Abstract
Background
Acute wheezing episodes are frequently associated with respiratory viral infections in children. However, the role of the recently described respiratory viruses is not yet fully understood.
Objective
The main objective of this study was to estimate the frequency of human metapneumovirus (HMPV), human bocavirus (HBoV), and 14 other respiratory viruses in hospitalized children with acute wheezing.
Methods
A prospective study was conducted on children <14 years old, admitted with an acute expiratory wheezing episode from September 2005 to June 2008. Viruses were detected in nasopharyngeal aspirates by polymerase chain reaction. Clinical data were prospectively recorded.
Results
A viral pathogen was identified in 444 (71%) out of 626 hospitalized acute wheezing episodes. Respiratory syncytial virus (RSV) was the most frequently detected (27%), followed by rhinovirus (24%), adenovirus (17.8%), HBoV (16%), and HMPV (4.7%). The rate of viral detection was significantly higher in infants (77.3%), than in older children (59.8%) (P < 0.001). RSV and HBoV were more prevalent in infants (P < 0.001) than in older children.
Conclusion
The most prevalent viruses found in severe acute wheezing episodes were RSV and rhinovirus not only in childhood, but also in infancy. However, other emerging viruses such as HBoV and metapneumovirus also play an important role in wheezing episodes. Pediatr Pulmonol. 2010; 45:585–591. © 2010 Wiley‐Liss, Inc.
Keywords: respiratory viruses, wheezing, human bocavirus, human metapneumovirus, rhinovirus, children, infants
REFERENCES
- 1. Johnston SL, Pattemore PK, Sanderson G, Smith S, Lampe F, Josephs L, Symington P, O'Toole S, Tyrrell DAJ, Holgate ST. Community study of role of viral infections in exacerbations of asthma in 9‐ to 11‐year‐old children. BMJ 1995; 310: 1225–1229. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Allander T, Jartti T, Gupta S, Niesters H, Lehtinen P, Österback R, Vuorinen T, Waris M, Bjerkner A, Tiveljung‐Lindell A, van den Hoogen BG, Hyypiä T, Ruuskanen O. Human bocavirus and acute wheezing in children. Clin Infect Dis 2007; 44: 904–910. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Heymann PW, Platts‐Mills TA, Johnston SL. Role of viral infections, atopy and antiviral immunity in the etiology of wheezing exacerbations among children and young adults. Pediatr Infect Dis J 2005; 24: S217–S222. [DOI] [PubMed] [Google Scholar]
- 4. Williams JV, Crowe JE, Jr. , Enriquez R, Minton P, Peebles RS, Jr. , Hamilton RG, Higgins S, Griffin M, Hartert TV. Human metapneumovirus infection plays etiologic role in acute asthma exacerbations requiring hospitalization in adults. J Infect Dis 2005; 192: 1149–1153. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. García‐García ML, Calvo C, Pérez‐Breña P, De Cea JM, Acosta B, Casas I. Prevalence and clinical characteristics of human metapneumovirus infections in hospitalized infants in Spain. Pediatric Pulmonol 2006; 41: 863–871. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Pozo F, García‐García ML, Calvo C, Cuesta I, Pérez‐Breña P, Casas I. High incidence of human bocavirus infection in children in Spain. J Clin Virol 2007; 40: 224–228. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Calvo C, García‐García ML, Blanco C, Frías ME, Casas I, Pérez‐Breña P. Role of rhinovirus in hospitalized infants with respiratory tract infections in Spain. Pediatr Infect Dis J 2007; 26: 904–908. [DOI] [PubMed] [Google Scholar]
- 8. Smuts H, Workman L, Zar HJ. Role of human metapneumovirus, human coronavirus NL63 and human bocavirus in infants and young children with acute wheezing. J Med Virol 2008; 80: 906–912. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. McConnochie K. Bronchiolitis. What's in the name? Am J Dis Child 1983; 137: 11–13. [PubMed] [Google Scholar]
- 10. Coiras MT, Perez‐Brena P, Garcia ML, Casas I. Simultaneous detection of influenza A, B, and C viruses, respiratory syncytial virus, and adenoviruses in clinical samples by multiplex reverse transcription nested‐PCR assay. J Med Virol 2003; 69: 132–144. [DOI] [PubMed] [Google Scholar]
- 11. Coiras MT, Aguilar JC, Garcia ML, Casas I, Perez‐Brena P. Simultaneous detection of fourteen respiratory viruses in clinical specimens by two multiplex reverse transcription nested‐PCR assays. J Med Virol 2004; 72: 484–495. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. López‐Huertas MR, Casas I, Acosta‐Herrera B, Garcia ML, Coiras MT, Pérez‐Breña P. Two RT‐PCR based assays to detect human metapneumovirus in nasopharyngeal aspirates. J Virol Methods 2005; 129: 1–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Khetsuriani N, Kazerouni NN, Erdman DD, Lu X, Redd SC, Anderson LJ, Teague WG. Prevalence of viral respiratory tract infections in children with asthma. J Allergy Clin Immunol 2007; 119: 314–321. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Kusel MM, de Klerk NH, Kebadze T, Vohma V, Holt PG, Johnston SL, Sly PD. Early‐life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma. J Allergy Clin Immunol 2007; 119: 1105–1110. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Gendrel D, Guedj R, Pons‐Catalano C, Emerian A, Raymond J, Rozenberg F, Lebon P. Human bocavirus in children with acute asthma. Clin Infect Dis 2007; 45: 404–405. [DOI] [PubMed] [Google Scholar]
