Etiology, seasonality and clinical characterization of viral respiratory infections in hospitalized children in Lebanon

Abstract

Background: Acute respiratory tract viral infections occur worldwide and are one of the major global burdens of diseases in children. To date, no data have addressed the prevalence of respiratory viruses in Lebanon. Therefore, the aim of this study is to determine the viral etiology of respiratory infections in hospitalized children over eighteen months, correlate disease severity to the presence of virus and understand the viral seasonality in Lebanon. Methods: Nasal and throat swabs were collected from 292 hospitalized children aged less than 16 years old. Total nucleic acids were extracted and samples were tested for the presence of 17 respiratory viruses using the multiplex real-time RT-PCR. Results: Pathogens were identified in 193 children (66%) out of 292 samples with a positive detection rate each month varying from 40 to 100%. The most frequently detected pathogens were human rhinovirus (hRV, 23%), Respiratory syncytial virus (RSV, 19%), human bocavirus (hBov, 15%), human metapneumovirus (hMPV, 10%) and human adenovirus (hAdv, 10%). The remaining viruses were present at a lower percentage (<5%). Co-infection was found in 37% of positive samples, frequently associated with hAdv, hBoV and hRV. Detection of any viral agents was frequently observed during fall and winter seasons with the highest number of positivity seen in December. Influenza, RSV, hRV, hBov and hMPV were often causing lower respiratory tract infections. Antibiotics were prescribed in 109 hospitalized children, 23% were positive for respiratory viruses. Conclusion: This study provides relevant facts on the circulatory pattern of respiratory viruses in Lebanon and the importance of using PCR as a useful tool for virus detection. Early diagnosis at the initial time of hospitalization may reduce the spread of the viruses in pediatric units and reduce the inappropriate use of antibiotics in a country where antimicrobial resistance is rapidly evolving.