Mazur, Natalie I.Bont, LouisCohen, Adam L.Cohen, CherylVon Gottberg, AnneGroome, Michelle J.Hellferscee, OrienkaKlipstein-Grobusch, KerstinMekgoe, Omphile TschegofatsoNaby, FathimaMoyes, JocelynTempia, StefanoTreurnicht, Florette K.Venter, MarietjieWalaza, SibongileWolter, NicoleMadhi, Shabir A.2017-05-022017-02Mazur, NI, Bont, L, Cohen, AL, Cohen, C, Von Gottberg, A, Groome, MJ, Hellferscee, O, Klipstein-Grobusch, K, Mekgoe, O, Naby, F, Moyes, J, Tempia, S, Treurnicht, FK, Venter, M, Walaza, S, Wolter, N & Madhi, SA 2017, 'Severity of respiratory syncytial virus lower respiratory tract infection with viral coinfection in HIV-uninfected children', Clinical Infectious Diseases, vol. 64, no. 4, pp. 443-450.1058-4838 (print)1537-6591 (online)10.1093/cid/ciw756http://hdl.handle.net/2263/60148BACKGROUND : Molecular diagnostics enable sensitive detection of respiratory viruses, but their clinical significance remains unclear in pediatric lower respiratory tract infection (LRTI). We aimed to determine whether viral coinfections increased life-threatening disease in a large cohort. METHODS : Molecular testing was performed for respiratory viruses in nasopharyngeal aspirates collected from children aged <5 years within 24 hours of hospital admission during sentinel surveillance for severe acute respiratory illness (SARI) hospitalization conducted in South Africa during February 2009–December 2013. The primary outcome was life-threatening disease, defined as mechanical ventilation, intensive care unit admission, or death. RESULTS : Of 2322 HIV-uninfected children with respiratory syncytial virus (RSV)–associated LRTI, 1330 (57.3%) had RSV monoinfection, 38 (1.6%) had life-threatening disease, 575 (24.8%) had rhinovirus, 347 (14.9%) had adenovirus (ADV), and 30 (1.3%) had influenza virus. RSV and any other viral coinfection was not associated with severe disease (odds ratio [OR], 1.4; 95% confidence interval [CI], OR, 0.74; 95% CI, .39–1.4), ADV coinfection had increased odds of life-threatening disease (adjusted OR, 3.4; 95% CI, 1.6–7.2; P = .001), and influenza coinfection had increased odds of life-threatening disease and prolonged length of stay (adjusted OR, 2.1; 95% CI, 1.0–4.5; P = .05) compared with RSV monoinfection. CONCLUSIONS : RSV coinfection with any respiratory virus is not associated with more severe disease when compared to RSV alone in this study. However, increased life-threatening disease in RSV-ADV and RSV-influenza coinfection warrants further studyen© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. . This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Clinical Infectious Diseases following peer review. The definitive publisher-authenticated version is : Severity of respiratory syncytial virus lower respiratory tract infection with viral coinfection in HIV-uninfected children, in Clinical Infectious Diseases, vol. 64, no. 4, pp. 443-450, 2017. doi : 10.1093/cid/ciw756, is available online at : http://cid.oxfordjournals.org.Respiratory syncytial virus (RSV)Viral coinfectionLower respiratory tract infection (LRTI)Postprint Article