Respiratory infection with human bocavirus 1. Report of a case of viral pneumonia in an infant without comorbidity

Abstract

Abstract: 

Human Bocavirus-1/HBoV1 causes acute respiratory infections/ARI (bronchiolitis/pneumonia) mostly in young children. It was identified in 2005 and has not yet been incorporated into the routine virus screening in ARI. Symptoms of viral pneumonia in children less than 2 years old are often interpreted as of bacterial etiology, leading to unnecessary administration of antibiotics. Objective: to report the case of a previously healthy infant who developed HBoV1 pneumonia without complications, in order to consider HBoV1 as one of the possible agents involved.

Clinical case. 19-month-old female, full-term/2780 grams. No relevant personal or familiar pathological history; complete vaccination.

Reason for consultation: fever, cough, and shortness of breath. Antecedents: 3 days before, she started with rhinitis and dry cough. She had a fever peak of 38.7°C, so her pediatrician prescribed oral amoxicillin. On Apr/26/2021 she went to the emergency service due to persistent fever and worsening cough. Mild/moderate respiratory distress was observed; inhaled adrenergic drugs were administered, with good clinical response and outpatient follow-up (prior swabbing for COVID-19). The next day, she returned with food rejection and was hospitalized. Laboratory: hemoglobin 10.9g/dl, hematocrit 34%; leukocytes: 15,380 (69/15/15); platelets 299,000/ml; gases: 7.48/27.2/84.2/19.9/-2.1); ionogram Na 134/K 4/Cl 100; CRP: 17.8. Chest X-ray compatible with viral pneumonia. O2 saturation: 93%. Amoxicillin was suspended; hydration, oxygen by nasal cannula (3 liters/min) and inhaled salbutamol were administered. The complete panel of respiratory viruses was negative (RSV, Parainfluenza 1-3, Metapneumovirus, Influenza A/B and Adenovirus by IF; PCR for COVID-19: negative). HBoV1 detected in nasal secretions and serum (PCR with high viral load/>1x106 c.gen/mL) was the only positive finding. Evolution: 48 hours after admission she was afebrile; O2 saturation 95%; supplementary oxygen therapy was suspended. Patient was discharged without complications. In the follow-up (10 days) she did not show relapses or respiratory symptoms, so aerosol therapy was suspended.

Conclusions. A case of HBoV1 infection in an infant with no comorbidity is reported. Recognition of the viral etiology in hospitalized cases of pneumonia contributes to optimize the clinical management of patients with rational use of antibiotics. HBoV1 should be included in the standard screening for respiratory infections in hospitalized infants.