Viral respiratory infections are among the leading causes of morbidity and mortality in children, overburdening emergency services and increasing hospital admissions. In Brazil, there is a scarcity of data on the frequency of viral agents and their relationship with disease severity and clinical outcomes. This study aims to describe the distribution of the main respiratory viruses in children aged 0 to 10 years with acute symptoms and to correlate the etiological agents with clinical presentation and disease evolution after diagnosis. This is a retrospective observational study based on the review of medical records of patients with positive results for respiratory pathogen testing. A molecular microarray panel capable of detecting 22 pathogens was used on nasal or oropharyngeal swab samples. Tests were performed in children with symptoms of acute upper respiratory tract infection who sought care at the pediatric emergency department of a tertiary hospital between 2017 and 2020. Participants were aged 0 to 10 years; children with primary immunodeficiency were excluded. Demographic, clinical, and laboratory data were collected from medical records. The study was approved by the research ethics committee, with a waiver of informed consent. A total of 584 patients were included, of whom 56.2% were male. In the sample, 50.5% were aged 0–24 months, 34.9% were 24.1–60 months, and 14.6% were older than 60 months. The most frequent pathogens were Rhinovirus/Enterovirus (45.5%), Respiratory Syncytial Virus (RSV, 6.5%), and Adenovirus (15.4%). RSV (p < 0.001) and Rhinovirus/Enterovirus (p = 0.004) were more common in children younger than 24 months, while Adenovirus (p = 0.018) was more frequent in those aged 25–60 months. Influenza frequency increased with age. RSV was associated with more severe respiratory presentations (p < 0.001), whereas Influenza was more frequent in eupneic patients presenting with fever (p < 0.001). RSV was the pathogen most commonly identified in children requiring hospitalization (p < 0.001). The use of bronchodilators and systemic corticosteroids was more frequent among RSV-positive patients (72.6% and 38.1%, respectively). Influenza was more frequent in older children and was more often associated with febrile conditions and a better respiratory pattern. RSV infections were more common in children younger than 24 months and were associated with more severe clinical presentations. Bronchodilators and corticosteroids are still widely used in RSV infections, despite the lack of evidence supporting their benefit.
Amaral et al. (Sun,) studied this question.