CORD-19-Sentences  

CORD-19:1319a4dbbc3d7b9001f67f9739ec378b7362ac8c JSONTXT 7 Projects

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Id Subject Object Predicate Lexical cue
TextSentencer_T1 0-64 Sentence denotes Impact of rhinoviruses on pediatric community-acquired pneumonia
TextSentencer_T2 66-74 Sentence denotes Abstract
TextSentencer_T3 75-272 Sentence denotes This study of 592 children seen in our Emergency Department with radiographically confirmed communityacquired pneumonia (CAP) was designed to evaluate the role of rhinoviruses (RVs) in the disease.
TextSentencer_T4 273-495 Sentence denotes The respiratory secretions of each child were assayed using RVP Fast in order to detect 17 respiratory viruses, and the RV-positive samples were characterised by means of real-time polymerase chain reaction and sequencing.
TextSentencer_T5 496-537 Sentence denotes RVs were identified in 172 cases (29.0%):
TextSentencer_T6 538-640 Sentence denotes 48/132 children aged <1 year (36.3%), 80/293 aged 1-3 years (27.3%), and 44/167 aged ≥4 years (26.3%).
TextSentencer_T7 641-767 Sentence denotes Sequencing demonstrated that 82 RVs (49.1%) were group A, 17 (10.1%) group B, and 52 (31.1%) group C; 21 (12.2%) were untyped.
TextSentencer_T8 768-871 Sentence denotes RVs were found as single agents in 99 cases, and together with two or more other viruses in 73 (40.7%).
TextSentencer_T9 872-993 Sentence denotes There were only marginal differences between the different RV groups and between single RV infection and RV coinfections.
TextSentencer_T10 994-1115 Sentence denotes RV CAP is frequent not only in younger but also in older children, and RV-A is the most common strain associated with it.
TextSentencer_T11 1116-1269 Sentence denotes The clinical relevance of RV CAP seems to be mild to moderate without any major differences between the A and B strains and the recently identified RV C.
TextSentencer_T12 1271-1369 Sentence denotes Rhinoviruses (RVs) have been known for a long time since they were first isolated in 1956 [1, 2] .
TextSentencer_T13 1370-1534 Sentence denotes It was long thought that they were of little medical significance because they were only associated with upper respiratory tract infections, mainly the common cold.
TextSentencer_T14 1535-1856 Sentence denotes About 20 years ago, the findings of cultures and bacterial antigen detection tests in patients with lower respiratory tract infections (LRTIs) suggested that RVs may sometimes be associated with LRTIs and the induction of asthma exacerbations, particularly in patients with underlying chronic severe disease [3] [4] [5] .
TextSentencer_T15 1857-2472 Sentence denotes The introduction of more specific and sensitive methods of respiratory viral screening, including polymerase chain reaction (PCR), made it possible to evaluate the role of RVs in LRTIs more precisely, and a number of studies using these methods have clearly shown that the association between RVs and LRTIs is significantly more frequent than previously thought, that RVs could be identified in the respiratory secretions of many infants and young children with bronchiolitis and community-acquired pneumonia (CAP), and that RVs were the agents most frequently associated with asthma exacerbations [6] [7] [8] [9] .
TextSentencer_T16 2473-2748 Sentence denotes Moreover, analysis of full-genome sequences demonstrated that, in addition to the group A (RV-A) and B RVs (RV-B) classified on the basis of the similarity of partial genetic sequences and responses to certain antiviral drugs, there is also a third group of RVs (RV-C) [10] .
TextSentencer_T17 2749-2982 Sentence denotes Together with genetic differences, these new RVs were characterised by the fact that they could not be grown in standard tissue cultures, which may explain why they were not discovered before the development of molecular diagnostics.
TextSentencer_T18 2983-3313 Sentence denotes These methods have led to breakthroughs in our understanding of the causative role played by RVs in lower airway diseases, but most of the data so far available have come from subjects with wheezing, asthma and chronic lung diseases [11] , and little is known about other LRTIs such as pediatric CAP in otherwise healthy children.
