BV Score Differentiates Viral from Bacterial-Viral Infection in Adenovirus PCR Positive Children

Background and Objectives: Adenovirus is one of the major pathogens causing acute pediatric respiratory illness that often mimics bacterial infection, making it challenging to differentiate adenoviral infection from adenoviral-bacterial infection. A host-protein score (BV score) for differentiating bacterial from viral infection that combines the expression levels of TNF-related apoptosis-induced ligand, interferon gamma-induced protein-10, and C-reactive protein exhibited a negative predictive value (NPV) of 98% in prior studies. Here we evaluate BV score`s performance in children with adenovirus PCR detection.

Methods: A retrospective analysis was performed on adenovirus PCR-positive children aged 3 months to 18 years recruited in two prospective studies, CURIOSITY (NCT01917461) and OPPORTUNITY (NCT01931254). Reference standard infection etiology was adjudicated by independent experts based on clinical, laboratory, microbiological, and radiological data. The BV score ranges from 0 to 100 and provides three results: viral (0-34), equivocal (35-65) and bacterial (66-100). Experts were blinded to BV score results.

Results: Out of 1779 children, 142 met inclusion criteria and were PCR-positive for adenovirus. 12 cases were adjudicated as bacterial, 115 as viral and 15 were indeterminate. The median age of the cohort was 1.2 (IQR 1.2) years, 50.4% were male and 52.8% were hospitalized. The BV score attained sensitivity of 100.0% (95% CI 100.0%-100.0%) specificity of 89.5% (83.2%-95.8%), and NPV of 100.0% (92.6%-100.0%). The equivocal rate was 19.7%.

Conclusions: The BV score accurately differentiates between adenoviral and bacterial-adenoviral infection in children with PCR-positive adenovirus detection, supporting potential to improve appropriate antibiotic use in this population.