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As little is known about the role of viruses in children with PTB, we investigated the prevalence of respiratory viruses in children with suspected PTB at presentation and follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In an observational cohort study, children &lt;\u200913\u2009years were routinely investigated for suspected PTB in Cape Town, South Africa between December 2015 and September 2017 and followed up for 24\u2009weeks. Nasopharyngeal aspirates (NPAs) were tested for respiratory viruses using multiplex PCR at enrolment, week 4 and 8.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy-three children were enrolled [median age 22.0\u2009months; (interquartile range 10.0\u201348.0); 56.2% male and 17.8% HIV-infected. Anti-tuberculosis treatment was initiated in 54.8%; of these 50.0% had bacteriologically confirmed TB. At enrolment, \u22651 virus were detected in 95.9% (70\/73) children; most commonly human rhinovirus (HRV) (74.0%). HRV was more frequently detected in TB cases (85%) compared to ill controls (60.6%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.02). Multiple viruses were detected in 71.2% of all children; 80% of TB cases and 60.6% of ill controls (<jats:italic>p<\/jats:italic>\u2009=\u20090.07). At follow-up, \u22651 respiratory virus was detected in 92.2% (47\/51) at week 4, and 94.2% (49\/52) at week 8.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found a high prevalence of viral respiratory co-infections in children investigated for PTB, irrespective of final PTB diagnosis, which remained high during follow up. Future work should include investigating the whole respiratory ecosystem in combination with pathogen- specific immune responses.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12879-020-05653-9","type":"journal-article","created":{"date-parts":[[2020,12,4]],"date-time":"2020-12-04T12:04:34Z","timestamp":1607083474000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["High burden of viral respiratory co-infections in a cohort of children with suspected pulmonary tuberculosis"],"prefix":"10.1186","volume":"20","author":[{"given":"M. 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