TextSentencer_T19 3314-3411 Sentence denotes Furthermore, the role of the different groups of RVs in pediatric CAP has not been fully defined.
TextSentencer_T20 3412-3503 Sentence denotes The aim of this study was to evaluate the role of the three groups of RVs in pediatric CAP.
TextSentencer_T21 3504-3875 Sentence denotes The study was approved by the Institutional Review Board of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, and was carried out in the Department of Maternal and Pediatric Sciences of the University of Milan between 1 November and 30 April of four consecutive winter and early spring seasons (2007-2008, 2008-2009, 2009-2010, and 2010-2011) .
TextSentencer_T22 3876-4004 Sentence denotes The written informed consent of a parent or legal guardian was required, and the older children were asked to give their assent.
TextSentencer_T23 4005-4402 Sentence denotes All of the children aged between one month and 14 years seen in the Emergency Room of the Department of Maternal and Pediatric Sciences with fever (an axillary temperature >38°C), signs and symptoms (i.e. cough, tachypnea, dyspnea or respiratory distress, and breathing with grunting or wheezing sounds with rales) and a chest radiograph consistent with CAP were considered eligible for the study.
TextSentencer_T24 4403-4822 Sentence denotes The exclusion criteria were chronic diseases increasing the risk of respiratory infections, including premature birth; chronic disorders of the pulmonary or cardiovascular systems, including asthma; chronic metabolic diseases, including diabetes mellitus; neoplasia; kidney or liver dysfunction; hemoglobinopathies; immunosuppression; diseases requiring long-term aspirin therapy; and genetic or neurological disorders.
TextSentencer_T25 4823-4994 Sentence denotes The children with presumed nosocomial pneumonia (i.e. pneumonia appearing more than 48 hours after admission or within two weeks of hospital discharge) were also excluded.
TextSentencer_T26 4995-5332 Sentence denotes All of the chest radiographs were evaluated by an independent expert radiologist who classified the findings as alveolar pneumonia, non-alveolar pneumonia or no pneumonia in accordance with the World Health Organisation (WHO) criteria for a standardised interpretation of pediatric chest radiographs for the diagnosis of pneumonia [12] .
TextSentencer_T27 5333-5547 Sentence denotes Alveolar pneumonia was defined as dense opacity appearing as fluffy consolidation of a part or all of a lobe, or an entire lung, often containing air on bronchography and sometimes associated with pleural effusion.
TextSentencer_T28 5548-5667 Sentence denotes Any pathologic density in the lung different from that considered alveolar was defined as interstitial pneumonia [12] .
TextSentencer_T29 5668-5745 Sentence denotes The children for whom informed consent of parents was obtained were enrolled.
TextSentencer_T30 5746-5857 Sentence denotes Their respiratory secretions were taken using a pernasal flocked swab, and stored in a tube of UTM-RT (Kit Cat.
TextSentencer_T31 5858-5861 Sentence denotes No.
TextSentencer_T32 5862-5898 Sentence denotes 360c, Copan Italia, Brescia, Italy).
TextSentencer_T33 5899-5997 Sentence denotes Viral tests were performed for study purposes and were always available after patient's discharge.
TextSentencer_T34 5998-6308 Sentence denotes Upon enrolment, detailed information regarding their demographics, clinical history and the clinical characteristics of the disease was collected together with a blood sample for the evaluation of laboratory variables including white blood cell (WBC) counts, C-reactive protein (CRP) levels and blood cultures.
TextSentencer_T35 6309-6433 Sentence denotes Drug treatment was chosen by the pediatrician in charge on the basis of the guidelines of the Italian Society of Pediatrics.
TextSentencer_T36 6434-6550 Sentence denotes In particular, these guidelines recommend the use of antibiotics in all the cases of radiographically confirmed CAP.
