Children with inborn errors of metabolism (IEMs) are recognized as a population at increased risk for severe infections that can precipitate acute metabolic deterioration, need for intensive care, and death. The pathogen-specific clinical course in this group is not well characterized. The authors conducted a single-center retrospective analysis to describe the epidemiology, viral etiology, and clinical severity of laboratory-confirmed respiratory viral infections in hospitalized children with IEMs during 2018–2024.
This was a retrospective review at a single center. Inclusion criteria were children with an established IEM who were hospitalized with an acute infectious illness and had laboratory-confirmed detection of a respiratory virus during the period 2018–2024. The study recorded demographic characteristics, underlying metabolic diagnoses, identified viral pathogens, clinical presentations, and outcomes. The abstract does not provide additional methodological details such as specific virologic assays used, criteria for defining metabolic vulnerability, or treatment protocols.
A total of 45 infection episodes occurring in 41 children were analyzed. The median age at presentation was 4 years, with an interquartile range of 0.5–9.5 years. Most patients were male (31 of 41, 75.6%). The most frequent categories of IEM were disorders of amino acid metabolism (36.6% of patients) and defects in degradation and processing of complex molecules (26.8%). The abstract does not provide a full breakdown of specific metabolic diagnoses or the distribution of other IEM categories.
Respiratory disease was the predominant clinical presentation, accounting for 77.8% of infection episodes. Non-respiratory presentations included gastroenteritis (8.9%), sepsis (6.7%), and meningoencephalitis (6.7%). Among patients classified as metabolically vulnerable, acute metabolic decompensation occurred in 11 of 23 infection episodes (47.8%). The abstract does not list the specific triggers, biochemical markers, or management strategies used for decompensation.
Respiratory viruses detected in this cohort were led by influenza, identified in 35.6% of infection episodes. Other frequently detected viruses included rhinovirus (22.2%), seasonal coronavirus (sCoV) (13.3%), and respiratory syncytial virus (RSV) (11.1%). The abstract summarizes pathogen frequencies but does not detail coinfection rates, subtyping (for example influenza A vs B), temporal trends across seasons or years, or laboratory methods for viral identification.
Overall, pediatric intensive care unit (PICU) admission was required in 13.3% of infection episodes (6 of 45). Infection-related mortality was reported as 6.7% (3 of 45 episodes). Notably, seasonal coronavirus (sCoV) was detected in all three infection-related deaths. The abstract does not provide additional case-level details such as age distribution of fatal cases, presence of coinfections, specific organ failures, or whether deaths were directly attributable to viral infection versus metabolic complications.
In this hospitalized cohort of children with IEMs, influenza was the most commonly identified respiratory virus, while sCoV was present in all reported infection-related fatalities. Nearly half of infection episodes in metabolically vulnerable patients were associated with acute metabolic decompensation. These findings emphasize that respiratory viral infections can carry a substantial clinical burden in children with IEMs and support close clinical monitoring and prompt supportive management when such patients present with viral respiratory illness.
Clinicians caring for children with IEMs should maintain heightened vigilance during respiratory viral seasons, consider early assessment for metabolic instability when infection is identified, and prioritize supportive measures. The pathogen distribution reported may inform local surveillance and preventive strategies, including vaccination efforts for influenza where applicable.
The study is limited by its single-center, retrospective design and the level of detail available in the abstract. Important methodological and clinical details were not reported in the source abstract, including the specific virologic testing methods, criteria used to define metabolic vulnerability, breakdown of individual IEM diagnoses, antiviral or other therapies administered, and timing of presentations relative to viral seasonality. The abstract also does not report whether coinfections or bacterial superinfections were assessed, nor does it provide granular clinical data for the fatal cases beyond detection of sCoV.
Further multicenter and prospective studies with standardized definitions, complete virologic characterization, and detailed clinical data would help clarify pathogen-specific risks and optimal management strategies for respiratory viral infections in children with IEMs.