Molecular Characterization of Respiratory Viral Infections and Co-Infections in Pediatric Patients Using FilmArray™ Multiplex PCR in a Tertiary-Care Hospital, South India

Year : 2026 | Volume : 16 | Issue : 02 | Page : 57 66
By

A. Vivek Vishnu,

Kavitha M.P,

Dilip,

Ezhilarasan,

  1. Molecular Biology Specialist, Department of Molecular Biology, Aster Clinical Labs LLP, Bengaluru, Karnataka, India
  2. Lab Head and HOD, Microbiology and Molecular Biology, Department of Microbiology and Molecular Biology, Aster Clinical Labs LLP, Bengalur, Karnataka, India
  3. Executive (Molecular Biology), Department of Molecular Biology, Aster Clinical Labs LLP, Bengaluru, Karnataka, India
  4. Technician (Molecular Biology), Department of Molecular Biology, Aster Clinical Labs LLP, Bengaluru, Karnataka, India

Abstract

Respiratory tract infections (RTIs) are a major cause of pediatric morbidity worldwide, with viruses, such as respiratory syncytial virus, rhinovirus/enterovirus, influenza virus, adenovirus, and parainfluenza virus, contribute significantly to hospitalizations. Conventional diagnostic methods often require prolonged processing times, which can delay clinical decision-making. Rapid molecular platforms, such as the FilmArray™ Panels, offer timely and comprehensive pathogen identification. This study aimed to evaluate the prevalence, seasonal trends, and co-infection patterns of respiratory pathogens among hospitalized children in South India using FilmArray™ Respiratory Panel. This study analyzed data from children under 10 years of age admitted with RTIs in a single pediatric-care hospital between August 2023 and March 2025. All the patients underwent testing with the FilmArray™ Respiratory Panel using nasopharyngeal swabs in Viral transport medium. Demographic characteristics, pathogen distribution, and Inflammatory markers – such as C-reactive protein (CRP) and neutrophil counts – were reviewed. Among the 248 children studied, rhinovirus/Enterovirus (26.63%), respiratory syncytial virus (14%), and adenovirus (13.55%) were the most frequently detected respiratory pathogens, followed by Mycoplasma pneumoniae (11.2%) and other viral agents included in the panel. A notable co-infection rate (28.6%) was identified, indicating concurrent circulation of multiple viruses. A subset of children showed elevated CRP levels and neutrophilia, suggesting a stronger inflammatory response. This study highlights the significant burden of respiratory syncytial virus, Rhinovirus/Enterovirus, and other viral RTIs among pediatric children in South India. Molecular Characterization using Film Array Respiratory Panel demonstrated high utility in rapid and accurate pathogen identification, enabling improved clinical decision-making and strengthening antibiotic stewardship decisions, thereby improving patient outcomes. 

Keywords: Molecular diagnostics, multiplex-PCR, respiratory tract infections, BioFire FilmArray, molecular epidemiology

[This article belongs to Research and Reviews: A Journal of Microbiology and Virology ]

How to cite this article: A. Vivek Vishnu, Kavitha M.P, Dilip, Ezhilarasan. Molecular Characterization of Respiratory Viral Infections and Co-Infections in Pediatric Patients Using FilmArray™ Multiplex PCR in a Tertiary-Care Hospital, South India. Research and Reviews: A Journal of Microbiology and Virology. 2026; 16(02):57-66.
How to cite this URL: A. Vivek Vishnu, Kavitha M.P, Dilip, Ezhilarasan. Molecular Characterization of Respiratory Viral Infections and Co-Infections in Pediatric Patients Using FilmArray™ Multiplex PCR in a Tertiary-Care Hospital, South India. Research and Reviews: A Journal of Microbiology and Virology. 2026; 16(02):57-66. Available from: https://journals.stmjournals.com/rrjomv/article=2026/view=257065

