Improved multiplex PCR detection methods are facilitating the correlation of the etiology of respiratory tract infections with specific symptoms or clinical manifestations. We conducted a retrospective analysis of the incidence of respiratory pathogens and initial symptoms in 1,286 patients at a tertiary care center tested by multiplex respiratory pathogen PCR from July 1, 2012, to June 30, 2013. Rhinovirus/enterovirus (Rhino/Entero) infections were the most prevalent (25.4%) followed by respiratory syncytial virus (RSV) (13.6%) and influenza A (6.2%). Eleven percent of patients were positive for multiple analytes with Rhino/Entero and RSV being the most common combination. Asthma or asthma exacerbation was the most common presenting symptom in patients positive for Rhino/Entero (38.4%) or positive for Rhino/Entero along with RSV or hMPV (34.8%). Of the patients positive for Rhino/Entero and presenting with asthma, 97% were ≤17 years of age. RSV positive patients most commonly presented with respiratory distress (40.3%) followed by asthma (18%) or pneumonia (18%). The most prevalent initial clinical manifestation for influenza was fever (27.4%) followed by respiratory distress (13%) or pneumonia (11.9%). The significant percentage of patients positive for Rhino/Entero virus presenting with asthma supports the role of rhinovirus as an important trigger for asthma exacerbation. 1. Introduction Acute respiratory tract illnesses are the most frequent illnesses of humans and are an important cause of disability and days lost from school or work [1, 2]. Respiratory infections are an important cause of mortality and hospitalization, particularly in the winter in temperate regions. In children less than 5 years of age, they are the leading cause of death [3]. Most acute respiratory infections are caused by viruses and bacteria, including rhinoviruses, respiratory syncytial viruses, adenoviruses, influenza viruses, and parainfluenza viruses. Many viruses have characteristic seasonal patterns. Influenza virus and respiratory syncytial virus (RSV) often contribute to the winter peak, but other respiratory viruses such as human metapneumovirus (hMPV), parainfluenza viruses (Para), and coronaviruses (CoronaV) also circulate in the fall and winter [4, 5]. Respiratory viruses such as adenovirus (Adeno) and rhinovirus cause illness year-round. An association between these specific respiratory agents and certain clinical syndromes has been shown to some degree [2]. Knowledge of the clinical signs and symptoms that are most predictive of the etiologic agent could help
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