Respiratory syncytial virus and adenovirus in acute lower respiratory infections in hospitalized infants and children


Background: Lower respiratory tract infection (LRTI) is a main cause of hospitalization in infants and children. These patients’ nasopharyngeal swabs more frequently contain respiratory syncytial virus (RSV) than human adenovirus (HAdV) in cold seasons; recent data suggest that oropharyngeal swabs more frequently contain HAdV than RSV. Knowing more about virus detection with oropharyngeal swabs, seasonal fluctuations and age-related distribution of RSV and HAdV would help treat children hospitalized for LRTI more effectively. We investigated the seasonal virus-related frequency (as assessed by oropharyngeal swabs) and environmental and clinical features in infants and children hospitalized for LRTI from autumn to spring. Methods: We studied 98 subjects hospitalized for LRTI in our Pediatric Unit, from November 2006 to May 2007. RSV and HAdV in oropharyngeal swabs were assessed by real-time polymerase chain reaction (PCR) assay. Results: PCR assays more frequently detected HAdV (29.6% of patients) than RSV (25.5%). The seasonal incidence also differed (RSV, narrow peak in December and HAdV, wide peak from April to May). Most patients infected with RSV were aged 2 yrs or younger (23/25: 88%); no difference was found in age between subjects who tested HAdV-positive (13/29: 45%) or undetectable-virus (23/44: 52%). Bronchiolitis was more frequently associated with RSV than HAdV or undetectable-virus oropharyngeal swabs. No difference was found in risk factors (school attendance, atopic parents, exposure to cigarette smoking, home dampness or exposure to animals) or clinical features (vital parameters or duration of hospital stay) among the three viral groups. Conclusions: Our findings show a high frequency of HAdV-positive oropharyngeal swabs during acute LRTIs in infants and children and differences in the seasonal distribution of RSV and HAdV in Rome.

Share and Cite:

Barberi, S. , Barreto, M. , La Penna, F. , Mazzarella, B. , Liverani, M. , Luca, O. , Simmaco, M. and Villa, M. (2012) Respiratory syncytial virus and adenovirus in acute lower respiratory infections in hospitalized infants and children. Open Journal of Pediatrics, 2, 31-37. doi: 10.4236/ojped.2012.21004.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Filippel, M.B. and Rearick, T. (1993) Respiratory syncytial virus. Nursing Clinics of North America, 28, 651-671.
[2] Sigurs, N., Bjarnason, R. and Sigurbergsson, F. (2000) Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7. American Journal of Respiratory and Critical Care Medicine, 161, 1501-1507.
[3] Simoes, EA. (1999) Respiratory syncytial virus infection. Lancet, 354, 847-852.
[4] Hall, C.B. (2001) Respiratory syncytial virus and parainfluenza virus. New England Journal of Medicine, 344, 1917-1928. doi:10.1056/NEJM200106213442507
[5] Leader, S. and Kohlhase, K. (2003) Recent trends in severe respiratory syncytial virus (RSV) among US infants 1997 to 2000. Journal of Pediatrics, 143, S127-S132. doi:10.1067/S0022-3476(03)00510-9
[6] Centers for disease control and prevention (CDC) (2004) Respiratory syncytial virus activity-United States 2003-2004. Morbidity and Mortality Weekly Report, 53, 1159-1160.
[7] Robertson, S.E., Roca, A., Alonso, P., et al. (2004) Respiratory syncytial virus infection: Denominator-based studies in Indonesia, Mozambique, Nigeria and South Africa. Bulletin World Health Organization, 82, 914-922.
[8] Medici, M.C., Arcangeletti, M.C., Merolla, R., et al. and The “Osservatorio VRS” Study Group (2004) Incidence of respiratory syncytial virus infection in infants and young children referred to the emergency departments for lower respiratory tract diseases in Italy. Acta Bio-Medica, 75, 26-33.
