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Respiratory viruses in exacerbations of non-cystic fibrosis bronchiectasis in children
  1. Nitin Kapur1,
  2. Ian M Mackay2,
  3. Theo P Sloots2,
  4. Ian B Masters1,
  5. Anne B Chang1,3
  1. 1Department of Respiratory Medicine, Royal Children's Hospital, Queensland, Australia
  2. 2Queensland Paediatric Infectious Diseases Laboratory, SASVRC, QCMRI, Herston, Queensland, Australia
  3. 3Child Health Division, Menzies School of Health Research, Darwin, Australia
  1. Correspondence to Dr Nitin Kapur, Department of Respiratory Medicine, 5th Floor, Woolworths Building, Royal Children's Hospital, Herston, QLD 4029, Australia; dr.nitinkapur{at}


Background Respiratory viral infections precipitate exacerbations of chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease though similar data in non-cystic fibrosis (CF) bronchiectasis are missing. Our study aimed to determine the point prevalence of viruses associated with exacerbations and evaluate clinical and investigational differences between virus-positive and -negative exacerbations in children with bronchiectasis.

Methods A cohort of 69 children (median age 7 years) with non-CF bronchiectasis was prospectively followed for 900 child-months. PCR for 16 respiratory viruses was performed on nasopharyngeal aspirates collected during 77 paediatric pulmonologist-defined exacerbations. Clinical data, systemic (C reactive protein (CRP), IL-6, procalcitonin, amyloid-A, fibrinogen) and lung function parameters were also collected.

Findings Respiratory viruses were detected during 37 (48%) exacerbations: human rhinovirus (HRV) in 20; an enterovirus or bocavirus in four each; adenoviruses, metapneumovirus, influenza A virus, respiratory syncytial virus, parainfluenza virus 3 or 4 in two each; coronavirus or parainfluenza virus 1 and 2 in one each. Viral codetections occurred in 6 (8%) exacerbations. HRV-As (n=9) were more likely to be present than HRV-Cs (n=2). Children with virus-positive exacerbations were more likely to require hospitalisation (59% vs 32.5% (p=0.02)) and have fever (OR 3.1, 95% CI 1.2 to 11.1), hypoxia (OR 25.5, 95% CI 2.0 to 322.6), chest signs (OR 3.3, 95% CI 1.1 to 10.2) and raised CRP (OR 4.7, 95% CI 1.7 to 13.1) when compared with virus-negative exacerbations.

Interpretation Respiratory viruses are commonly detected during pulmonary exacerbations of children with bronchiectasis. HRV-As were the most frequently detected viruses with viral codetection being rare. Time-sequenced cohort studies are needed to determine the role of viral–bacterial interactions in exacerbations of bronchiectasis.

  • Bronchiectasis
  • Exacerbation
  • Virus
  • Biomarkers
  • Children

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