Coronavirus, Other Respiratory Viruses Can Cause Severe Bronchiolitis

Coinfections with endemic coronaviruses and other respiratory viruses can cause severe bronchiolitis, according to new findings.

Four endemic coronaviruses (OC43, 229E, NL63 and HKU1) cause respiratory illness in hospitalized children (as does the newly identified SARS-CoV-2), but little is known about viral coinfections and the importance of viral load to acute severity.

Dr. Jonathan M. Mansbach of Harvard Medical School and Boston Children's Hospital and colleagues used data from the 30th and 35th Multicenter Airway Research Collaboration studies of children hospitalized with bronchiolitis in the pre-COVID-19 era to examine endemic coronavirus bronchiolitis, with a focus on viral coinfections and the association between viral load and acute severity.

About 12% (219/1,880) of children hospitalized with bronchiolitis had one of the four endemic coronaviruses, the team reports in Pediatrics.

Only 15% of these were solo coronavirus infections. Among the rest, the most common coinfecting virus was respiratory syncytial virus (RSV, 69% of cases).

"In other words," the authors note, "identifying RSV or another respiratory virus would not exclude the possibility of endemic coronavirus infection in children hospitalized for bronchiolitis."

In a multivariable model, RSV and coronavirus coinfection had a similar risk of intensive-care use, compared with solo RSV infection. But a higher genomic load of coronavirus was associated with a significantly higher risk of intensive-care use.

"Although SARS-CoV-2 may interact with other respiratory viruses differently from these 4 endemic coronaviruses, comprehensive virology data in children hospitalized with COVID-19 are lacking," the researchers note. "Until SARS-CoV-2 testing is more rapid and widely available and false-negatives are better understood, the present results are a warning to clinicians currently caring for children with respiratory symptoms that identifying a common respiratory virus (e.g., RSV or rhinovirus) does not exclude coinfection with SARS-CoV-2."

"These viral load results suggest that antiviral agents may benefit children with endemic coronavirus bronchiolitis and possibly children with COVID-19," they add.

Dr. Mansbach did not respond to a request for comments.

—Reuters Staff

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