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Polymicrobial Acute Respiratory Infections in a Hospital-based Pediatric Population

Chorazy, Margaret L. PhD, MPH*; Lebeck, Mark G. MS; McCarthy, Troy A. BA; Richter, Sandra S. MD§; Torner, James C. PhD, MS*; Gray, Gregory C. MD, MPH

The Pediatric Infectious Disease Journal: May 2013 - Volume 32 - Issue 5 - p 460–466
doi: 10.1097/INF.0b013e31828683ce
Original Studies

Background: The clinical impact of polymicrobial respiratory infections remains uncertain. Previous reports are contradictory regarding an association with severe disease.

Methods: Three hundred forty-six specimens from children with acute respiratory illness identified at the University of Iowa Hospitals and Clinics Clinical Microbiology Laboratory were evaluated by direct immunofluorescent assay and/or viral culture by Clinical Microbiology Laboratory and later by molecular study for the presence of influenza, parainfluenza, respiratory syncytial virus, adenovirus, human metapneumovirus, rhinovirus and human bocavirus. Demographic and clinical data were abstracted from medical records.

Results: Multiple viruses were detected in 46 (21.7%) of 212 virus-positive specimens with the most frequent virus–virus combinations being HRV-respiratory syncytial virus (n = 12), HRV-human bocavirus (n = 6) and HRV-parainfluenza virus 3 (n = 4). Risk factors for coinfection included male gender (OR [odds ratio]: 1.70, 95% confidence interval [CI]: 0.83–3.46), 6 months to 1 year age (OR: 2.15, 95% CI: 0.75–6.19) and history of immunosuppression (OR: 2.05, 95% CI: 0.99–4.23). Children with viral coinfections were less likely than children with single virus infections to be admitted to an intensive care unit (OR: 0.32, 95% CI: 0.08–1.27); however, this may be explained by undetected viral–bacterial coinfections.

Conclusions: HRV, respiratory syncytial virus, human bocavirus, and polymicrobial infections were prevalent in this study. Although the cross-sectional design could not easily examine polymicrobial infection and disease severity, prospective, population-based research regarding the clinical impact of such infections is warranted.

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From the Departments of *Epidemiology and Occupational and Environmental Health, College of Public Health; Center for Biocatalysis and Bioprocessing, College of Medicine, University of Iowa, Iowa City, IA; §Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH; and Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL.

This work was supported by the US Armed Forces Health Surveillance Center—Global Emerging Infections Surveillance Operations (grants to G.C.G.) and the National Institute of Allergy and Infectious Diseases (R01 AI053034 to G.C.G.). Dr. Dean D. Erdman from the Centers for Disease Control and Prevention, Atlanta, GA, provided the HBoV plasmid, which served as a positive PCR control. The authors have no other funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Margaret L. Chorazy, MPH, PhD, Department of Epidemiology, College of Public Health, The University of Iowa, 105 River Street, S449 CPHB, Iowa City, IA 52242. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.