References

  1. Sambo KH, Samuel J, Yakubu N, Mohammad A, Sulaiman M. Antibiotic Resistance Profiles of Bacterial Isolates from Students’ Hands: Implications for Public Health. Health Science Research International. 2026 May 12;3(2):142-6.
  2. World Health Organization: WHO. Influenza (seasonal). Who.int. World Health Organization: WHO; 2019. Available from: https://www.who.int/health-topics/influenza-seasonal#tab=tab_1
  3. Centers for Disease Control and Prevention. Increased Respiratory Syncytial Virus (RSV) Activity in Parts of the Southeastern United States: New Prevention Tools Available to Protect Patients [September 05, 2023, 2:00 PM ET].
  4. Zimmermann P, Curtis N. Why is COVID-19 less severe in children? A review of the proposed mechanisms underlying the age-related difference in severity of SARS-CoV-2 infections. Archives of disease in childhood. 2021 May;106(5):429-39.
  5. Haddadin Z, Schuster JE, Spieker AJ, Rahman H, Blozinski A, Stewart L, Campbell AP, Lively JY, Michaels MG, Williams JV, Boom JA. Acute respiratory illnesses in children in the SARS-CoV-2 pandemic: prospective multicenter study. Pediatrics. 2021 Aug 1;148(2):e2021051462.
  6. Waites KB, Xiao L, Liu Y, Balish MF, Atkinson TP. Mycoplasma pneumoniae from the respiratory tract and beyond. Clin Microbiol Rev. 2017;30(3):747–809.
  7. Ramanan P, Bryson AL, Binnicker MJ, Pritt BS, Patel R. Syndromic panel-based testing in clinical microbiology. Clinical microbiology reviews. 2018 Jan;31(1).
  8. Merckx J, Wali R, Schiller I, Caya C, Gore GC, Chartrand C, et al. Diagnostic accuracy of novel and traditional rapid tests for influenza infection compared with reverse transcriptase polymerase chain reaction: A systematic review and meta-analysis. Ann Intern Med. 2017;167(6):394–409.
  9. Babady NE. The FilmArray® respiratory panel: An automated, broadly multiplexed molecular test for the rapid and accurate detection of respiratory pathogens. Expert Rev Mol Diagn. 2013 Nov 1;13(8):779–88.
  10. Pierce VM, Elkan M, Leet M, McGowan KL, Hodinka RL. Comparison of the Idaho Technology FilmArray system to real-time PCR for detection of respiratory pathogens in children. J Clin Microbiol. 2012 Feb;50(2):364–71.
  11. Anand M, Nimmala P. Seasonal incidence of respiratory viral infections in Telangana, India: Utility of a multiplex PCR assay to bridge the knowledge gap. Trop Med Int Health. 2020 Dec;25(12):1503–9.
  12. Chadha MS, Hirve S, Dawood FS, Lele P, Deoshatwar A, Sambhudas S, Juvekar S, LaFond KE, Mott JA, Lal RB, Mishra AC. Burden of seasonal and pandemic influenza-associated hospitalization during and after 2009 A (H1N1) pdm09 pandemic in a rural community in India. PloS one. 2013 May 15;8(5):e55918.
  13. Hirve S, Newman LP, Paget J, Azziz-Baumgartner E, Fitzner J, Bhat N, Vandemaele K, Zhang W. Influenza seasonality in the tropics and subtropics–when to vaccinate?. PloS one. 2016 Apr 27;11(4):e0153003.
  14. Caldwell JM, Espinosa CM, Banerjee R, Domachowske JB. Rapid diagnosis of acute pediatric respiratory infections with Point-of-Care and multiplex molecular testing. Infection. 2025 Jun;53(Suppl 1):1-4.
  15. Tsai TA, Tsai CK, Kuo KC, Yu HR. Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children. J Microbiol Immunol Infect. 2021;54(4):557–565.
  16. Tang M, Wang D, Tong X, Wu Y, Zhang J, Zhang L, Yin Y, Cao Q. Comparison of different detection methods for Mycoplasma pneumoniae infection in children with community-acquired pneumonia. BMC pediatrics. 2021 Feb 19;21(1):90.
  17. Yen TY, Chen JF, Lu CY, Wu ET, Wang CC, Lu FL, Huang LM, Chang LY. Application of nested multiplex polymerase chain reaction respiratory and pneumonia panels in children with severe community‐acquired pneumonia. Journal of Medical Virology. 2023 Jan;95(1):e28334.
  18. Tiew WT, Chen YC, Hsiao HL, Chen CL, Chen CJ, Chiu CH. Impact of multiplex polymerase chain reaction syndromic panel on antibiotic use among hospitalized children with respiratory tract illness during COVID-19 pandemic. Journal of Microbiology, Immunology and Infection. 2023 Aug 1;56(4):688-94.
  19. Agarwal A, Chakma N, Manchanda V, Dabas A. Virological profile of upper respiratory tract infections in children under 5 years of age-a cross sectional study in a tertiary care hospital in North India. Indian Journal of Medical Microbiology. 2023 Jul 1;44:100378.
  20. Maglione M, Tipo V, Barbieri E, Ragucci R, Ciccarelli AS, Esposito C, Carangelo L, Giannattasio A. Changes in respiratory viruses’ activity in children during the COVID-19 pandemic: a systematic review. Journal of clinical medicine. 2025 Feb 19;14(4):1387.
  21. Singh M, Gupta A, Agarwal A, Singh V, Omar B. Precision diagnosis of viral respiratory infections: Unleashing the power of multiplex polymerase chain reaction (PCR) for enhanced infection management. Cureus. 2024 Nov 5;16(11):e73100.
  22. Gao L, Sun Y. Laboratory diagnosis and treatment of Mycoplasma pneumoniae infection in children: a review. Annals of medicine. 2024 Dec 31;56(1):2386636.
  23. Ding G, Zhang X, Vinturache A, van Rossum AM, Yin Y, Zhang Y. Challenges in the treatment of pediatric Mycoplasma pneumoniae pneumonia. European Journal of Pediatrics. 2024 Jul;183(7):3001-11.
  24. Khan T, Das RS, Jaiswal A, Halder S, Majhi RM, Mahato A, Ghosh T, Satpathi P, Bhattacharya SD. Epidemiology and surveillance of influenza, RSV and SARS-CoV-2 in children admitted with severe acute respiratory infection in West bengal, India from 2022 to 2023. BMC Infectious Diseases. 2025 Aug 20;25(1):1047.
  25. Kumar S, Saigal SR, Kumar S, Sethi GR. Mycoplasma pneumoniae among children hospitalized in a tertiary hospital with community-acquired lower respiratory tract infections. Indian journal of medical microbiology. 2025 Jan 1;53:100781.
  26. Singh M, Gupta A, Agarwal A, Singh V, Omar B. Precision diagnosis of viral respiratory infections: Unleashing the power of multiplex polymerase chain reaction (PCR) for enhanced infection management. Cureus. 2024 Nov 5;16(11):e73100.
Regular Issue Subscription Original Research
Volume 16
Issue 02
Received 01/08/2026
Accepted 20/08/2026
Published 21/08/2026
Publication Time 20 Days

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