Chest CT patterns linked to severity in children with human bocavirus

Uneven lung inflation and atelectasis on chest computed tomography were independently associated with critical illness in hospitalized children with PCR-confirmed human bocavirus mono-infection, according to a retrospective cohort study. Ground-glass opacity, the most common CT finding, occurred in more than 90% of cases across all severity groups and was not associated with critical disease.

The researchers analyzed 194 children younger than 18 years who were hospitalized with lower respiratory tract infection and human bocavirus detected by PCR between September 2022 and December 2023. Investigators classified disease as moderate, severe or critical. Two pediatric radiologists independently reviewed the CT images while blinded to the clinical severity classifications, and logistic regression was used to assess associations between imaging findings and critical illness.

Of the 194 children, 124, or 63.9%, had moderate disease, 46, or 23.7%, had severe disease, and 24, or 12.4%, had critical disease. Ground-glass opacity appeared in more than 90% of patients in every category. Because this feature was consistently present throughout the severity range, it did not distinguish critical illness from moderate or severe disease in the cohort.

Uneven lung inflation showed a stepwise increase in prevalence as clinical severity rose. It was identified in 24.2% of children with moderate disease, 54.3% of those with severe disease and 66.7% of those with critical illness, with a statistically significant difference among the groups (P < 0.001). The study reported an association between the imaging feature and greater severity, rather than evidence that uneven inflation caused the clinical worsening.

After adjustment for age and sex, uneven lung inflation was independently associated with critical illness, with an adjusted odds ratio of 3.74 and a 95% confidence interval of 1.53–9.82 (P = 0.005). Atelectasis was also independently associated with critical illness, with an adjusted odds ratio of 3.51 and a 95% confidence interval of 0.99–11.08 (P = 0.038). The atelectasis confidence interval extended close to 1, indicating appreciable uncertainty around that estimate.

Kaplan–Meier analysis examined whether the imaging findings were associated with the duration of hospitalization. Uneven lung inflation was associated with longer hospital stays, with a significant difference between groups (log-rank P = 0.048). Atelectasis showed a similar trend toward longer hospitalization, but the association was not statistically significant. The duration analysis therefore provided stronger statistical support for uneven lung inflation than for atelectasis.

The results distinguish a nearly ubiquitous CT abnormality from findings whose frequency increased with clinical severity. Ground-glass opacity was observed consistently across the three disease categories and showed no association with critical illness. In contrast, uneven lung inflation and atelectasis remained associated with critical illness after adjustment for age and sex, while only uneven lung inflation was significantly associated with longer hospitalization.

The findings have boundaries imposed by the study design and population. This was a retrospective analysis of hospitalized children with PCR-confirmed human bocavirus mono-infection and lower respiratory tract infection; it does not directly describe children with other manifestations of the infection or those treated outside hospital. Although the regression analysis accounted for age and sex, the observational design cannot exclude other clinical factors that could influence both CT findings and disease severity, and the findings do not establish a clinical prediction rule or causal relationship.

Subject of Research: Chest CT features associated with disease severity in children with human bocavirus mono-infection

Article Title: Association between chest CT features and disease severity in children with human bocavirus mono-infection: a retrospective cohort study

Article References: Lao, Y., Lin, L., Wu, Y., & Huang, L. (2026). Association between chest CT features and disease severity in children with human bocavirus mono-infection: a retrospective cohort study. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14339-7

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14339-7

Keywords: human bocavirus, pediatric infection, chest CT, lower respiratory tract infection, disease severity, uneven lung inflation, atelectasis, ground-glass opacity, Association, between, chest, features