[9] Stensballe, L.G., Devasundaram, J.K. and Simoes, E.A. (2003) Respiratory syncytial virus epidemics: The ups and downs of a seasonal virus. Pediatrics Infectious Disease Journal, 22, S21-S32. doi:10.1097/01.inf.0000053882.70365.c9
[10] Van Der Sande, M.A., Goetghebuer, T., Sanneh, M., et al. (2004) Seasonal variation in respiratory syncytial virus epidemics in the Gambia, West Africa. Pediatrics Infectious Disease Journal, 23, 73-74. doi:10.1097/01.inf.0000105183.12781.06
[11] Mullins, J.A., Lamonte, A.C., Bresee, J.S., et al. (2003) Substantial variability in community respiratory syncytial virus season timing. Pediatrics Infectious Disease Journal, 22, 857-862. doi:10.1097/01.inf.0000090921.21313.d3
[12] Duppenthaler, A., Gorgievski-Hrisoho, M., Frey, U., et al. (2003) Two-year periodicity of respiratory syncytial virus epidemics in Switzerland. Infection, 31, 75-80. doi:10.1007/s15010-002-3124-8
[13] Weigl, J.A., Puppe, W. and Schmitt, H.J. (2002) Seasonality of respiratory syncytial virus-positive hospitalizations in children in Kiel, Germany, over a 7-year period. Infection, 30, 186-192. doi:10.1007/s15010-002-2159-1
[14] Eriksson, M., Bennet, R., Rotzen-Ostlund, M., et al. (2002) Population-based rates of severe respiratory syncytial virus infection in children with and without risk factors, and out-come in a tertiary care setting. Acta Paediatrica, 91, 593-598. doi:10.1111/j.1651-2227.2002.tb03282.x
[15] Lyon, J.L., Stoddard, G., Ferguson, D., et al. (1996) An every other year cyclic epidemic of infants hospitalized with respiratory syncytial virus. Pediatrics, 97, 152-153.
[16] Chang, P.W.K., Chew, F.T., Tan, T.N., et al. (2002) Seasonal variation in respiratory syncytial virus chest infections in the tropics. Pediatric Pulmonology, 34, 47-51. doi:10.1002/ppul.10095
[17] Waris, M. (1991) Pattern of respiratory syncytial virus epidemics in Finland: two-year cycles with alternating prevalence of groups A and B. Journal of Infectious Diseases, 163, 464-469. doi:10.1093/infdis/163.3.464
[18] Medici, M.C., Arcangeletti, M.C., Rossi, G.A., et al. and The “Osservatorio VRS” Study Group (2006) Four year incidence of respiratory syncytial virus infection in infants and young children referred to emergency departments for lower respiratory tratc disease in Italy: The “Osservatorio VRS” Study (2000-2004). The New Microbiologica, 29, 35-43.
[19] Moro, M.R., Bonville, C.A., Suryadevara, M., et al. (2009) Clinical Features, adenovirus types, and local production of inflammatory mediators in adenovirus infections. Pediatrics Infectious Disease Journal, 28, 376-380. doi:10.1097/INF.0b013e31819075a6
[20] Zhang, Y. and Bergelson, J.M. (2005) Adenovirus receptors. Journal of Virology, 79, 12125-12131. doi:10.1128/JVI.79.19.12125-12131.2005
[21] Weissenbacher, M., Carballal, G., Avila, M., et al. (1990) Etiologic and clinical evaluation of acute lower respiratory tract infections in young Argentinian children: An overview. Reviews of Infectious Diseases, 12, S889-S898. doi:10.1093/clinids/12.Supplement_8.S889
[22] Videla, C., Carballai, G., Misirlian, A., et al. (1998) Acute lower respiratory infections due to syncytial virus and adenovirus among hospitalized children from Argentina. Clinical and Diagnostic Virology, 10, 17-23. doi:10.1016/S0928-0197(98)00017-8
[23] Kim, C., Ahmed, J.A., Eidex, R.B., et al. (2011) Comparison of nasopharyngeal and oropharyngeal swabs for the diagnosis of eight respiratory viruses by real-time reverse transcription-pcr assays. PLoS ONE, 6, 1-6.
[24] American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis (2006) Diagnosis and management of bronchiolitis. Pediatrics, 118, 1774-1793. doi:10.1542/peds.2006-2223
[25] Madhi, S.A., Ludewick, H., Kuwanda, L., et al. (2007) Seasonality, incidence, and repeat human metapneumovirus lower respiratory tract infections in an area with a high prevalence of human immunodeficiency virus type-1 infection. Pediatrics Infectious Disease Journal, 26, 693-699. doi:10.1097/INF.0b013e3180621192
[26] Klig, J.E. (2006) Office pediatrics: Current perspectives on the outpatient evaluation and management of lower respiratory infections in children. Current Opinion in Pediatrics, 18, 71-76. doi:10.1097/01.mpo.0000192520.48411.fa
[27] Hierholzer, J.C. (1995) Adenoviruses. In: Lennette, E.H., Lennette, D.A. and Lennette, E.T., Eds., Diagnostic Procedures for Viral, Rickettsial, and Chlamydial Infections, American Public Health Association, Washington, 169-188.
