Pediatric viral respiratory tract infection often complicated by bacterial sinusitis

By Joanna Lyford, Senior medwireNews Reporter

Nearly 1 in 10 cases of viral upper respiratory tract infections (URI) in infants and young children is complicated by acute bacterial sinusitis (ABS), often in conjunction with acute otitis media, a longitudinal cohort study has found.

The study also suggests that girls are more prone than boys to bacterial colonisation during URI and that the specific combination of rhinovirus and Moraxella catarrhalis is associated with a particularly high likelihood of developing complications.

Tasnee Chonmaitree (University of Texas Medical Branch, Galveston, USA) and team analysed details of 1295 viral URI episodes in 294 children aged 6–35 months at baseline who were monitored over a 1-year period.

ABS was diagnosed in 103 of the URI episodes, affecting 73 children and equating to a rate of 8% and an annual incidence of 0.4 ABS episodes per child–year. One child required hospitalisation while the remainder were treated conservatively, with antibiotics.

The rate of ABS was significantly higher in girls than boys (0.5 vs 0.3 episodes/year). White ethnicity was positively associated with ABS while Hispanic/Latino ethnicity was negatively associated with ABS.

Interestingly, ABS was more common in children who had been fully immunised with the 7-valent pneumococcal vaccine whereas other supposed risk factors for ABS, such as breastfeeding, number of siblings and smoking exposure, were not associated with this complication.

ABS was diagnosed on average 11 days after onset of URI symptoms; 31% of ABS episodes occurred concurrently with acute otitis media, and all such cases were in children under 36 months of age. Concurrent ABS and acute otitis media was more prevalent in boys than girls.

Bacterial culture indicated that M. catarrhalis and Streptococcus pneumoniae were the most prevalent single organisms, accounting for 20% and 10% of ABS cases, respectively. However, the majority of cases (56%) were polymicrobial.

For the 82 episodes for which both viral and bacterial data were available, the most common finding was mixed bacterial pathogens without an identified virus. Significantly, the presence of M. catarrhalis and rhinovirus, alone or in combination, was a risk factor for ABS.

Writing in the Pediatric Infectious Disease Journal, the authors remark: “Our findings suggest that rhinovirus alone may cause severe symptoms in young children, thus leading to ABS diagnosis. Yet, rhinovirus RNA shedding can persist up to 5-6 weeks after the onset of symptomatic URI.”

They conclude: “Therefore, the correlation between the presence of rhinovirus and subsequent ABS development needs to be interpreted with caution.”

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