Infection with multiple viruses is not associated with increased disease severity in children with bronchiolitis

Pediatr Pulmonol. 2012 Apr;47(4):393-400. doi: 10.1002/ppul.21552. Epub 2011 Sep 7.


Background: The clinical relevance of parallel detection of multiple viruses by real-time polymerase chain reaction (RT-PCR) remains unclear. This study evaluated the association between the detection of multiple viruses by RT-PCR and disease severity in children with bronchiolitis.

Methods: Children less than 2 years of age with clinical symptoms of bronchiolitis were prospectively included during three winter seasons. Patients were categorized in three groups based on disease severity; mild (no supportive treatment), moderate (supplemental oxygen and/or nasogastric feeding), and severe (mechanical ventilation). Multiplex RT-PCR of 15 respiratory viruses was performed on nasopharyngeal aspirates.

Results: In total, 142 samples were obtained. Respiratory Syncytial virus (RSV) was the most commonly detected virus (73%) followed by rhinovirus (RV) (30%). In 58 samples (41%) more than one virus was detected, of which 41% was a dual infection with RSV and RV. In RSV infected children younger than 3 months, disease severity was not associated with the number of detected viruses. Remarkably, in children older than 3 months we found an association between more severe disease and RSV mono-infections.

Conclusion: Disease severity in children with bronchiolitis is not associated with infection by multiple viruses. We conclude that other factors, such as age, contribute to disease severity to a larger extent.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bronchiolitis / virology*
  • Female
  • Humans
  • Infant
  • Male
  • Picornaviridae Infections / diagnosis*
  • Picornaviridae Infections / virology
  • Prospective Studies
  • Respiratory Syncytial Virus Infections / diagnosis*
  • Respiratory Syncytial Virus Infections / virology
  • Reverse Transcriptase Polymerase Chain Reaction
  • Rhinovirus / isolation & purification
  • Severity of Illness Index