Comprehensive analysis of severe human rhinovirus pneumonia in children: epidemiology, clinical features, and genotype-specific correlations

Abstract Background Comprehensive reports on severe human rhinovirus pneumonia (S-HRVP) in children remain limited. This study aimed to explore the epidemiology, clinical symptoms, imaging features and treatment of S-HRVP. Methods Our study retrospectively analyzed 131 pediatric cases of S-HRVP. Clinical data including general manifestations, complications, radiological features, HRV genotypes, co-infections and treatment were retrospectively analyzed. Results S-HRVP was detected in 4.59% (131/2856), with the highest incidence in children aged 4-6 years (38.17%) and co-infection was nearly universal (96.18%, 126/131). A total of 301 co-pathogens (158 bacteria, 46 viruses, 9 fungus and 88 Mycoplasma pneumoniae (MP)) were identified in S-HRVP in children, the most prevalent pathogen was MP (29.24%,88/301), followed by Streptococcus pneumoniae (SPn) (14.29%,43/301). Biannual peaks were observed in spring (March) and autumn (November). Clinically, cough (94.66%) and fever (81.68%) were predominant, with pulmonary consolidation (70.99%, 93/131) and pleural thickening (49.62%, 65/131) as the main imaging finding. Comparative analysis revealed significant inter-species differences: children with HRV-C were younger, had a higher prevalence of wheezing 44.83% (HRV-C) vs. 15.94% (HRV-A) and 15.00% (HRV-B), and a greater likelihood of Pediatric Intensive Care Unit (PICU) admission (24.14% vs. 2.90%-15% for A/B). Conversely, HRV-A infection was associated with longer durations of fever and cough. Regarding treatment, the utilization rate of fiberoptic bronchoscopy with no significant differences in three groups (P=0.7490). However, the use of Intravenous Immunoglobulin (IVIG) therapy differed significantly (p=0.0485) (HRV-B vs. HRV-A/C, 15.00% vs. 1.45%/3.45%). Conclusions HRV is frequently associated with co-infections with other pathogens in S-HRVP. Different HRV genotypes may be associated with distinct clinical presentations and potentially different treatment considerations in severe pneumonia, and no significant differences in imaging findings have been observed among the various genotypes.