American Journal of Infectious Diseases and Microbiology
ISSN (Print): 2328-4056 ISSN (Online): 2328-4064 Website: Editor-in-chief: Maysaa El Sayed Zaki
Open Access
Journal Browser
American Journal of Infectious Diseases and Microbiology. 2016, 4(2), 35-40
DOI: 10.12691/ajidm-4-2-3
Open AccessArticle

Molecular Epidemiology of Respiratory Viruses in Febrile Infants Under 90 Days Attending Pediatric Emergency Department

Najwa Al-Mously1, , Amani Azizalrahman2, Turki M. Al Harbi3 and Saleh A. Altamimi4

1Faculty of Medicine at King Fahad Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

2Paediatric Emergency Department, King Fahad Medical City, Riyadh, Saudi Arabia

3Al Raheema Clinical Medical Center, Riyadh, Saudi Arabia

4Dr. Sulaiman Al Habib Medical Services Group, Riyadh, Saudi Arabia

Pub. Date: March 28, 2016

Cite this paper:
Najwa Al-Mously, Amani Azizalrahman, Turki M. Al Harbi and Saleh A. Altamimi. Molecular Epidemiology of Respiratory Viruses in Febrile Infants Under 90 Days Attending Pediatric Emergency Department. American Journal of Infectious Diseases and Microbiology. 2016; 4(2):35-40. doi: 10.12691/ajidm-4-2-3


Fever is one of the most common presenting complaints in paediatric emergency departments (ED). Acute viral respiratory infection is the most common findings. The aim of this study is to define types of respiratory viruses among febrile infants under 90 days attending to emergency department. Methods: In addition to sepsis workup, nasopharyngeal aspirates were collected from 265 febrile infants without an apparent source of infection. A multiplex PCR assay was used to detect 15 human viral species and subtypes. Results: Overall, 154/265 (58.1%) NPA specimens from febrile infants were positive for at least one human virus. Viral types detected were as follows: (60/265,22.6%) rhinovirus, (50/265,18.9%) respiratory syncytial virus, (28/265,10.6%) parainfluenza virus, (11/265,4.2%) influenza virus, (12/265,4.5%) coronavirus, (10/265,3.8%) metapneumo, (8/265,3%) adenovirus, (2/265,0.75%) enterovirus, and (2/265,0.75%) bocavirus. Co-detection of two viruses or more was also observed. Positive bacterial cultures were reported in 16.5%, 3.5%, and 2.8% of urine, blood and CSF samples respectively. Conclusion: Viral infections are frequent in febrile infants without an apparent source. Testing NPA for molecular identification of viruses in addition to the routine sepsis workup may help more accurate management of febrile infants. This could also limit the unnecessary use of antibiotics, and nosocomial spread of viruses, however, this needs to be further investigated.

febrile infants under 90 days respiratory viruses molecular epidemiology emergency department

