Respiratory syncytial virus load, viral dynamics, and disease severity in previously healthy naturally infected children

Chadi M. El Saleeby, Andy J. Bush, Lisa M. Harrison, Jody A. Aitken, John Devincenzo

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Background. Respiratory syncytial virus (RSV) disease severity was thought to be a result of host immunopathology but alternatively may be driven by high-level viral replication. The relationships between RSV load, viral clearance dynamics, and disease severity have not been carefully evaluated. Methods. Previously healthy RSV-infected children <2 years old were recruited. RSV load was measured in respiratory secretions by fresh quantitative culture over 3 hospital days. Measures of disease severity were hospital admission, duration of hospitalization, requirement for intensive care, and respiratory failure. Results. Multivariate logistic regression models revealed independent predictors of increased duration of hospitalization: male sex, lower weight, and higher viral load on any day. Viral loads at day 3 were more significantly associated with requirement for intensive care and respiratory failure than were viral loads at earlier time points. Faster RSV clearance was independently associated with shorter hospitalization. Discussion. These observations challenge the immunopathology-based pathogenesis paradigm. They also have major therapeutic implications, suggesting that application of antiviral agents early in the disease course, even at a time when viral replication is at its highest, might improve subsequent morbidity by significantly lowering viral load and direct viral cytopathic effects, and aborting the potential downstream immunopathology.

Original languageEnglish (US)
Pages (from-to)996-1002
Number of pages7
JournalJournal of Infectious Diseases
Volume204
Issue number7
DOIs
StatePublished - Oct 1 2011

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Respiratory Syncytial Viruses
Virus Diseases
Viral Load
Hospitalization
Critical Care
Respiratory Insufficiency
Viral Cytopathogenic Effect
Logistic Models
Antiviral Agents
Morbidity
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Infectious Diseases

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Respiratory syncytial virus load, viral dynamics, and disease severity in previously healthy naturally infected children. / El Saleeby, Chadi M.; Bush, Andy J.; Harrison, Lisa M.; Aitken, Jody A.; Devincenzo, John.

In: Journal of Infectious Diseases, Vol. 204, No. 7, 01.10.2011, p. 996-1002.

Research output: Contribution to journalArticle

El Saleeby, Chadi M. ; Bush, Andy J. ; Harrison, Lisa M. ; Aitken, Jody A. ; Devincenzo, John. / Respiratory syncytial virus load, viral dynamics, and disease severity in previously healthy naturally infected children. In: Journal of Infectious Diseases. 2011 ; Vol. 204, No. 7. pp. 996-1002.
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