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Volume 15, Number 9—September 2009

Research

Clinical Assessment and Improved Diagnosis of Bocavirus-induced Wheezing in Children, Finland

Maria Söderlund-VenermoComments to Author , Anne Lahtinen, Tuomas Jartti, Lea Hedman, Kaisa Kemppainen, Pasi Lehtinen, Tobias Allander, Olli Ruuskanen, and Klaus Hedman
Author affiliations: University of Helsinki, Helsinki, Finland (M. Söderlund-Venermo, A. Lahtinen, L. Hedman, K. Kemppainen, K. Hedman); Helsinki University Central Hospital, Helsinki (L. Hedman, K. Hedman) Turku University Hospital, Turku, Finland (T. Jartti, P. Lehtinen, O. Ruuskanen); Karolinska Institute, Stockholm, Sweden (T. Allander); Karolinska University Hospital, Stockholm (T. Allander)

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Table 3

Clinical characteristics of pediatric patients with acute wheezing caused by HBoV, rhinovirus, RSV, or mixed virus infections*†

Factor Between groups infected with
Virus infection
Single virus 
(n = 104)
Single + mixed (n = 46)‡
HBoV 
(n = 12) Mixed 
(n = 34) Rhinovirus (n = 56) RSV 
(n = 36) p value§ Adjusted p value¶ p value§
Age, y
1.4 
(0.8–3.2)
1.3 
(0.3–6.1)
2.2 
(0.4–12.5)
0.9 
(0.3–4.5)

<0.0001


0.57
Male, no. (%)
9 (75)
23 (68)
36 (64)
20 (56)

0.45
0.073

0.64
At admission
   Severity of illness, scale 0–12 7 (4–10) 7 (2–10) 6 (2–10) 7 (4–10) 0.057 0.15 0.43
   % Oxygen saturation 97 (88–99) 96 (91–99) 96 (88–100) 96 (89–99) 0.98 0.97 0.95
   Temperature, °C 37.6 
(36.1–39.1) 37.7 
(36.2–39.5) 37.4 
(36.2–39.3) 37.9 
(36.3–40.1) 0.0014 0.032 0.71
   CRP, mg/L 7.50 (0–78) 10 (0–45) 18 (0–191) 8 (0–96) 0.25 0.81 0.48
   Leukocyte count, × 109/L
8.50 
(6.3–11.9)
11.1 
(5.1–23.6)
12.1 
(5.6–20.8)
9.4 
(4.9–20.7)

0.0003
<0.0001

0.029
Duration of hospitalization, h
30 (18–78)
27 (6–90)
18 (6–74)
38 (6–138)

<0.0001
0.0066

0.12
Duration of cough, d 15 (4–66) 11 (2–38) 8 (1–36) 11 (4–22) 0.0022 0.020 0.062
   Before admission 5 (1–60) 3 (1–28) 2 (0–19) 4 (1–14) <0.0001 <0.0001 0.038
   After hospitalization 6 (2–14) 5 (0–14) 6 (0–14) 4 (0–13) 0.40 0.42 0.36
   Moderate–severe after hospitalization
1 (0–8)
1 (0–14)
2 (0–14)
0 (0–4)

0.019
0.0052

0.34
Duration of breathing difficulty, h 4 (1–9) 4 (1–11) 3 (0–36) 6 (1–14) <0.0001 0.0047 0.48
   Before admission 1 (0–7) 1 (0–7) 1 (0–19) 2 (0–6) 0.040 0.67 0.63
   After hospitalization 0 (0–4) 1 (0–10) 0 (0–14) 3 (0–11) 0.028 0.071 0.40
   Moderate–severe after hospitalization
0 (0–0)
0 (0–6)
0 (0–14)
0 (0–1)

0.39
0.49

0.13
Other symptoms, no. (%) patients
   Acute otitis media 4 (33) 16 (47) 16 (29) 26 (72) 0.0003 0.073 0.41
   Nonrespiratory symptoms
      Diarrhea 1 (8) 4 (12) 2 (4) 7 (19) 0.072 0.21 0.74
      Balance problems 0 1 (3) 2 (4) 2 (6) 0.92 0.53 0.45
      Rash 0 0 2 (4) 0 1.00 1.00
      Arthritis or arthralgia 0 0 0 0

*Mixed infections consisted of HBoV plus >1 virus. Values are median (range) except as indicated. HBoV, human bocavirus; RSV, respiratory syncytial virus; CRP, C-reactive protein.
†Analysis by regression analysis using generalized linear models after logarithmic transformation for continuous data or by logistic regression analysis for categorical data. Significant intergroup differences were found when persons with HBoV infections were compared with those with other infections: age: HBoV vs. RSV, p = 0.036; leukocyte count: HBoV vs. rhinovirus, p = 0.0009 unadjusted and p = 0.0002 adjusted; duration of hospitalization: HBoV vs. rhinovirus, p = 0.0027 unadjusted and p = 0.0069 adjusted; duration of cough: HBoV vs. rhinovirus, p = 0.0009 unadjusted and p = 0.0012 adjusted; duration of cough before admission: HBoV vs. rhinovirus, p<0.0001 unadjusted and p<0.0001 adjusted and HBoV vs. RSV, p = 0.028 unadjusted and p = 0.019 adjusted; acute otitis media: HBoV vs. RSV, p = 0.0005 unadjusted.
‡A child with 1 PCR-positive nasopharygeal aspirate and a PCR-negative serum sample was classified as having a subacute HBoV infection. In Table 1, he was 1 of 3 nonviremic children with a serodiagnosis for HBoV infection.
§Unadjusted.
¶Adjusted for age.

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