529 - Pathogen-Specific Effects of Rhinovirus/Enterovirus Coinfections on Illness Severity

Publication Number: 1508.529

Mawada Abbaker, hurley medical center, Grand Blanc, MI, United States; Jenny Lachance, Michigan State University College of Human Medicine, Flint, MI, United States; Rashed Hasan, Hurley Medical Center, Flint, MI, United States

Background: The clinical impact of viral co-detection is unclear; examining Rhinovirus/Enterovirus( RV/EV)-positive patients with additional viral infections helps reveal how specific virus combinations affect illness severity.

Objective: To assess how viral co-infections affect the need for respiratory support, hypothesizing that Respiratory Syncytial Virus (RSV) co-infection increases the odds of requiring oxygen, while other viruses might lower the level of support needed.

Design/Methods: A retrospective cohort study via chart review of patients presenting to the emergency department (ED) with Rhinorrhea, cough, respiratory distress, and/or apnea. Lower respiratory tract infection cases were identified using ICD-10 codes. Patients tested by multiplex PCR for respiratory pathogens were included . Infections were classified as single or dual. Pathogens with prevalence > 4% were analyzed. Rates of oxygen therapy, high-flow nasal cannula (HFNC) therapy, continuous positive airway pressure(CPAP), bilevel positive airway pressure(BPAP), and invasive mechanical ventilation (IMV) were compared between RV/EV-only and RV/EV-coinfected groups. Descriptive statistics, chi-square tests, and logistic regression adjusted for age and sex were performed. This study was approved by the IRB.

Results: Of 11,768 cases, 8,463 (73.8%) had at least one pathogen detected. The most common pathogen was RV/EV (4,671, 39.7%), followed by RSV (2,143, 21.1%), adenovirus (9.7%), parainfluenza (8.3%), SARS-CoV-2 (5.2%), other coronavirus (5.1%), and influenza (4.3%). Compared with RV/EV-only infections, RV/EV +RSV coinfection was associated with higher rates of oxygen therapy (47.8% vs.36.8%, p< 0.001; OR 1.5, 95% CI 1.2-1.9) [Figure 1]and CPAP/BPAP use (16.2% vs. 8.4%,p < 0.001; OR 2.0, 95% CI 1.5-2.8) [Figure 2]. Among RSV-positive encounters, co-positivity with RV/EV did not further increase oxygen therapy (47.8% vs. 46.4%; OR 0.9, 95% CI 0.7-1.2) or CPAP/BPAP use (17.2% vs. 16.1%; OR 0.9, 95% CI 0.6-1.3). RV/EV coinfection with other key viruses was associated with lower rates of respiratory support. Patterns remained consistent after adjusting for age and gender, which were also significant predictors. No significant differences were observed in HFNC or IMV groups [Figure 3].

Conclusion(s): RSV coinfection is the driving factor for increased oxygen requirement, whereas other viral coinfections may reduce illness severity. These findings underscore the importance of assessing specific viral combinations rather than overall coinfection status for risk stratification and clinical management of pediatric respiratory infections.

Abbaker's good standing letter
Abbaker Good Standing Letter.pdf

Figure 2:Crude Odds Ratios for CPAP/BPAP Use in RV/EV Coinfections vs RV/EV Alone
Forest plot showing crude odds ratios (95% CI) for CPAP/BPAP use in children with RV/EV coinfections compared to those with RV/EV alone. RSV coinfection had the highest odds of noninvasive ventilation. Other coinfections, like parainfluenza, adenovirus, and hMPV, showed lower or neutral associations.

Figure 3: Crude Odds Ratios for MV use in RV/EV Co-infections vs RV/EV Alone
Forest plot displaying the crude odds ratios (95% CI) for M) among patients with RV/EV co-infections compared to those with RV/EV infection alone.
None of the viral co-infections showed a significant difference in the odds of requiring MV compared to RV/EV infection alone.