TextSentencer_T37 6551-6839 Sentence denotes In mild cases, ten days of oral therapy with amoxicillin (80-90 mg/kg/day in 3 doses) for children< 5 years or with an oral macrolide (dosage according to the chosen drug; clarithromycin 15 mg/kg/day in 2 doses is the macrolide used in our hospital) for children ≥5 years are recommended.
TextSentencer_T38 6840-7131 Sentence denotes For severe cases, therapy for 10-14 days with a combination of a third generation cephalosporin (cefotaxime 100 mg/kg/day i.v. in 3 doses is the antibiotic used in our hospital) plus a macrolide (clarithromycin 7.5 mg/kg/day i.v., in 2 doses or 15 mg/kg/day orally in 2 doses) is prescribed.
TextSentencer_T39 7132-7542 Sentence denotes The data collected during hospitalisation were recorded daily, and all of the enrolled children (whether they were hospitalised or sent home immediately after enrolment) were re-evaluated 15±2 days later by means of interviews and clinical examinations carried out by trained investigators using standardised questionnaires that also collected information regarding household illnesses and related morbidities.
TextSentencer_T40 7543-7602 Sentence denotes No additional samples were obtained at the follow-up visit.
TextSentencer_T41 7603-7821 Sentence denotes Viral RNA or DNA was extracted immediately after collection of the respiratory secretions by means of a NuclisensEasyMAG automated extraction system (Biomeriéux, Craponne, France), and maintained in a freezer at −80°C.
TextSentencer_T42 7822-7982 Sentence denotes They were subsequently tested using the RVP Fast assay in accordance with the manufacturer's instructions (Luminex Molecular Diagnostics Inc., Toronto, Canada).
TextSentencer_T43 7983-8084 Sentence denotes All of the xTAG RVP FAST reagents were provided by Abbott GmbH & Co. (Wiesbaden-Delkenheim, Germany).
TextSentencer_T44 8085-8323 Sentence denotes The RVP Fast assay consists of a single multiplex polymerase chain reaction (PCR) with labelled primers, followed by the single-step hybridisation of the PCR products with the fluorescent bead array, and incubation with reporter reagents.
TextSentencer_T45 8324-8585 Sentence denotes The plate was analysed using a Bio-Plex 200 System (Bio-rad Laboratories, Milan, Italy) and its associated software Luminex x PONENT version 3.1 (Luminex Molecular Diagnostics Inc., provided by Abbott), and the median fluorescent intensity (MFI) was determined.
TextSentencer_T46 8586-8718 Sentence denotes An MFI above the threshold level determined by the manufacturer for a particular target indicated a positive result for that target.
TextSentencer_T47 8719-8831 Sentence denotes The mean positive fluorescence intensities were established using Tag-It Data Analysis Software (TDAS, Luminex).
TextSentencer_T48 8832-9149 Sentence denotes The RVP Fast assay simultaneously detects influenza A virus (subtyped H1 or H3), influenza B virus, respiratory syncytial virus (RSV)-A and -B, parainflunzavirus-1, -2, -3 and −4, adenovirus, human metapneumovirus (hMPV), coronaviruses 229E, NL63, OC43 and HKU1, enterovirus/rhinovirus, and human bocavirus [13, 14] .
TextSentencer_T49 9150-9347 Sentence denotes It also tests an internal positive control added to each specimen at the extraction stage (Escherichia coli phage MS2 RNA) and a positive run control added to each plate (bacteriophage lambda DNA).
TextSentencer_T50 9348-9435 Sentence denotes The enterovirus/rhinovirus-positive samples were retested in order to identify the RVs.
TextSentencer_T51 9436-9624 Sentence denotes This RT-PCR assay was performed using the iAg-Path-ID one-step RT-PCR Kit (Applied Biosystems, Foster City, CA), and the primers and probe sequences were those reported by Lu et al. [15] .
TextSentencer_T52 9625-9753 Sentence denotes Briefly, each 25-μL reaction mixture contained 1 μM forward and reverse primers, 0.1 μM probe, and 5 μL of nucleic acid extract.
