Simultaneous viral infection and childhood bronchiolitis obliterans

Hirschheimer, Mário; Silva, Paulo S. L.; Giudici, Roseli; Carrilho, Milene; Mauad, Thaís; Ishida, María Akíko

doi:10.1590/s1413-86702002000300009

Cited by 13 publications

(6 citation statements)

References 16 publications

(18 reference statements)

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“…Contudo, esse vírus tem sido identificado em pacientes que evoluem com BOPI em até 30% dos casos 10 . Já foi descrito que a ocorrência de infecção simultânea entre adenovírus e VRS pode estar associada à pior evolução 16,17 . A coinfecção entre vírus e bactérias pode estar relacionada à maior chance de lesão pulmonar 3 .…”

Section: Etiologiaunclassified

Post-infectious bronchiolitis obliterans in children

Champs

Lasmar²,

Camargos³

et al. 2011

J Pediatr (Rio J)

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Objective: To review publications about the main features of postinfectious bronchiolitis obliterans and its history, etiology, epidemiology, risk factors, pathogenesis, histological findings, clinical presentation, complementary tests, diagnostic criteria, differential diagnosis, treatment and prognosis.Sources: Non-systematic review of MEDLINE and LILACS databases and selection of 66 most relevant studies. Summary of the findings:In the post-infectious bronchiolitis obliterans there is an insult to respiratory epithelial cells, and its clinical severity is associated with the degree of lesion and inflammation. Diagnosis is made according to clinical signs and symptoms, by exclusion of main differential diagnoses and with the aid of complementary tests. High resolution CT, particularly images obtained during inspiration and expiration, provide information for the evaluation of the small airways. Pulmonary function tests show fixed airway obstructions and marked decrease of FEF 25-75% . Treatment has not been definitely established, and corticoids have been administered as pulse therapy or by inhalation of high doses of steroids. However, data about its efficacy are scarce in the literature. Long-term prognosis is variable, and there might be either clinical improvement or deterioration into respiratory insufficiency and death.Conclusion: Post-infectious bronchiolitis obliterans is a disease with a high morbidity rate; it should be treated by a multidisciplinary team, and patients should be followed up for a long period of time.J Pediatr (Rio J). 2011;87(3):187-198: Bronchiolitis obliterans, diagnosis, spirometry, CT, child. ResumoObjetivo: Revisar os trabalhos publicados sobre os principais aspectos da bronquiolite obliterante pós-infecciosa, relacionados com sua história, etiologia, epidemiologia, fatores de risco, patogenia, alterações histológicas, manifestações clínicas, exames complementares, critérios diagnósticos, diagnóstico diferencial, tratamento e prognóstico. Fonte dos dados:Realizou-se uma revisão não sistemática nas bases de dados MEDLINE e LILACS, selecionando-se 66 referências mais relevantes. Síntese dos dados:Na bronquiolite obliterante pós-infecciosa ocorre lesão do epitélio respiratório, e a gravidade clínica está relacionada aos diferentes graus de lesão e ao processo inflamatório. O diagnóstico baseia-se no quadro clínico, na exclusão dos principais diagnósticos diferenciais e no auxílio dos exames complementares. A tomografia computadorizada de alta resolução, principalmente com imagens em inspiração e expiração, possibilta a avaliação das pequenas vias aéreas. As provas de função pulmonar caracterizam-se por padrão obstrutivo fixo com redução acentuada do FEF 25-75% . O tratamento não está bem estabelecido, e o uso de corticoides tem sido preconizado em forma de pulsoterapia ou por via inalatória em elevadas doses, no entanto, os dados da literatura a respeito de sua eficácia ainda são escassos. O prognóstico a longo prazo é variável, podendo haver melhora clínica ou evolução par...

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Section: Etiologiaunclassified

Post-infectious bronchiolitis obliterans in children

Champs

Lasmar²,

Camargos³

et al. 2011

J Pediatr (Rio J)

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“…Parainfluenza viruses (PIV) are the most common cause of croup in young children, with PIV1 and PIV3 also being the causes of severe bronchiolitis and pneumonia (3,4,25), but there are currently no licensed PIV vaccines. Adenoviruses (AV) have long been recognized as pathogens of the lower respiratory tract that can be associated with severe or lethal lower respiratory tract infection (3,26,27) or bronchiolitis obliterans (28-31). Coronaviruses (CV) cause common cold and have been historically thought to be a very rare cause of ALRI (32), despite the fact that they sporadically caused catastrophic disease in livestock (33).…”

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confidence: 99%

Viral etiology of hospitalized acute lower respiratory infections in children under 5 years of age – a systematic review and meta-analysis

et al. 2013

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AimTo estimate the proportional contribution of influenza viruses (IV), parainfluenza viruses (PIV), adenoviruses (AV), and coronaviruses (CV) to the burden of severe acute lower respiratory infections (ALRI).MethodsThe review of the literature followed PRISMA guidelines. We included studies of hospitalized children aged 0-4 years with confirmed ALRI published between 1995 and 2011. A total of 51 studies were included in the final review, comprising 56 091 hospitalized ALRI episodes.ResultsIV was detected in 3.0% (2.2%-4.0%) of all hospitalized ALRI cases, PIV in 2.7% (1.9%-3.7%), and AV in 5.8% (3.4%-9.1%). CV are technically difficult to culture, and they were detected in 4.8% of all hospitalized ALRI patients in one study. When respiratory syncytial virus (RSV) and less common viruses were included, at least one virus was detected in 50.4% (40.0%-60.7%) of all hospitalized severe ALRI episodes. Moreover, 21.9% (17.7%-26.4%) of these viral ALRI were mixed, including more than one viral pathogen. Among all severe ALRI with confirmed viral etiology, IV accounted for 7.0% (5.5%-8.7%), PIV for 5.8% (4.1%-7.7%), and AV for 8.8% (5.3%-13.0%). CV was found in 10.6% of virus-positive pneumonia patients in one study.ConclusionsThis article provides the most comprehensive analysis of the contribution of four viral causes to severe ALRI to date. Our results can be used in further cost-effectiveness analyses of vaccine development and implementation for a number of respiratory viruses.

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“…Simultaneous infections with RSV and AV have also been reported. 21 In these cases it would seem most likely that the AV infection is the cause of BO. Studies from Malaysia and Korea reveal mycoplasma as the second most common etiology of post-infectious BO behind AV, occurring in about 20% of all BO patients, with almost all secondary to outbreaks of mycoplasma in the 1990s.…”

Section: Discussionmentioning

confidence: 99%