators, Mechanical
Viruses*

Figure

• 

  Fig. 1 Incidence of respiratory viruses detected in pediatric patients admitted to intensive care unit with acute respiratory manifestations. RSV, respiratory syncytial virus; hRV, human rhinovirus; ADV, adenovirus; PIV, parainfluenza virus; IFV, influenza virus; hMPV, human metapneumovirus; CoV, coronavirus.

• 

  Fig. 2 Monthly distribution of respiratory viruses detected. CoV, coronavirus; hMPV, human metapneumovirus; hRV, human rhinovirus; IFV, influenza virus; ADV, adenovirus; PIV, parainfluenza virus; RSV, respiratory syncytial virus.

Reference

1. Ghani AS, Morrow BM, Hardie DR, Argent AC. An investigation into the prevalence and outcome of patients admitted to a pediatric intensive care unit with viral respiratory tract infections in Cape Town, South Africa. Pediatr Crit Care Med. 2012; 13:e275–e281.

2. Kwon JH, Chung YH, Lee NY, Chung EH, Ahn KM, Lee SI. An Epidemiological study of acute viral lower respiratory tract infections in hospitalized children from 2002 to 2006 in Seoul, Korea. Pediatr Allergy Respir Dis. 2008; 18:26–36.

3. Diniz EM, Vieira RA, Ceccon ME, Ishida MA, Vaz FA. Incidence of respiratory viruses in preterm infants submitted to mechanical ventilation. Rev Inst Med Trop Sao Paulo. 2005; 47:37–44.

4. Lim G, Park TS, Suh JT, Lee HJ. Comparison of R-mix virus culture and multiplex reverse transcriptase-PCR for the rapid detection of respiratory viruses. Korean J Lab Med. 2010; 30:289–294.

5. Lim JS, Woo SI, Kwon HI, Baek YH, Choi YK, Hahn YS. Clinical characteristics of acute lower respiratory tract infections due to 13 respiratory viruses detected by multiplex PCR in children. Korean J Pediatr. 2010; 53:373–379.

6. Kim HY, Kim KM, Kim SH, Son SK, Park HJ. Clinical manifestations of respiratory viruses in hospitalized children with acute viral lower respiratory tract infections from 2010 to 2011 in Busan and Gyeongsangnam-do, Korea. Pediatr Allergy Respir Dis. 2012; 22:265–272.

7. Aramburo A, van Schaik S, Louie J, Boston E, Messenger S, Wright C, et al. Role of real-time reverse transcription polymerase chain reaction for detection of respiratory viruses in critically ill children with respiratory disease: Is it time for a change in algorithm? Pediatr Crit Care Med. 2011; 12:e160–e165.

8. Roh EJ, Chang YP, Kim JK, Rheem IS, Park KS, Chung EH. Clinical significance of codetection of the causative agents for acute respiratory tract infection in hospitalized children. Korean J Pediatr. 2009; 52:661–666.

9. Richard N, Komurian-Pradel F, Javouhey E, Perret M, Rajoharison A, Bagnaud A, et al. The impact of dual viral infection in infants admitted to a pediatric intensive care unit associated with severe bronchiolitis. Pediatr Infect Dis J. 2008; 27:213–217.

10. Hon KL, Leung E, Tang J, Chow CM, Leung TF, Cheung KL, et al. Premorbid factors and outcome associated with respiratory virus infections in a pediatric intensive care unit. Pediatr Pulmonol. 2008; 43:275–280.

11. Crowcroft NS, Zambon M, Harrison TG, Mok Q, Heath P, Miller E. Respiratory syncytial virus infection in infants admitted to paediatric intensive care units in London, and in their families. Eur J Pediatr. 2008; 167:395–399.

12. Lee SJ, Shin EW, Park EY, Oh PS, Kim KN, Yoon HS, et al. Epidemiology and clincal analysis of acute viral respiratory tract infections in children (September, 1998-May, 2003). Korean J Pediatr. 2005; 48:266–275.

13. Han MY, Lee BL, Seo WH, Ahn SH, Kim SJ, Hwang SJ, et al. Epidemiology of respiratory syncytial virus lower respiratory tract infection and analysis of risk factors in severe infections from 1995 to 2004. Pediatr Allergy Respir Dis. 2005; 15:150–159.

14. Kim MR, Lee HR, Lee GM. Epidemiology of acute viral respiratory tract infections in Korean children. J Infect. 2000; 41:152–158.

15. Ko JM, Ha EJ, Lee EH, Lee SY, Kim HB, Hong SJ, et al. Clinical outcome and prognostic factors of acute respiratory distress syndrome in children. Korean J Pediatr. 2005; 48:599–605.

16. Farias JA, Fernandez A, Monteverde E, Flores JC, Baltodano A, Menchaca A, et al. Mechanical ventilation in pediatric intensive care units during the season for acute lower respiratory infection: a multicenter study. Pediatr Crit Care Med. 2012; 13:158–164.

17. van de Pol AC, Wolfs TF, Jansen NJ, van Loon AM, Rossen JW. Diagnostic value of real-time polymerase chain reaction to detect viruses in young children admitted to the paediatric intensive care unit with lower respiratory tract infection. Crit Care. 2006; 10:R61.

18. Straliotto SM, Siqueira MM, Machado V, Maia TM. Respiratory viruses in the pediatric intensive care unit: prevalence and clinical aspects. Mem Inst Oswaldo Cruz. 2004; 99:883–887.

19. Kim NK, Choi JY. Respiratory syncytial virus prevention in children with congenital heart disease: who and how? Korean J Pediatr. 2011; 54:197–200.

20. Laurent C, Dugue AE, Brouard J, Nimal D, Dina J, Parienti JJ, et al. Viral epidemiology and severity of respiratory infections in infants in 2009: a prospective study. Pediatr Infect Dis J. 2012; 31:827–831.

21. Choi BG, Lee DW, Kim YH, Hyun MC, Lee HJ. Clinical aspects of pneumonia with tachypnea in pediatric patients with influenza H1N1. Pediatr Allergy Respir Dis. 2010; 20:114–121.

22. Ventre KM, Wolf GK, Arnold JH. Pediatric respiratory diseases: 2011 update for the Rogers' textbook of pediatric intensive care. Pediatr Crit Care Med. 2011; 12:325–338.