Simultaneous infection with respiratory syncytial virus and other respiratory pathogens
D. A. Tristram, R. W. Miller, J. A. McMillan and L. B. Weiner
Department of Pediatrics, State University, New York Health Science Center, Syracuse.
The presentation and subsequent course of respiratory syncytial virus (RSV)
bronchiolitis may be atypical and unusually severe when simultaneous
infection due to other pathogenic agents is present. During the past two
years, nine of the 189 pediatric patients hospitalized with documented RSV
infection were found to have the following simultaneous isolates from
initial respiratory tract specimens: four adenovirus, four pneumococcus,
one cytomegalovirus, and one Pneumocystis carinii. Noted complications
attributable to the second pathogen included thrombocytopenia and anemia
(cytomegalovirus), hepatitis and disseminated intravascular coagulation
(adenovirus), and sepsis and osteomyelitis (pneumococcus). Three of the
four patients with RSV and adenovirus died of severe respiratory failure
despite mechanical ventilation; two of these patients received ribavirin
therapy. Rapid identification of RSV is important but should not be a
substitute for more comprehensive viral and bacterial evaluation.
