Nasopharyngeal density of respiratory viruses in childhood pneumonia in a highly vaccinated setting: findings from a case–control study
Background Detection of pneumonia-causing respiratory viruses in the nasopharynx of asymptomatic children has made their actual contribution to pneumonia unclear. We compared nasopharyngeal viral density between children with and without pneumonia to understand if viral density could be used to diag...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-09-01
|
| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/7/1/e000593.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850127789598965760 |
|---|---|
| author | Andrew Martin Peter Richmond Adam Jaffe Mejbah Uddin Bhuiyan Jurissa Lang Chisha Sikazwe Meredith Borland David Smith Tom Snelling Christopher Blyth |
| author_facet | Andrew Martin Peter Richmond Adam Jaffe Mejbah Uddin Bhuiyan Jurissa Lang Chisha Sikazwe Meredith Borland David Smith Tom Snelling Christopher Blyth |
| author_sort | Andrew Martin |
| collection | DOAJ |
| description | Background Detection of pneumonia-causing respiratory viruses in the nasopharynx of asymptomatic children has made their actual contribution to pneumonia unclear. We compared nasopharyngeal viral density between children with and without pneumonia to understand if viral density could be used to diagnose pneumonia.Methods Nasopharyngeal swabs (NPS) were collected from hospitalised pneumonia cases at Princess Margaret Hospital (PMH) and contemporaneous age-matched controls at PMH outpatient clinics and a local immunisation clinic in Perth, Australia. The density (copies/mL) of respiratory syncytial virus (RSV), influenza A virus (InfA), human metapneumovirus (HMPV) and rhinovirus in NPS was determined using quantitative PCR. Linear regression analysis was done to assess the trend between viral density and age in months. The association between viral density and disease status was examined using logistic regression. Area under receiver operating characteristic (AUROC) curves were assessed to determine optimal discriminatory viral density cut-offs.Results Through May 2015 to October 2017, 230 pneumonia cases and 230 controls were enrolled. Median nasopharyngeal density for any respiratory virus was not substantially higher in cases than controls (p>0.05 for each). A decreasing density trend with increasing age was observed—the trend was statistically significant for RSV (regression coefficient −0.04, p=0.004) but not for other viruses. After adjusting for demographics and other viral densities, for every log10 copies/mL density increase, the odds of being a case increased by six times for RSV, three times for HMPV and two times for InfA. The AUROC curves were <0.70 for each virus, suggesting poor case–control discrimination based on viral density.Conclusion The nasopharyngeal density of respiratory viruses was not significantly higher in children with pneumonia than those without; however, the odds of being a case increased with increased density for some viruses. The utility of viral density, alone, in defining pneumonia was limited. |
| format | Article |
| id | doaj-art-04ee73c2af274d4b8d313c1165c8bf28 |
| institution | OA Journals |
| issn | 2052-4439 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj-art-04ee73c2af274d4b8d313c1165c8bf282025-08-20T02:33:35ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392020-09-017110.1136/bmjresp-2020-000593Nasopharyngeal density of respiratory viruses in childhood pneumonia in a highly vaccinated setting: findings from a case–control studyAndrew Martin0Peter Richmond1Adam Jaffe2Mejbah Uddin Bhuiyan3Jurissa Lang4Chisha Sikazwe5Meredith Borland6David Smith7Tom Snelling8Christopher Blyth93Department of Neurology, Blacktown Hospital, Blacktown, NSW, AustraliaMedical School, Paediatrics, The University of Western Australia, Perth, WA, AustraliaSchool of Women`s and Children`s Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, AustraliaSchool of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia4 Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia4 Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, AustraliaEmergency Department, Perth Children`s Hospital, Nedlands, Western Australia, Australia1Vanderbilt University Medical Center, Nashville, TN, USA8 Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, West Perth, Western Australia, AustraliaAneurin Bevan University Health Board, Newport, Gwent, UKBackground Detection of pneumonia-causing respiratory viruses in the nasopharynx of asymptomatic children has made their actual contribution to pneumonia unclear. We compared