- 16. Mansbach JM, McAdam AJ, Clark S, Hain PD, Flood RG, Acholonu U, Camargo CA, Jr. Prospective multicenter study of the viral etiology of bronchiolitis in the emergency department. Acad Emerg Med 2008; 15: 111–118. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Stempel HE, Martin ET, Kuypers J, Englund JA, Zerr DM. Multiple viral respiratory pathogens in children with bronchiolitis. Acta Paediatr 2009; 98: 123–126. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Bosis S, Esposito S, Niesters HG, Zuccotti GV, Marseglia G, Lanari M, Zuin G, Pelucchi C, Osterhaus AD, Principi N. Role of respiratory pathogens in infants hospitalized for a first episode of wheezing and their impact on recurrences. Clin Microbiol Infect 2008; 14: 677–684. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Chung JY, Han TH, Kim SW, Kim CK, Hwang ES. Detection of viruses identified recently in children with acute wheezing. J Med Virol 2007; 79: 1238–1243. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Moonnumakal SP, Fan LL. Bronchiolitis obliterans in children. Curr Opin Pediatr 2008; 20: 272–278. [DOI] [PubMed] [Google Scholar]
- 21. Saçkesen C, Pinar A, Sekerel BE, Akyön Y, Saraçlar Y. Use of polymerase chain reaction for detection of adenovirus in children with or without wheezing. Turk J Pediatr 2005; 47: 227–231. [PubMed] [Google Scholar]
- 22. Chen HL, Chiou SS, Hsiao HP, Ke GM, Lin YC, Lin KH, Jong YJ. Respiratory adenoviral infections in children: a study of hospitalized cases in southern Taiwan in 2001–2002. J Trop Pediatr 2004; 50: 279–284. [DOI] [PubMed] [Google Scholar]
- 23. Rocholl C, Gerber K, Daly J, Pavia AT, Byington CL. Adenoviral infections in children: the impact of rapid diagnosis. Pediatrics 2004; 113: e51–e56. [DOI] [PubMed] [Google Scholar]
- 24. van den Hoogen BG, de Jong JC, Groen J, Kuiken TRA, Groot R, Fouchier RA, Osterhaus AD. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 2001; 7: 719–724. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25. Freymouth F, Vabret A, Legrand L, Eterradossi N, Lafay‐Delaire F, Brouard J, Guillois B. Presence of the new human metapneumovirus in French children with bronchiolitis. Pediatr Infect Dis J 2003; 22: 92–94. [DOI] [PubMed] [Google Scholar]
- 26. Jartti T, van den Hoogen B, Garofalo RP, Osterhaus AD, Ruuskanen O. Metapneumovirus and acute wheezing in children. Lancet 2002; 360: 1393–1394. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Bosis S, Esposito S, Niersters HG, Crovari P, Osterhaus AD, Principi N. Impact of human metapneumovirus in childhood: comparison with respiratory syncytial virus and influenza virus. J Virol 2004; 75: 101–104. [DOI] [PubMed] [Google Scholar]
- 28. van der Hoek L. Human coronaviruses: what do they cause? Antivir Ther 2007; 12: 651–658. [PubMed] [Google Scholar]
- 29. Gergen PJ, Mitchell H, Lynn H. Understanding the seasonal pattern of childhood asthma: results from the National Cooperative Inner‐City Asthma Study (NCICAS). J Pediatr 2002; 141: 631–636. [DOI] [PubMed] [Google Scholar]
- 30. Johnston NW, Johnston SL, Norman GR, Dai J, Sears MR. The September epidemic of asthma hospitalization: school children as disease vectors. J Allergy Clin Immunol 2006; 117: 557–562. [DOI] [PubMed] [Google Scholar]
- 31. Johnston SL, Pattemore PK, Sanderson G, Smith S, Campbell MJ, Josephs LK, Cunningham A, Robinson BS, Myint SH, Ward ME, Tyrrell DA, Holgate ST. The relationship between upper respiratory infections and hospital admissions for asthma: a time‐trend analysis. Am J Respir Crit Care Med 1996; 154: 654–660. [DOI] [PubMed] [Google Scholar]
- 32. Storr J, Lenney W. School holidays and admissions with asthma. Arch Dis Child 1989; 64: 103–107. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33. Julious SA, Osman LM, Jiwa M. Increases in asthma hospital admissions associated with the end of the summer vacation for school‐age children with asthma in two cities from England and Scotland. Public Health 2007; 121: 482–484. [DOI] [PubMed] [Google Scholar]
- 34. Harju T, Keistinen T, Tuuoponen T, Kivela S‐L. Seasonal variation in childhood asthma hospitalizations in Finland, 1972–1992. Eur J Pediatr 1997; 156: 436–439. [DOI] [PubMed] [Google Scholar]
- 35. García‐García ML, Calvo C, Pozo F, Pérez‐Breña P, Quevedo S, Bracamonte T, Casas I. Human bocavirus detection in nasopharyngeal aspirates of children without clinical symptoms of respiratory infection. Pediatr Infect Dis J 2008; 27: 358–360. [DOI] [PubMed] [Google Scholar]