[28] Raty, R., Kleemola, M., Melen, K., et al. (1999) Efficacy of PCR and other diagnostic methods for the detection of respiratory adenoviral infections. Journal of Medical Virology, 59, 66-72. doi:10.1002/(SICI)1096-9071(199909)59:1<66::AID-JMV11>3.0.CO;2-#
[29] Simoes, E.A. and Carbonell-Estrany, X. (2003) Impact of severe disease caused by respiratory syncytial virus in children living in developed countries. Pediatrics Infectious Disease Journal, 22, S13-S18. doi:10.1097/01.inf.0000053881.47279.d9
[30] Midulla, F., Scagnolari, C., Bonci, E., et al. (2010) Respiratory syncytial virus, human bocavirus and rhinovirus bronchiolitis in infants. Archives of Disease in Childhood, 95, 35-41. doi:10.1136/adc.2008.153361
[31] Fabbiani, M., Terrosi, C., Martorelli, B., et al. (2009) Epidemiological and clinical study of viral respiratory tract infection in children from Italy. Journal of Medical Virology, 81, 750-756. doi:10.1002/jmv.21457
[32] Lanari, M., Giovannini, M., Giuffré, L., et al. and the Investigators R.A.DA.R. Study Group (2002) Prevalence of respiratory syncytial virus infection in Italian infants hospitalized for acute lower respiratory tract infections, and association between respiratory syncytial virus infection risk factors and disease severity. Pediatric Pulmonology, 33, 458-465. doi:10.1002/ppul.10047
[33] Rossi, G.A., Medici, M.C., Merolla, R. and The “Osservatorio VRS” Study Group (2005) Incidence of respiratory syncytial positivity in young Italian children referred to the emergency departements for lower respiratory tract infection over two consecutive epidemic seasons. Infection, 33, 18-24. doi:10.1007/s15010-005-4010-y
[34] Thomazelli, L.M., Vieira, S., Leal, A.L., et al. (2007) Surveillance of eight respiratory viruses in clinical samples of pediatric patients in southeast Brazil. Jornal de Pediatria, 83, 422-428. doi:10.1590/S0021-75572007000600005
[35] Choi, E.H., Lee, H.J., Kim, S.J., et al. (2006) The association of newly identified respiratory viruses with lower respiratory tract infection in Korean children, 2000-2005. Clinical Infection Disease, 43, 585-592. doi:10.1086/506350
[36] Hong, J.Y., Lee, H.J., Piedra, P.A., et al. (2001) Lower respiratory tract infections due to adenovirus in hospitalized Korean children: epidemiology, clinical features and prognosis. Clinical Infection Disease, 32, 1423-1429. doi:10.1086/320146
[37] Mlinaric-Galinovic, G., Vilibic-Cavlek, T., Ljubin-Sternak, S., et al. (2009) Eleven consecutive years of respiratory syncytial virus outbreaks in Croatia. Pediatrics International, 51, 237-240. doi:10.1111/j.1442-200X.2008.02723.x
[38] Chan, P.W.K., Goh, A.Y.T., Chua, K.B., et al. (1999) Viral aetiology of lower respiratory tract infection young Malaysian children. Journal of Paediatrics and Child Health, 35, 287-290. doi:10.1046/j.1440-1754.1999.00359.x
[39] Simoes, E.A. (2008) RSV disease in the pediatric population: Epidemiology, seasonal variability, and long-term outcomes. Managed Care, 17, 18-19.
[40] Okiro, E.A., Ngama, M., Bett, A., et al. (2008) Factors associated with increased risk of progression to respiratory syncytial virus-associated pneumonia in young Kenyan children. Tropical Medicine & International Health, 13, 914-926. doi:10.1111/j.1365-3156.2008.02092.x
[41] Corsello, G., Di Carlo, P., Salsa, L., et al. (2008) Respiratory syncytial virus infection in a Sicilian pediatric population: Risk factors, epidemiology, and severity. Allergy and Asthma Proceedings, 29, 205-210. doi:10.2500/aap.2008.29.3101
[42] Morrow, B.M., Hatherill, M., Smuts, H.E., et al. (2006) Clinical course of hospitalised children infected with human metapneumovirus and respiratory syncytial virus. Journal of Paediatrics and Child Health, 42, 174-178. doi:10.1111/j.1440-1754.2006.00825.x
[43] James, L., Vernon, M.O., Jones, R.C., et al. (2007) Outbreak of human adenovirus type 3 infection in a pediatric long-term care facility—Illinois, 2005. Clinical Infectious Diseases, 45, 416-420. doi:10.1086/519938

Copyright © 2021 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.