Published online Apr 9, 2019. doi: 10.5409/wjcp.v8.i2.33
Peer-review started: November 30, 2018
First decision: January 9, 2019
Revised: February 20, 2019
Accepted: February 27, 2019
Article in press: February 27, 2019
Published online: April 9, 2019
Respiratory syncytial virus (RSV) is the most frequent agent of viral-associated acute lower respiratory diseases (ALRI) and is known to be associated with hospitalization and mortality among high-risk cases.
Early diagnosis of viral infections using a simple test such as the RSV and viral fluorescent antibody assay (DFA) test, in settings where PCR is not feasible, would be useful in the timely institution of appropriate supportive care, minimization of antibiotic overuse, and appropriate follow-up care for complications and sequelae, potentially leading to a reduction of costs of medical care.
The principal objective of the study was to investigate the proportion of RSV and non-RSV respiratory viral infections as a cause of ALRI among 1-59 mo old children admitted to a tertiary care hospital in India. The study also assesses the seasonality, clinical features, risk factors and outcome of RSV and non-RSV respiratory viral infections among these hospitalized children.
The prospective study was conducted on hospitalized children aged < 5 years, with a diagnosis of acute lower respiratory infections (ALRI), admitted between August 2011-August 2013, were included. Nasopharyngeal (NP) swabs were obtained from eligible children, and transported to the laboratory in suitable media. Slides were prepared from the media, and DFA staining was performed using SimulFluor Respiratory Screen kit on NP wash samples.
The median age of subjects was 8 mo (inter quartile range 5-15 mo), and 89.0% were less than 2 years of age. Viral etiology (RSV, influenza A or B, adenovirus, para influenza 1, 2 or 3) was confirmed in 33.9% (130/383) of children hospitalized for ALRI. RSV was positive in 24.5% (94/383) non-RSV viruses in 14.8% (57/383) while co-infection with RSV and non-RSV viruses was seen in 5.5% (21/383) children. A peak of RSV positive cases was seen after the rainy season during the months of August through November. The RSV infection was significantly associated with being exclusively breastfed for less than 3 mo. There was no significant association between RSV infection and independent variables such as low birth weight, prematurity, complicated neonatal course, family history of asthma, household smoking or indoor wood fuel usage. Mean hospital stay was 4.6 ± 5.1 d and 8.3 ± 6.5 d in RSV-positive and RSV-negative children, respectively. The respiratory complications such as acute respiratory distress syndrome and respiratory failure requiring PICU admission, were 13.8% (13/94), 8.7% (5/57) and 16.6% (42/253) of children with RSV positive, non-RSV positive and viral negative results.
A high proportion of RSV and other virus-associated ALRI were seen among hospitalized children in India. The study demonstrates that exclusive breastfeeding for over 3 mo of age, may have a protective effect against RSV and other respiratory viral infections. The viral DFA test was easy to perform and results were available within 4-5 h.
Early diagnosis of viral infections using a simple test such as the RSV and would be useful in the timely institution of appropriate supportive care, minimization of antibiotic overuse, and appropriate follow-up care for complications and sequelae, potentially leading to a reduction of costs of medical care.