TextSentencer_T53 9754-9897 Sentence denotes The samples were amplified using a 7900 HT Fast Real-Time PCR detection system (Applied Biosystems) and the following thermocycling conditions:
TextSentencer_T54 9898-10015 Sentence denotes 10 min at 48°C for RT, 3 min at 95°C for polymerase activation, and then 45 cycles of 15 s at 95°C and 1 min at 60°C.
TextSentencer_T55 10016-10069 Sentence denotes Each run included template and non-template controls.
TextSentencer_T56 10070-10263 Sentence denotes The hypervariable part of the 5' NCR, the entire VP4 gene, and the 5′ terminus of the VP2 gene of RVs was amplified using a RT-PCR assay as previously described [16] , with minor modifications.
TextSentencer_T57 10264-10459 Sentence denotes The eluted RNA was transcribed into cDNA using Moloney Murine Reverse Trascriptase (MMLV-RT, Invitrogen) and random hexamers for one hour at 37°C, after which the MMLV-RT was denaturated at 70°C.
TextSentencer_T58 10460-10725 Sentence denotes The PCR was carried out in a final volume of 50 μL, which contained the virus-specific oligonucleotide primers (0.2 μM each), 2 U AmpliTaq Gold 360 DNA Polymerase (Applied Biosystems), 1x reaction Buffer, 0.2 mM of each dNTP, 2 mM MgCl 2 and 2 μL of c-DNA template.
TextSentencer_T59 10726-10868 Sentence denotes The 40 PCR cycles consisted of a denaturation step (45 s at 95°C), an annealing step (45 s at 61°C), and a DNA extension step (1 min at 72°C).
TextSentencer_T60 10869-10977 Sentence denotes The 549 bp PCR products were visualised after electrophoresis on an ethidium bromide-stained 2% agarose gel.
TextSentencer_T61 10978-11045 Sentence denotes Positive and negative controls were tested in all of the reactions.
TextSentencer_T62 11046-11264 Sentence denotes The PCR products were purified using the Wizard SV Gel and PCR Clean-Up System (Promega), and the purified products were sequenced in both directions using the same forward and reverse primers as those used in the PCR.
TextSentencer_T63 11265-11416 Sentence denotes Nucleotide sequences were obtained by means of automated DNA sequencing using an ABI PRISM 3730 genetic analyser (Applied Biosystems, Foster City, CA).
TextSentencer_T64 11417-11687 Sentence denotes When identifying the RV species, newly determined sequences were checked and aligned with the BioEdit program, and the resulting consensus sequences were compared with sequences from GenBank using the nucleotide-nucleotide BLAST algorithm (http:// www.ncbi.nlm.nih.gov).
TextSentencer_T65 11688-11743 Sentence denotes The analysed fragment was 400 nt in the VP4/VP2 region.
TextSentencer_T66 11744-11782 Sentence denotes Descriptive statistics were generated.
TextSentencer_T67 11783-12251 Sentence denotes The continuous variables are given as mean values ± standard deviation (SD), and were analysed using a two-sided, non-parametric Wilcoxon rank-sum test or, when the data were normally distributed (on the basis of the Shapiro-Wilks statistic), a two-sided Student's t-test; the categorical variables are given as absolute numbers and percentages, and were compared between groups using contingency table analysis with the χ 2 test or Fisher's exact test as appropriate.
TextSentencer_T68 12252-12603 Sentence denotes Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to measure the association between positivity for the selected RV type and (1) the presence of high fever, (2) hospitalisation, (3) the presence of rales, (4) the presence of wheezes, (5) having a relative with a similar illness, and (6) radiological evidence of alveolar pneumonia.
TextSentencer_T69 12604-12745 Sentence denotes The ORs were obtained using unconditional multiple logistic regression, and adjusted for age (three groups: <1, 1-3 and ≥4 years) and gender.
