Viral Bacterial Interactions in Children: Impact on Clinical Outcomes

Pediatr Infect Dis J. 2019 Jun;38(6S Suppl 1):S14-S19. doi: 10.1097/INF.0000000000002319.


Respiratory viral infections are associated with significant morbidity and mortality in children < 5 years of age worldwide. Among all respiratory viruses, respiratory syncytial virus (RSV) is the world's leading cause of bronchiolitis and pneumonia in young children. There are known populations at risk for severe disease but the majority of children who require hospitalization for RSV infection are previously healthy. Viral and host factors have been associated with the pathogenesis of RSV disease; however, the mechanisms that explain the wide variability in the clinical presentation are not completely understood. Recent studies suggest that the complex interaction between the respiratory microbiome, the host's immune response and the virus may have an impact on the pathogenesis and severity of RSV infection. In this review, we summarize the current evidence regarding the epidemiologic link, the mechanisms of viral-bacterial interactions, and the associations between the upper respiratory tract microbiome and RSV disease severity.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Child, Preschool
  • Humans
  • Infant
  • Microbial Interactions*
  • Microbiota*
  • Respiratory Syncytial Virus Infections / microbiology
  • Respiratory Syncytial Virus Infections / virology
  • Respiratory Syncytial Virus, Human / pathogenicity
  • Respiratory System / microbiology
  • Respiratory System / virology
  • Respiratory Tract Infections / microbiology*
  • Respiratory Tract Infections / virology*
  • Severity of Illness Index