1778. Epidemiology and Clinical Presentation of Parainfluenza Type 4 in Children: A Three Year Comparative Study to Parainfluenza Types 1-3
Session: Poster Abstract Session: Viral Infections; Pathogenesis and Epidemiology
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Holly_Frost_Parainfluenza4Children_IDWeek_2013.png (316.0 kB)
  • Background: Human parainfluenza viruses (HPIV) are among the most common causes of respiratory tract infections in children. While HPIV types 1-3 have been well characterized, less is known about the epidemiology and clinical presentation of HPIV type 4.

    Methods: Respiratory specimens collected from patients at Children’s Hospital Colorado between 2009 and 2012 were analyzed using multiplex respiratory viral polymerase chain reaction. Retrospective chart review and comparison of patients positive for HPIV without concurrent bacterial or viral infections was performed.

    Results: Of 11,533 samples submitted, 752 (6.5%) were positive for HPIV. 316 were eligible for the study, of which 123 were positive for HPIV-1, 33 for HPIV-2, 61 for HPIV-3, and 99 for HPIV-4. HPIV-4 was identified year round, with biennial peaks in odd- numbered years when HPIV-1 also peaked. HPIV-2 and 3 had biannual peaks in fall and spring. HPIV 1-2 infected patients more often had stridor than HPIV 3-4 patients (23.6% and 24.2% vs. 6.6% and 0%, p<0.01). No patients in the HPIV-4 group had croup.  Clinical presentation of HPIV-4 most often resembled HPIV-3. Hypoxia was more frequent in the HPIV 3-4 groups than the HPIV 1-2 groups (50.8% and 51.5% vs.  20.3% and 33.3%, (p<0.01).  More patients with HPIV3-4 were admitted for neurologic reasons than HPIV 1-2 (9.8% and 10.1% vs. 0.8% and 6.1%, p<0.01).  All HPIV groups had similar lengths of stay and mortality.

    Conclusion: This study presents the first large scale description of HPIV-4 clinical and epidemiologic features in children. Clinical presentation and severity of HPIV-4 infections most closely resembled HPIV-3 infections. HPIV-4 was the only HPIV type not associated with croup.  HPIV-4 was detected year round, with peaks in the fall of odd numbered years. HPIV-4 is a common and under-appreciated respiratory pathogen capable of causing considerable morbidity in pediatric patients.

    Holly M. Frost, MD, Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, Christine C. Robinson, PhD, Children's Hospital Colorado, Denver, CO; Department of Pathology and Clinical Medicine, The Children's Hospital, University of Colorado Health Science Center, Denver, CO and Samuel R. Dominguez, MD, PhD, Pediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO


    H. M. Frost, None

    C. C. Robinson, None

    S. R. Dominguez, None

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