TextSentencer_T70 12746-12942 Sentence denotes We also analysed the association between the presence of RVs together with another viral infection and the same clinical and radiological characteristics, adjusting for age, gender and type of RV.
TextSentencer_T71 12943-13011 Sentence denotes All of the analyses were made using SAS version 9.1 (Cary, NC, USA).
TextSentencer_T72 13012-13075 Sentence denotes A total of 607 children were considered eligible for the study.
TextSentencer_T73 13076-13302 Sentence denotes Parents did not give their consent for the inclusion of their child in 15 cases so that 592 children with radiographically confirmed CAP (311 males; mean age±SD, 3.2±3.0 years) were enrolled during the four years of the study.
TextSentencer_T74 13303-13582 Sentence denotes More than 50% of them were hospitalized taking into account the severity of the disease (respiratory distress, SpO 2 and radiological findings), and for infants, even in case of mild respiratory involvement, the presence of high fever (axillary temperature ≥39°C) was considered.
TextSentencer_T75 13583-13722 Sentence denotes Information regarding clinical evolution of the disease and involvement of family members were available for all the children at follow-up.
TextSentencer_T76 13723-13850 Sentence denotes More than 97% of the children received the antibiotic therapy according to the guidelines of the Italian Society of Pediatrics.
TextSentencer_T77 13851-13925 Sentence denotes Among enrolled patients, 435 (73.5%) were positive for at least one virus.
TextSentencer_T78 13926-14098 Sentence denotes RVs were identified in 172 cases (29.0%) and were the second most common infectious agents after respiratory syncytial virus (RSV), which was found in 188 children (31.7%).
TextSentencer_T79 14099-14356 Sentence denotes A preliminary analysis of the prevalence of RVs and the RV A, B and C subgroups showed that there were no statistically significant differences by year of sample collection; consequently, all of the data collected in the four years were considered together.
TextSentencer_T80 14357-14400 Sentence denotes Table 1 Table 2 shows the RV co-infections.
TextSentencer_T81 14401-14523 Sentence denotes Dual infections were observed in 60 cases (10.1%), triple infections in 11 (1.9%), and quadruple infections in two (0.3%).
TextSentencer_T82 14524-14617 Sentence denotes The most common dual infection was RV + RSV (35 cases) followed by RV + bocavirus (12 cases).
TextSentencer_T83 14618-14710 Sentence denotes RSV was also found in six cases with triple infection and both cases of quadruple infection.
TextSentencer_T84 14711-14841 Sentence denotes The only RV-infected child who had a bacteriapositive blood culture (Streptoccoccus pneumoniae) was co-infected with RV-A and RSV.
TextSentencer_T85 14842-14936 Sentence denotes Table 3 shows the characteristics of the CAP associated with single RV infections by RV group.
TextSentencer_T86 14937-14996 Sentence denotes The differences between the groups were generally marginal.
TextSentencer_T87 14997-15254 Sentence denotes All of the considered demographic and clinical variables were similarly distributed in the three groups with the exception of highgrade fever, which was significantly less frequent in the children infected by RV-C than in those infected with RV-A (p<0.001).
TextSentencer_T88 15255-15345 Sentence denotes Hospitalisation rates and duration were also similar in the three groups, as was drug use.
TextSentencer_T89 15346-15666 Sentence denotes The data regarding the social impact of RV infection showed that, although the rates of absence from the community of the infected child were similar in the three groups, the number of similar illnesses within the family was significantly lower in the children infected with RV-C than in those infected by RV-A (p=0.02).
TextSentencer_T90 15667-16001 Sentence denotes Analysis of the laboratory data showed that neutrophil cell counts were significantly higher in the children infected with RV-C than those infected with RV-A (p=0.02), whereas monocyte counts and CRP levels were significantly lower in the children infected with RV-C than in those infected with RV-A (p=0.04 and p=0.01, respectively).
TextSentencer_T91 16002-16082 Sentence denotes There was no difference in the radiographic characteristics of the three groups.
