Pediatric respiratory viral infection failure: A case series of eight fatalities in children under 5 years old in Iran

Mahnaz Ramzali¹Saeed Samadizadeh²Mohsen Ebrahimi³Leila Barati³Britt Nakstad⁴Alireza Tahamtan^5*

• ¹Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
• ²Wellcome-Wolfson Centre for Experimental Medicine, Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
• ³Clinical Research Development Unit, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
• ⁴Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
• ⁵Golestan University of Medical Sciences, Gorgan, Iran

Acute respiratory tract infection (ARTI) is a significant health concern for children under five, causing illness and deaths worldwide. According to WHO, more than 12 million children are hospitalized annually due to ARTI, and around one million die. A third of the fatalities occur in low-income countries. The respiratory tract hosts a variety of microorganisms, with pathogenic respiratory viruses and bacteria being the primary causes of ARTI. The most prevalent viruses linked to ARTIs are respiratory syncytial virus (RSV), human metapneumovirus (HMPV), influenza viruses, human parainfluenza viruses (HPIVs), human rhinovirus (HRV), and human coronaviruses (HCoVs). Among them, RSV is widespread and can cause a range of clinical symptoms and manifestations, including life-threatening illnesses, particularly in high-risk cases such as infants with chronic lung disease or congenital heart disease, prematurity, and children with weakened immune systems.Multiple risk factors, such as age, gender, living environment, seasonality, and underlying diseases, can significantly affect the severity of the disease. Publishing detailed case series, including characteristics and outcomes of ARTI in children, particularly those with complex underlying diseases, is important for describing the impact and outcomes of ARTI among children and assisting clinicians in managing complicated cases. Here, we report a case series of eight pediatric patients from Taleghani Children's Hospital in Gorgan, northern Iran, who tragically succumbed to viral respiratory infections. As all cases presented symptoms suspected to the viral respiratory infections, so the cases have been tested for respiratory viruses. This showed that infections other than RSV, such as HMPV, HRV, HPIV, and SARS-CoV-2, can lead to severe respiratory failure and fatalities in children with underlying health conditions.