Molecular detection of respiratory pathogens in tonsillar tissue from asymptomatic children: implications for result interpretation among the asymptomatic and symptomatic

The diagnosis of upper respiratory infections is commonly made using nucleic acid amplification technologies (NAAT). The impact of asymptomatic carriage is not often appreciated. We aimed to detect respiratory pathogens present in tonsil tissues from children without acute infection. Remnant tonsil tissues were obtained from children undergoing tonsillectomy procedures. Nucleic acids of respiratory pathogens were detected using laboratory-developed PCR assays. The most frequently detected virus was Enterovirus, followed by Adenovirus and Rhinovirus. Among 522 enrolled children, 41.0% had at least one pathogen detected, and co-detections with more than one pathogen were found in 5.6%. Younger children were more likely to have a virus detected, and co-detection was more frequent. Results of standard of care testing for children with suspected respiratory infection during the same study period were also analyzed. Our data demonstrate that a wide array of pathogens can be detected in the tonsil tissues from children absent of acute respiratory symptoms. It emphasizes the need for careful interpretation of test results, particularly in the era of widespread multiplex NAAT usage. IMPORTANCE The diagnosis of upper respiratory infections is now commonly made using nucleic acid amplification technologies (NAATs). One potential limitation of NAATs is the increased detection of the nucleic acids of pathogens in healthy individuals in the absence of symptoms. The findings from this study highlight the critical importance of understanding asymptomatic carriage of respiratory pathogens, particularly in pediatric populations. The detection of pathogens in asymptomatic individuals, especially younger children, calls for cautious interpretation of test results to avoid misdiagnosis and unnecessary treatment. It emphasizes the need for careful interpretation of test results, particularly in the era of widespread multiplex NAAT usage.