TextSentencer_T92 16083-16410 Sentence denotes Multivariate analysis confirmed the similarity of the RV groups: the only differences between them related to the RV-C positive cases, which were significantly less frequently associated with high fever (OR 0.13, 95% CI 0.04-0.40) or a similar illness within the family (OR 0.16, 95% CI 0.03-0.82) than the RV-A positive cases.
TextSentencer_T93 16411-16545 Sentence denotes Table 4 shows the demographic, clinical, laboratory and radiographic variables associated with single RV infections and co-infections.
TextSentencer_T94 16546-16823 Sentence denotes The only significant differences were in mean age (the children with a single RV infection were older; p=0.0002), and neutrophil and lymphocyte counts, which were, respectively, significantly lower (p=0.001) and significantly higher (p<0.001) in the children with coinfections.
TextSentencer_T95 16824-17069 Sentence denotes Multivariate analysis showed that the only differences between the groups were related to RV-B positive co-infections, which were significantly less frequently associated with high-grade fever (OR 0.08, 95% CI 0.01-0.82) than RV-A co-infections.
TextSentencer_T96 17071-17253 Sentence denotes Our data confirm the findings of epidemiological studies of RV infections using molecular diagnostics, i.e. the high frequency of the association between RVs and pediatric CAP [17] .
TextSentencer_T97 17254-17406 Sentence denotes However, given the very large number of infectious agents sought by us, they add significant information concerning the potential causative role of RVs.
TextSentencer_T98 17407-17600 Sentence denotes Using molecular methods capable of identifying 17 different respiratory viruses, we found RVs in more than 28% of our patients with radiographically confirmed pediatric CAP, second only to RSV.
TextSentencer_T99 17601-17894 Sentence denotes The presence of a virus in the nasopharynx of a child with CAP does not necessarily mean that it is the etiological agent because it may only indicate a coincidental upper airways infection, or be due to a carrier state or the prolonged shedding of a pathogen that caused a previous infection.
TextSentencer_T100 17895-18113 Sentence denotes This may be particularly important in the case of RVs because a number of epidemiological studies have shown that they can be found in the respiratory secretions of 12-22% of asymptomatic subjects [18] [19] [20] [21] .
TextSentencer_T101 18114-18225 Sentence denotes We looked for most of the known respiratory viruses with methods able to give reliable results in a short time.
TextSentencer_T102 18226-18525 Sentence denotes However, because all the viral samples were evaluated some days after respiratory specimens' collection, we did not ascertain the impact that the availability of the information due to this method could have had on physician's behavior, particularly as far as antibiotic prescriptions are concerned.
TextSentencer_T103 18526-18713 Sentence denotes This can explain why in almost all our patients antibiotic therapy was initiated and maintained for the entire period recommended by Italian pediatric guidelines for the treatment of CAP.
TextSentencer_T104 18714-18869 Sentence denotes Further studies that evaluate the impact on antimicrobial prescribing of viral findings with methods able to identify multiple viruses should be performed.
TextSentencer_T105 18870-18984 Sentence denotes In our study population, we found RVs as a single agent in about 60% of the children in which RVs were identified.
TextSentencer_T106 18985-19163 Sentence denotes This strongly suggests that RVs were the cause of the CAP diagnosed in many of our study patients, particularly in those in whom very low values of WBC counts and CRP were found.
TextSentencer_T107 19164-19311 Sentence denotes However, it cannot be excluded that in some of these cases RVs could have been associated with bacteria as recently found by Honkinen et al. [22] .
TextSentencer_T108 19312-19591 Sentence denotes Unfortunately, definition of bacterial etiology of lower respiratory tract infections is very difficult, particularly in younger children because the poor co-operation of the patient does not easily permit the collection of the secretions coming from the lower respiratory tract.
TextSentencer_T109 19592-19857 Sentence denotes Moreover, microbiological evaluation of the sputum, as performed by Honkinen et al. [22] , does not necessarily lead to the identification of the true etiology because bacteria might be contaminants from the nasopharynx and are frequently carried by young children.
