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Role of Nasopharyngeal Bacteria and Respiratory Viruses in Acute Symptoms of Young Children

Uitti, Johanna M. MD*†; Tähtinen, Paula A. MD, PhD*‡§; Laine, Miia K. MD*; Huovinen, Pentti MD, PhD; Ruuskanen, Olli MD, PhD*; Ruohola, Aino MD, PhD*†

The Pediatric Infectious Disease Journal: October 2015 - Volume 34 - Issue 10 - p 1056–1062
doi: 10.1097/INF.0000000000000800
Original Studies

Background: The spectrum of acute symptoms in young outpatient children with respiratory tract infection (RTI) is variable, and it cannot be explained by the diagnosis of acute otitis media (AOM) versus uncomplicated RTI. We studied that the variation of symptoms is explained by the nasopharyngeal bacteria and/or respiratory viruses.

Methods: Children aged 6–35 months with acute symptoms with AOM (n = 201) or without AOM (n = 225) were eligible in this cross-sectional study. We analyzed their nasopharyngeal samples for pathogenic bacteria by culture and for respiratory viruses by polymerase chain reaction. We surveyed 17 symptoms (fever, respiratory, ear related, nonspecific, gastrointestinal) with a structured questionnaire.

Results: Fever had a positive association with influenza viruses [odds ratio (OR): 6.61; 95% confidence interval (CI): 1.66–26.27], human metapneumovirus (OR: 3.84; 95% CI: 1.25–11.77), coronaviruses (OR: 3.45; 95% CI: 1.53–7.75) and parainfluenza viruses (OR: 2.18; 95% CI: 1.07–4.47). Rhinitis (OR: 5.07; 95% CI: 1.93–13.36), nasal congestion (OR: 2.03; 95% CI: 1.25–3.31) and cough (OR: 1.91; 95% CI: 1.15–3.17) had positive associations with Moraxella catarrhalis. Furthermore, cough had a positive association with respiratory syncytial virus (OR: 7.20; 95% CI: 1.59–32.71) and parainfluenza viruses (OR: 2.79; 95% CI: 1.02–7.69).

Conclusions: The variation of acute symptoms in young children may be influenced by both nasopharyngeal bacteria and respiratory viruses. Our results showed a strong association between fever and respiratory viruses; rhinitis, nasal congestion and cough were associated with M. catarrhalis in the presence of viruses. Further studies are required to determine the possible synergistic role of M. catarrhalis in symptoms of RTI.

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From the *Department of Paediatrics and Adolescent Medicine, Turku University Hospital; Department of Paediatrics and Adolescent Medicine, University of Turku, Turku, Finland; Division of Pediatric Infectious Diseases, Boston Medical Center; §Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts; and Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland.

Accepted for publication May 28, 2015.

This work was supported by grants from Research Funds from Specified Government Transfers; the Foundation for Paediatric Research; the Jenny and Antti Wihuri Foundation; The Finnish Medical Foundation; the National Graduate School of Clinical Investigation; the Outpatient Care Research Foundation; University of Turku Graduate School and Doctoral Programme of Clinical Investigation and by the Fellowship Award of the European Society for Paediatric Infectious Diseases (to A.R.). The authors have no conflicts of interest to disclose.

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Address for correspondence: Aino Ruohola, MD, PhD, Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu 4–8, 20520 Turku, Finland. E-mail:

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