Rhinovirus causes increased acute symptoms in children with first time wheezing compared to either controls with cold symptoms or children with first time wheezing and Respiratory Syncytial Virus.

RATIONALE: Rhinovirus (RV) and Respiratory Syncytial Virus (RSV) are drivers of asthma inception in children. We evaluate viral genomes and microbiomes of children with first time wheezing (FTW) (n=21) and controls with colds (n=36) and compare clinical markers of disease severity to determine differences between acute illness with either virus in each group.

METHODS: Children ages 7 days to 4 years were recruited from Arkansas Children’s Hospital Emergency Department. Pediatric Respiratory Symptom Score (PRSS) and Modified Jackson Criteria (MJC) surveys were completed. Nasopharyngeal swabs were obtained and sent for viral genome sequencing, qPCR testing for RV, and 16S ribosomal RNA for microbiome. Clinical data of children with RV, RSV, or no identified virus were compared between FTW and controls. Microbiome data was evaluated for bacterial abundance associated with viral wheezing.

RESULTS: FTW with RV had higher PRSS than controls with RV, RSV, or no identified virus (p<0.05). FTW with RV had higher PRSS than those FTW with RSV (p=0.05). There were significant differences in lower respiratory symptoms (LRS) by MJC between FTW and controls with RV (p<0.05); however, there were no differences between LRS in FTW and controls with RSV. At the genus level, controls with virus trended towards more Corynebacterium than those FTW with virus (p=0.06).

CONCLUSIONS: RV causes increased acute symptoms in FTW compared to RSV by PRSS. RV causes more LRS by MJC in FTW than controls, while RSV causes LRS in FTW and controls, equally. These findings suggest a subset of children that develop LRS with RV, requiring further study.