TextSentencer_T110 19858-20228 Sentence denotes On the other hand, blood culture, that was performed in this study in all the enrolled children, or molecular methods specifically devoted to the identification of bacterial pathogens in blood samples can give only a partial contribution to the solution of the problem because bacteremic CAPs are only the smallest part of the total number of CAPs diagnosed in children.
TextSentencer_T111 20229-20515 Sentence denotes The incidence of CAP associated with RV infection was a little higher in the children aged <1 year than in the other age groups, but the prevalence of cases due to RV alone was highest among the older children: more than one-third of these cases was found in the patients aged ≥4 years.
TextSentencer_T112 20516-20899 Sentence denotes This is in line with the finding of Miller et al. [23] who found that CAP is the most frequent cause of RV-associated hospitalisations in children aged 24-50 months, whereas other diseases are more frequent causes in younger patients, and this seems to suggest that, unlike RSV (whose importance is strictly age-related) [24] , RVs are also a frequent cause of CAP in older children.
TextSentencer_T113 20900-21114 Sentence denotes The role of RVs as causes of CAP in older children is further supported by the frequency of RVassociated LRTIs in children aged 1-15 years, including pneumonia severe enough to require mechanical ventilation [25] .
TextSentencer_T114 21115-21263 Sentence denotes In our study population, the most frequently detected RVs associated with pediatric CAP were in the RV-A group, followed by RV-C and RV-B pathogens.
TextSentencer_T115 21264-21514 Sentence denotes In this regard, our data are similar to those of Xiang et al. [26] , but are different from those of Calvo et al. [27] and Linsuwanon et al. [28] , who studied patients with LRTIs and found that RV-B pathogens were predominant when CAP was diagnosed.
TextSentencer_T116 21515-21639 Sentence denotes However, these studies enrolled a and included patients whose diagnosis of CAP was not confirmed by chest radiography [28] .
TextSentencer_T117 21640-21781 Sentence denotes We only enrolled children whose radiographic findings were consistent with CAP, and the study was carried out in the winter and early spring.
TextSentencer_T118 21782-21989 Sentence denotes It is also worth noting that the circulation of RV strains can significantly differ from place to place and from month to month [3] , and that their importance in causing LRTIs other than CAP may vary [29] .
TextSentencer_T119 21990-22248 Sentence denotes Consequently, it is possible that some studies enrolled children but with an LRTI other than CAP, and that the final prevalence rates may have been affected by the different circulation of the various RVs during the year and/or in different places [27, 28] .
TextSentencer_T120 22249-22432 Sentence denotes Regardless of the type of RV involved in causing the disease, the clinical and laboratory characteristics of CAP were only slightly different in the children with single RV infection.
TextSentencer_T121 22433-22779 Sentence denotes Most of the cases were relatively mild as only CRP C-reactive protein, RV rhinovirus, SD standard deviation, SpO 2 peripheral oxygen saturation a 38.0°C or more any time during the illness (before or upon enrolment, or during follow-up) b 39.0°C or more any time during the illness (before or upon enrolment, or during follow-up) *p<0.05 vs RV-C.
TextSentencer_T122 22780-22932 Sentence denotes No other significant between-group differences two-thirds of the children were hospitalised and none of them needed admission to an intensive care unit.
TextSentencer_T123 22933-23204 Sentence denotes In terms of the clinical role of the different types of RV, our findings are similar to those of by Xiang et al. [26] , but once again, different from those of Linsuwanon et al. [28] , who found a significantly higher incidence of severe CAP in children infected by RV-B.
TextSentencer_T124 23205-23329 Sentence denotes However, as said above, this difference may be explained by the possible inclusion of cases with a diagnosis other than CAP.
TextSentencer_T125 23330-23567 Sentence denotes Interestingly, the chest radiographs of a considerable number of the children with CAP and RV infection (regardless of the type of RV) suggested alveolar involvement, a finding that is usually considered indicative of bacterial etiology.