nasopharyngeal viral density between children with and without pneumonia to understand if viral density could be used to diagnose pneumonia.Methods Nasopharyngeal swabs (NPS) were collected from hospitalised pneumonia cases at Princess Margaret Hospital (PMH) and contemporaneous age-matched controls at PMH outpatient clinics and a local immunisation clinic in Perth, Australia. The density (copies/mL) of respiratory syncytial virus (RSV), influenza A virus (InfA), human metapneumovirus (HMPV) and rhinovirus in NPS was determined using quantitative PCR. Linear regression analysis was done to assess the trend between viral density and age in months. The association between viral density and disease status was examined using logistic regression. Area under receiver operating characteristic (AUROC) curves were assessed to determine optimal discriminatory viral density cut-offs.Results Through May 2015 to October 2017, 230 pneumonia cases and 230 controls were enrolled. Median nasopharyngeal density for any respiratory virus was not substantially higher in cases than controls (p>0.05 for each). A decreasing density trend with increasing age was observed—the trend was statistically significant for RSV (regression coefficient −0.04, p=0.004) but not for other viruses. After adjusting for demographics and other viral densities, for every log10 copies/mL density increase, the odds of being a case increased by six times for RSV, three times for HMPV and two times for InfA. The AUROC curves were <0.70 for each virus, suggesting poor case–control discrimination based on viral density.Conclusion The nasopharyngeal density of respiratory viruses was not significantly higher in children with pneumonia than those without; however, the odds of being a case increased with increased density for some viruses. The utility of viral density, alone, in defining pneumonia was limited.https://bmjopenrespres.bmj.com/content/7/1/e000593.full |
| spellingShingle | Andrew Martin Peter Richmond Adam Jaffe Mejbah Uddin Bhuiyan Jurissa Lang Chisha Sikazwe Meredith Borland David Smith Tom Snelling Christopher Blyth Nasopharyngeal density of respiratory viruses in childhood pneumonia in a highly vaccinated setting: findings from a case–control study BMJ Open Respiratory Research |
| title | Nasopharyngeal density of respiratory viruses in childhood pneumonia in a highly vaccinated setting: findings from a case–control study |
| title_full | Nasopharyngeal density of respiratory viruses in childhood pneumonia in a highly vaccinated setting: findings from a case–control study |
| title_fullStr | Nasopharyngeal density of respiratory viruses in childhood pneumonia in a highly vaccinated setting: findings from a case–control study |
| title_full_unstemmed | Nasopharyngeal density of respiratory viruses in childhood pneumonia in a highly vaccinated setting: findings from a case–control study |
| title_short | Nasopharyngeal density of respiratory viruses in childhood pneumonia in a highly vaccinated setting: findings from a case–control study |
| title_sort | nasopharyngeal density of respiratory viruses in childhood pneumonia in a highly vaccinated setting findings from a case control study |
| url | https://bmjopenrespres.bmj.com/content/7/1/e000593.full |
| work_keys_str_mv | AT andrewmartin nasopharyngealdensityofrespiratoryvirusesinchildhoodpneumoniainahighlyvaccinatedsettingfindingsfromacasecontrolstudy AT peterrichmond nasopharyngealdensityofrespiratoryvirusesinchildhoodpneumoniainahighlyvaccinatedsettingfindingsfromacasecontrolstudy AT adamjaffe nasopharyngealdensityofrespiratoryvirusesinchildhoodpneumoniainahighlyvaccinatedsettingfindingsfromacasecontrolstudy AT mejbahuddinbhuiyan nasopharyngealdensityofrespiratoryvirusesinchildhoodpneumoniainahighlyvaccinatedsettingfindingsfromacasecontrolstudy AT jurissalang nasopharyngealdensityofrespiratoryvirusesinchildhoodpneumoniainahighlyvaccinatedsettingfindingsfromacasecontrolstudy AT chishasikazwe nasopharyngealdensityofrespiratoryvirusesinchildhoodpneumoniainahighlyvaccinatedsettingfindingsfromacasecontrolstudy AT meredithborland nasopharyngealdensityofrespiratoryvirusesinchildhoodpneumoniainahighlyvaccinatedsettingfindingsfromacasecontrolstudy AT davidsmith nasopharyngealdensityofrespiratoryvirusesinchildhoodpneumoniainahighlyvaccinatedsettingfindingsfromacasecontrolstudy AT tomsnelling nasopharyngealdensityofrespiratoryvirusesinchildhoodpneumoniainahighlyvaccinatedsettingfindingsfromacasecontrolstudy AT christopherblyth nasopharyngealdensityofrespiratoryvirusesinchildhoodpneumoniainahighlyvaccinatedsettingfindingsfromacasecontrolstudy |