Journal Article

Viral Burden of Respiratory Syncytial Virus and Viral Coinfections as Factors Regulating Paediatric Disease Severity

Raponi, Massimiliano, Perno, Carlo Federico, Galeno, Eugenia, Colagrossi, Luna, Villani, Alberto, Mastropaolo, Martina, Cristaldi, Sebastian, Linardos, Giulia, Pisani, Mara, Di Maio, Velia Chiara, Coltella, Luana, Russo, Cristina, Ranno, Stefania, Vittucci, Anna Chiara, Scutari, Rossana

2025

Overview

Background: Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infections (ARIs) in children. However, the clinical impact of RSV co-infection with other respiratory viruses remains unclear. This study investigates the frequency and clinical outcomes of RSV infections in a large paediatric cohort. Methods: Paediatric patients with RSV-positive respiratory samples admitted to Bambino Gesù Children’s Hospital between January 2022 and April 2024 were analysed. Results: Within 17,259 respiratory samples from 9877 paediatric patients, 952 (9.6%) were RSV-positive. Among these, 637 patients with ARI were included. RSV affected the lower respiratory tract in 549 cases (86.2%) and the upper tract in 88 (13.8%) cases. RSV mono-infection was found in 286 (44.9%) patients, while 351 (55.1%) patients had co-infections. Mono-infections showed lower cycle-threshold (CT) than co-infections in both upper and lower tract (p-value:0.002 and 0.037, respectively). Pneumonia was associated with RSV co-infection (N = 48, 15.4%), whereas bronchiolitis was mostly seen in mono-infection (N = 196, 78.1%, p-value:0.002). Regression analysis showed an association between pneumonia and co-infection (AOR: 1.97 [1.06–3.64], p-value = 0.031), higher CT (AOR [95% CI]: 1.07 [1.02–1.11], p-value = 0.006) and older age (AOR [95% CI]: 1.48 [1.31–1.68], p-value < 0.001), whereas bronchiolitis was associated with mono-infection, younger age and lower CT. Conclusions: This study highlights the role of RSV in paediatric disease and emphasises the importance of early diagnosis, personalised treatment and preventive strategies to improve outcomes and reduce the burden of disease.

• Publisher: MDPI AG,Multidisciplinary Digital Publishing Institute (MDPI)
• Subject: Antibiotics / Antigens / Bronchopneumonia / Care and treatment / Child / Child, Preschool / Children / Children & youth / co-infection / Coinfection - epidemiology / Coinfection - virology / Comorbidity / COVID-19 vaccines / Diagnosis / disease burden / disease severity / Diseases / Dosage and administration / Drug therapy / Ear diseases / Female / Humans / Immunoassay / Infant / Infant, Newborn / Infections / Influenza / Male / Monoclonal antibodies / paediatric patients / Pathogens / Patient outcomes / Patients / Pediatrics / Pneumonia / Proteins / Respiratory syncytial virus / Respiratory syncytial virus infection / Respiratory Syncytial Virus Infections - epidemiology / Respiratory Syncytial Virus Infections - virology / Respiratory Syncytial Virus, Human - isolation & purification / Respiratory tract infection / Respiratory Tract Infections - epidemiology / Respiratory Tract Infections - virology / Severe acute respiratory syndrome coronavirus 2 / Severity of Illness Index / Viral Load / Viruses