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Gorelick MH, Alpern ER, Alessandrini EA. A system for grouping presenting complaints: the paediatric emergency reason for visit clusters. Academic emergency medicine 2005; 12:723-731.
[2]  Baraff LJ, Bass JW, Fleisher GR, et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Agency for Health Care Policy and Research. Annals of emergency medicine 1993; 22:1198-1210.
[3]  Hsiao AL., Chen L, Baker MD. Incidence and predictors of serious bacterial infections among 57- to 180-day-old infants.Pediatrics 2006; 5: 1695-1701.
[4]  Watt K, Waddle E, Jhaveri R. Changing Epidemiology of Serious Bacterial Infections in Febrile Infants without Localizing Signs. Public Library of Science 2010.
[5]  Colvin JM, Muenzer JT, Jaffe DM, et al. Detection of viruses in young children with fever without an apparent source. Pediatrics 2012; 130:e1455-1462.
[6]  Baker MD, Avner JR, Bell LM. Failure of infant observation scales in detecting serious illness in febrile, 4- to 8-week-old infants. Pediatrics 1990 ;85 :1040-1043.
[7]  Breese Hall C, Powell KR, Schnabel KC, et al. Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection. The Journal of paediatrics 1988; 113:266-271.
[8]  Nash DR, Harman J, Wald ER, Kelleher KJ. Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections. Archives of pediatrics & adolescent medicine 2002; 156:1114-1119.
[9]  Hernandez Dennis A, Nguyen Vu. Fever in Infants < 3 Months Old: What is the Current Standard? Pediatric Emergency Medicine Reports 2011; 16 :1.
[10]  Leland D S and Ginocchio C C. Role of Cell Culture for Virus Detection in the Age of Technology. Clin Microbiol Rev. 2007 Jan; 20(1): 49-78.
[11]  Coiras MT, Perez-Brena P, Garcia ML, et al. Simultaneous detection of influenza A, B, and C viruses, respiratory syncytial virus, and adenoviruses in clinical samples by multiplex reverse transcription nested-PCR assay. Journal of medical virology 2003; 69: 132-144.
[12]  Nolte FS, Marshall DJ, Rasberry C, et al. MultiCode-PLx system for multiplexed detection of seventeen respiratory viruses. Journal of clinical microbiology 2007; 45: 2779-2786.
[13]  Kim SR, Ki CS, Lee NY. Rapid detection and identification of 12 respiratory viruses using a dual priming oligonucleotide system-based multiplex PCR assay. Journal of virological methods 2009; 156: 111-116.
[14]  McCulloh RJ , Andrea S , Reinert S, et al. Potential Utility of Multiplex Amplification Respiratory Viral Panel Testing in the Management of Acute Respiratory Infection in Children: A Retrospective Analysis. Journal of Pediatric Infectious Disease 2013; 13:1–8. First published online November 13.
[15]  Armstrong GL, Conn LA, Pinner RW. Trends in infectious disease mortality in the United States during the 20th century. JAMA. 1999; 281:61-66.
[16]  Williams BG, Gouws E, Boschi-Pinto C, et al. Estimates of worldwide distribution of child deaths from acute respiratory infections. Lancet Infectious Disease 2002; 2 : 25-32.
[17]  Anders KL, Nguyen HL, Nguyen NM, Van Thuy NT, Hong Van NT, Hieu NT, Hong Tham NT, Thanh Ha PT, Lien le B, Vinh Chau NV, Ty Hang VT, van Doorn HR,Simmons CP. Epidemiology and virology of acute respiratory infections during the first year of life: a birth cohort study in Vietnam. Pediatr Infect Dis J. 2015 Apr;34(4):361-70.
[18]  National Committee for Clinical and Laboratory Standards (NCCLS). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. Approved Standard. 8th ed. Wayne, PA: NCCLS; 2010: M7-A8.
[19]  Bleeker SE, Moons KG, Derksen-Lubsen G, Grobbee DE, Moll HA. Predicting serious bacterial infection in young children with fever without apparent source. Acta Paediatr. 2001 Nov; 90(11):1226-32.
[20]  Byington CL, Rittichier KK, Bassett KE, Castillo H, Glasgow TS, Daly J, Pavia AT. Serious bacterial infections in febrile infants younger than 90 days of age: the importance of ampicillin-resistant pathogens. Pediatrics. 2003 May;111(5 Pt 1):964-8.
[21]  Pratt A1, Attia MW. Duration of fever and markers of serious bacterial infection in young febrile children. Pediatr Int. 2007 Feb;49(1):31-5.
[22]  Shaikh, Nader ; Morone, Natalia E. ; Bost, James E. ; Farrell, Max H. Prevalence of Urinary Tract Infection in Childhood: A Meta-Analysis. The Pediatric Infectious Disease Journal Issue: Volume 27(4), April 2008, pp 302-308.
[23]  Hernández-Bou S, Trenchs V, Alarcón M, Luaces C. Afebrile Very Young Infants With Urinary Tract Infection and the Risk for Bacteremia. Pediatr Infect Dis J. 2014;33(3):244-247.
[24]  Canducci F, Debiaggi M, Sampaolo M, et al. Two-year prospective study of single infections and co-infections by respiratory syncytial virus and viruses identified recently in infants with acute respiratory disease. Journal of medical virology 2008; 80 :716-723.
[25]  Wright PF, Deatly AM , Karron RA , et al. Comparison of Results of Detection of Rhinovirus by PCR and Viral Culture in Human Nasal Wash Specimens from Subjects with and without Clinical Symptoms of Respiratory Illness. Journal of clinical microbiology 2007; 45: 2126-2129.
[26]  Miller EK, Bugna J, Libster R, et al. Human rhinoviruses in severe respiratory disease in very low birth weight infants. Pediatrics 2012;129: e60-67.
[27]  Bonzel L, Tenenbaum T, Schroten H, Schildgen, et al. Frequent detection of viral coinfection in children hospitalized with acute respiratory tract infection using a real-time polymerase chain reaction. Pediatric Infectious Disease Journal 2008; 27 :589-594.
[28]  Laurent C, Dugué AE, Jacques B, et al. Viral Epidemiology and Severity of Respiratory Infections in Infants in 2009: A Prospective Study. Pediatric Infectious Disease Journa. 2012; 31: 827-831.
[29]  AlShehri MA, Sadeq A, Quli K. Bronchiolitis in Abha, Southwest Saudi Arabia: viral etiology and predictors for hospital admission. West African journal of medicine 2005; 24:299-304.
[30]  Pierangeli A, Scagnolari C, Selvaggi C, et al. Virological and clinical characterization of respiratory infections in children attending an emergency department during the first autumn-winter circulation of pandemic A (H1N1) 2009 influenza virus. Clinical microbiology and infection 2012; 18:366-73.
[31]  Shi WX, Peng XM, Han LL, et al. Virus etiology in children with acute upper respiratory infection in Beijing. Chinese Journal of Health Laboratory Technology 2008; 18: 1263-1265.
[32]  Weinberg GA , Hall CB , Iwane MK, et al. New Vaccine Surveillance Network. Parainfluenza Virus infection of Young Children: Estimates of the Population-Based Burden of Hospitalization. The Journal of Pediatrics 2009; 154:694-699.
[33]  Kwofie TB, Anane YA, Nkrumah B, et al. Respiratory viruses in children hospitalized for acute lower respiratory tract infection in Ghana. Virology Journal 2012; 10:9-78.
[34]  Zhang G, Hu Y, Wang H, et al. High Incidence of Multiple Viral Infections Identified in Upper Respiratory Tract Infected Children under Three Years of Age in Shanghai, China. Public Library of Science 2012; 7:e44568.
[35]  Talbot HK, Crowe JE Jr, Edwards KM, et al. New Vaccine Surveillance Network. Coronavirus infection and hospitalizations for acute respiratory illness in young children. Journal of medical virology 2009; 81:853-856.
[36]  Mao HW, Yang XQ, Wang LJ, et al. Isolation of human metapneumovirus from children with acute respiratory tract infection in Chongqing, China. Zhonghua er ke za zhi. Chinese journal of pediatrics 2007; 45:42-45.
[37]  Lu Y , Wang S , Zhang L , et al. Epidemiology of Human Respiratory Viruses in Children with Acute Respiratory Tract Infections in Jinan, China. Clinical and Developmental Immunology 2013; 21049:1-8.
[38]  Bonner AB, Monroe KW, Talley LI, et al. Impact of the rapid diagnosis of influenza on physician decision-making and patient management in the pediatric emergency department: results of a randomized, prospective, controlled trial. Pediatrics 2003;112s:363-367.