J Pediatr Infect Dis 2022; 17(01): 011-017
DOI: 10.1055/s-0041-1736216
Original Article

Respiratory Tract Pathogens in the COVID-19 Era: Data from a Pediatric Emergency Department

1   Department of Pediatric Emergency, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
,
Bahri Unal
1   Department of Pediatric Emergency, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
,
1   Department of Pediatric Emergency, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
,
Pembe Derin Oygar
2   Department of Pediatric Infectious Diseases, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
,
Sibel Lacinel Gurlevic
2   Department of Pediatric Infectious Diseases, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
,
1   Department of Pediatric Emergency, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
,
Mustafa Oguz Kaynak
1   Department of Pediatric Emergency, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
,
Nilay Korgal
3   Department of General Pediatrics, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
,
Musa Gurel Kukul
2   Department of Pediatric Infectious Diseases, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
,
Sare Ilbay
2   Department of Pediatric Infectious Diseases, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
,
4   Department of Clinical Microbiology, Hacettepe University Medical School, Ankara, Turkey
,
Yasemin Ozsurekci
2   Department of Pediatric Infectious Diseases, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
,
Ozlem Teksam
1   Department of Pediatric Emergency, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
› Author Affiliations

Abstract

Objective The frequency of coinfections in pediatric Coronavirus disease 2019 (COVID-19) cases and their impact on the clinical course are not fully understood. We aimed to investigate the viral and bacterial respiratory pathogens in children admitted to the pediatric emergency department (PED), their clinical course, and the presence of coinfections during the early months of the COVID-19 pandemic.

Methods Clinical, laboratory and radiological findings, viral and bacterial pathogens detected by multiplex polymerase chain reaction (PCR) tests in nasopharyngeal swabs, clinical course, and treatments of all children who were tested for severe acute respiratory coronavirus 2 (SARS-CoV-2) at the PED between March 16 and May 15, 2020, were recorded. SARS-CoV-2 PCR-positive and negative groups were compared.

Results Out of 570 patients tested for SARS-CoV-2 during the study period, 43 were found positive (7.5%). Non-SARS-CoV-2 viral pathogens were more common in the SARS-CoV-2 PCR-negative group than the SARS-CoV-2 PCR-positive group (13.2%, n = 68 versus 4.7%, n = 2), but this result was not statistically significant. Leukocyte, neutrophil, lymphocyte, and platelet counts were lower in SARS-CoV-2 PCR-positive group. Bacterial panel positivity was significantly higher in the SARS-CoV-2 PCR-positive group compared with the SARS-CoV-2 PCR-negative group (52%, n = 12 versus 28%, n = 91; p < 0.05). The presence of coinfection did not alter the course of therapy in SARS-CoV-2 PCR-positive cases.

Conclusion While viral coinfections were rare, bacterial panel positivity was common in children with COVID-19, but this had not influenced management decisions. The limitations of the tests should be kept in mind while interpreting the results.