TextSentencer_T126 23568-23687 Sentence denotes However, none of our children with RV infection alone had a blood culture suggesting a concomitant bacterial infection.
TextSentencer_T127 23688-23950 Sentence denotes The fact that some of the patients had received antibiotics before they were enrolled would have limited the possibility of identifying bacteria, but it is reasonable to think that the alveolar CAP was directly due to the RV infection in a large number of cases.
TextSentencer_T128 23951-24097 Sentence denotes On the other hand, alveolar involvement has been previously found in patients with LRTIs due to other viruses such as human metapneumovirus [30] .
TextSentencer_T129 24098-24266 Sentence denotes In terms of the social impact of RV infection, our analyses showed that RV-C was associated with a significantly lower incidence of similar illnesses within the family.
TextSentencer_T130 24267-24486 Sentence denotes This suggests that RV-C pathogens are less widespread in the community but it is difficult to explain as there are no published data concerning possible differences in the duration of shedding of the various RV strains.
TextSentencer_T131 24487-24606 Sentence denotes Further studies should clarify whether ours is a chance finding or due to a difference in the shedding of RV-C strains.
TextSentencer_T132 24607-24758 Sentence denotes The clinical importance of viral co-infections is questioned because the data regarding the severity of single and multiple infections are conflicting.
TextSentencer_T133 24759-24997 Sentence denotes It has been found that RVs have no illness-promoting effect in the case of coinfections with RSV or influenza viruses [11] , but it has also been demonstrated that RV and adenovirus coinfections can cause severely obstructive LRTIs [31] .
TextSentencer_T134 24998-25121 Sentence denotes There are few data concerning the possible additive effect of multiple viral infections including RVs in children with CAP.
TextSentencer_T135 25122-25293 Sentence denotes Most of the co-infections observed during our study involved RSV, which may explain why we found only marginal clinical differences between single and multiple infections.
TextSentencer_T136 25294-25569 Sentence denotes The high incidence of co-infections with RSV, a virus that mainly causes lower respiratory tract involvement (including bronchiolitis) in the first months of life, also reasonably explains why the co-infected children had a younger mean age than those with single infections.
TextSentencer_T137 25570-25838 Sentence denotes However, the lack of any significant difference in almost all of the clinical and laboratory findings between the children with single RV infections of all types and RV coinfections confirms that all of the RV strains played a similar clinical role in determining CAP.
TextSentencer_T138 25839-25872 Sentence denotes This study has three limitations.
TextSentencer_T139 25873-26017 Sentence denotes First of all, it covered only some months of a single year and the activity of respiratory viruses can significantly vary from season to season.
TextSentencer_T140 26018-26140 Sentence denotes Second, it was confined to a single centre and so the cohort of enrolled children may not reflect nationwide RV infection.
TextSentencer_T141 26141-26398 Sentence denotes Third, it only enrolled children attending a hospital and, as it is highly likely that hospital assistance was not sought for some children with milder CAP, our data may not correctly estimate the true importance of RV as a potential cause of pediatric CAP.
TextSentencer_T142 26399-26552 Sentence denotes However, despite these limitations, we believe that our findings extend current knowledge of the clinical importance of RVs as causes of CAP in children.
TextSentencer_T143 26553-26729 Sentence denotes RV-associated CAP seems to be common not only in the first years of life but also in older children, and RV-A is the strain that is most frequently associated with the disease.
TextSentencer_T144 26730-26902 Sentence denotes The clinical relevance of RV-associated CAP seems to be mild-moderate, without any substantial differences between the old A and B strains and the recently identified RV-C.
TextSentencer_T145 26903-26994 Sentence denotes Co-infections with other viruses do not seem to increase the severity of RV-associated CAP.
TextSentencer_T146 26995-27179 Sentence denotes All of these data are important for the management of pediatric CAP, the identification of the pathogens that require further study, and the development of safe and effective vaccines.