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In our study, HBoV and RV were the most common concomitantly detected viruses. Of those with HBoV in the sputum, 79% also had other viruses detected. This high rate of HBoV co-infection is in concordance with many previous studies [16,19,20]. The clinical consequences of mixed infections are not fully learn more understood. Some evidence suggests that mixed viral�Cbacterial infections may potentially induce more severe disease than individual viral or bacterial infections [21�C23]. Previously, mixed influenza virus�CS. aureus infection has been shown to be able to cause severe, fatal pneumonia in children [22�C25], and mixed RV�CS.?pneumoniae infection has been shown to be associated with severe pneumonia in adults [26]. In children with invasive pneumococcal disease, viral co-infections are also common and are possibly associated with higher mortality [27]. Limited evidence suggests that viral co-infections may also induce more severe clinical illness than individual viral infections. Cilla et?al. [4] have reported children with viral co-infections being hospitalized more frequently than those infected with a single virus. In addition, Esposito et?al. [19] demonstrated that HBoV co-infections with other viruses were associated with greater disease burden (more hospitalizations and loss of school days) in children with respiratory tract infection than in those with HBoV infection alone. In our study, it is of interest that all children (8%) with treatment failure had evidence of mixed viral�Cbacterial infection. Our study has many important Erastin limitations. The diversity of findings in relation to the size of our study population limits the conclusions that can be drawn. The duration of the study period was short. Only the sputum samples with a high leukocyte count were included in this study. This may have influenced our results, especially in terms of viruses which may not induce leukocytes to the sputum. We did not use serology, which could have established thiram infections caused by some viruses. It must be stressed that the detection of bacteria or viruses in the sputum sample does not necessarily mean that they are the causative agents of the concomitant lung infection. Bacteria might be contaminants from the nasopharynx, which, in healthy young children, often carries pathogenic bacteria. The detected virus might be found because of the concomitant upper respiratory tract infection. Furthermore, respiratory viruses, especially RV, have been detected in asymptomatic children (up to 60% in children