Publication History

Received: 12 May 2021

Accepted: 20 August 2021

Article published online:
16 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 World Health Organization. COVID-19 Situation Report - 52. Accessed June 19, 2021 at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200312-sitrep-52-covid-19.pdf?sfvrsn=e2bfc9c0_4
  • 2 World Health Organization Regional Office for Europe. Turkey's response to COVID-19: first impressions. Accessed June 19, 2021 at: https://apps.who.int/iris/handle/10665/335803?search-result=true&query=Turkey%27s+response+to+covid&scope=&rpp=10&sort_by=score&order=desc
  • 3 Tezer H, Bedir Demirdağ T. Novel coronavirus disease (COVID-19) in children. Turk J Med Sci 2020; 50 (SI-1): 592-603
  • 4 Walker DM, Tolentino VR. COVID-19: the impact on pediatric emergency care. Pediatr Emerg Med Pract 2020; 17 (Suppl 6-1): 1-27
  • 5 Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020; 109 (06) 1088-1095
  • 6 World Health Organization. Clinical management of COVID-19: interim guidance. Accessed June 12, 2020 at: https://apps.who.int/iris/handle/10665/332196
  • 7 Calvo C, García-García ML, Blanco C. et al. Multiple simultaneous viral infections in infants with acute respiratory tract infections in Spain. J Clin Virol 2008; 42 (03) 268-272
  • 8 Gerna G, Campanini G, Rognoni V. et al. Correlation of viral load as determined by real-time RT-PCR and clinical characteristics of respiratory syncytial virus lower respiratory tract infections in early infancy. J Clin Virol 2008; 41 (01) 45-48
  • 9 Aberle JH, Aberle SW, Pracher E, Hutter HP, Kundi M, Popow-Kraupp T. Single versus dual respiratory virus infections in hospitalized infants: impact on clinical course of disease and interferon-gamma response. Pediatr Infect Dis J 2005; 24 (07) 605-610
  • 10 O'Grady KF, Grimwood K, Sloots TP. et al. Upper airway viruses and bacteria and clinical outcomes in children with cough. Pediatr Pulmonol 2017; 52 (03) 373-381
  • 11 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507-513
  • 12 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323 (11) 1061-1069
  • 13 Guan WJ, Ni ZY, Hu Y. et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382 (18) 1708-1720
  • 14 Machado BAS, Hodel KVS, Barbosa-Júnior VG, Soares MBP, Badaró R. The main molecular and serological methods for diagnosing COVID-19: An overview based on the literature. Viruses 2020; 13 (01) 40-75
  • 15 Zhang Y, Wang C, Han M. et al. Discrimination of false negative results in RT-PCR detection of SARS-CoV-2 RNAs in clinical specimens by using an internal reference. Virol Sin 2020; 35 (06) 758-767
  • 16 Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E. et al; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19). Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis 2020; 34: 101623-101635
  • 17 Ferrari D, Motta A, Strollo M, Banfi G, Locatelli M. Routine blood tests as a potential diagnostic tool for COVID-19. Clin Chem Lab Med 2020; 58 (07) 1095-1099
  • 18 Zhang JJ, Dong X, Cao YY. et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 2020; 75 (07) 1730-1741
  • 19 Liu Y, Du X, Chen J. et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect 2020; 81 (01) e6-e12
  • 20 Gao Y, Li T, Han M. et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol 2020; 92 (07) 791-796
  • 21 Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect 2020; 81 (02) 266-275
  • 22 Nowak MD, Sordillo EM, Gitman MR, Paniz Mondolfi AE. Coinfection in SARS-CoV-2 infected patients: Where are influenza virus and rhinovirus/enterovirus?. J Med Virol 2020; 92 (10) 1699-1700
  • 23 Lin D, Liu L, Zhang M. et al. Co-infections of SARS-CoV-2 with multiple common respiratory pathogens in infected patients. Sci China Life Sci 2020; 63 (04) 606-609
  • 24 Kim KW, Deveson IW, Pang CNI. et al. Respiratory viral co-infections among SARS-CoV-2 cases confirmed by virome capture sequencing. Sci Rep 2021; 11 (01) 3934-3942
  • 25 Singh V, Upadhyay P, Reddy J, Granger J. SARS-CoV-2 respiratory co-infections: Incidence of viral and bacterial co-pathogens. Int J Infect Dis 2021; 105: 617-620
  • 26 Wu Q, Xing Y, Shi L. et al. Co-infection and other clinical characteristics of COVID-19 in children. Pediatrics 2020; 146 (01) e20200961-e20200971
  • 27 Tagarro A, Epalza C, Santos M. et al. Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. JAMA Pediatr 2020
  • 28 Wehl G, Laible M, Rauchenzauner M. Co-infection of SARS CoV-2 and influenza A in a pediatric patient in Germany. Klin Padiatr 2020; 232 (04) 217-218
  • 29 Pigny F, Wagner N, Rohr M. et al; Geneva Pediatric COVID Group. Viral co-infections among SARS-CoV-2-infected children and infected adult household contacts. Eur J Pediatr 2021; 180 (06) 1991-1995
  • 30 Aykaç K, Karadağ-Öncel E, Bayhan C. et al. Prevalence and seasonal distribution of viral etiology of respiratory tract infections in inpatients and outpatients of the pediatric population: 10 year follow-up. Turk J Pediatr 2018; 60 (06) 642-652
  • 31 Centers for Disease Control and Prevention. Weekly U.S. influenza surveillance report, key updates for week 8, ending February 22. Accessed March 19, 2020 at: https://www.cdc.gov/flu/weekly/weeklyarchives2019-2020/Week08.htm
  • 32 World Health Organization. Influenza update N° 362. Accessed March 17, 2020 at: https://www.who.int/publications/m/item/influenza-update-n-362
  • 33 Verbeke V, Reynders M, Floré K. et al. Human bocavirus infection in Belgian children with respiratory tract disease. Arch Virol 2019; 164 (12) 2919-2930
  • 34 Yum S, Hong K, Sohn S, Kim J, Chun BC. Trends in viral respiratory infections during COVID-19 pandemic, South Korea. Emerg Infect Dis 2021; 27 (06) 1685-1688
  • 35 Pranay S, Reifler K, Rossi M, Sagar M. COVID-19 mitigation strategies were associated with decreases in other respiratory virus infections. Open Forum Infect Dis 2021
  • 36 Karadag-Oncel E, Ciblak MA, Ozsurekci Y, Badur S, Ceyhan M. Viral etiology of influenza-like illnesses during the influenza season between December 2011 and April 2012. J Med Virol 2014; 86 (05) 865-871
  • 37 Ceyhan M, Karadag-Oncel E, Hascelik G. et al. Nasopharyngeal carriage of Streptococcus pneumoniae in healthy children aged less than five years. Vaccine 2021; 39 (15) 2041-2047