Respiratory pathogens detected in children with community-acquired sepsis-like syndrome in 6 European countries

26 Apr, 2020

Authors: V. Matheeussen, K. Loens, K. Jacobs, P. Horby, H. Goossens, M. Kohns Vasconcelos, M. Sharland, M. De Jong, M. P. G. Koopmans, P. Fraaij, M. Ieven

Published in: 30th European Congress on Clinical Microbiology and Infectious Diseases (ECCMID), April 2020

Background: The management of infants admitted to hospital with sepsis-like syndrome (SLS) without apparent focus remains challenging. There is growing evidence indicating that this clinical picture is triggered by viral pathogens, like adenovirus, enterovirus or parechovirus with a possible respiratory point of entry. We aimed to identify an association in the presence of respiratory pathogens in nasopharyngeal swabs between children with SLS and controls.

Materials/methods: A total of 102 children (≤ 6 months old) admitted to hospital with community-acquired SLS and 308 asymptomatic controls (0-6 years old) were enrolled in a prospective case-control study as part of the MERMAIDS Trial (Multi-centre EuRopean study of MAjor Infectious Disease Syndromes, in 12 hospitals in 6 European countries. The Fast Track Diagnostics Respiratory pathogens 21 plus real-time PCR assay was used to determine the presence of respira- tory pathogens in nasopharyngeal swabs

Results: The most prevalent respiratory viral targets detected in the nasopharyngeal swabs of SLS patients were rhinovirus (28%), RSV A/B (9%), enterovirus (8%) and parainfluenzavirus (5%). All other viruses (influenzavirus, coronavirus, parechovirus, human metapneumovirus, adenovirus and bocavirus) were detected in <5%. Also bacterial targets like Staphylococcus aureus and Streptococcus pneumoniae, possibly colonizers, were often detected, both in 30% of the samples. Neither Myco- plasma pneumoniae, Chlamydophila pneumoniae nor Haemophilus influenzae type B were present. Compared to the control group, enterovirus and RSV A/B were detected more frequently in the SLS patients (8 versus 2% for enterovirus, p=0.01 and 9 versus 2% for RSV A/B, p=0.01). Adeno- and bocavirus were found more often in the control group (7 versus 1% for both viruses, p=0.02). No respiratory target was detected in 25% of the SLS samples.

Conclusions: Most (75%) of the nasopharyngeal samples from SLS patients contained one or more viral or bacterial respiratory targets. In our study, the role of influenza viruses was relatively limited. The possible role of enterovirus and RSV A/B in the pathophysiology of SLS should be further elucidated.