In Very Young Infants Severity of Acute Bronchiolitis Depends On Carried Viruses

Abstract

BackgroundRT amplification reaction has revealed that various single viruses or viral co-infections caused acute bronchiolitis in infants, and RV appeared to have a growing involvement in early respiratory diseases. Because remaining controversial, the objective was to determine prospectively the respective role of RSV, RV, hMPV and co-infections on the severity of acute bronchiolitis in very young infants.Methods and Principal Findings209 infants (median age: 2.4 months) were enrolled in a prospective study of infants <1 year old, hospitalized for a first episode of bronchiolitis during the winter epidemic season and with no high risk for severe disease. The severity was assessed by recording SaO2% at admission, a daily clinical score (scale 0–18), the duration of oxygen supplementation and the length of hospitalization. Viruses were identified in 94.7% by RT amplification reaction: RSV only (45.8%), RV only (7.2%), hMPV only (3.8%), dual RSV/RV (14.3%), and other virus only (2%) or coinfections (9%). RV compared respectively with RSV and dual RSV/RV infection caused a significant less severe disease with a lower clinical score (5[3.2–6] vs. 6[4–8], p = 0.01 and 5.5[5–7], p = 0.04), a shorter time in oxygen supplementation (0[0–1] days vs. 2[0–3] days, p = 0.02 and 2[0–3] days, p = 0.03) and a shorter hospital stay (3[3–4.7] days vs.6 [5–8] days, p = 0.001 and 5[4–6] days, p = 0.04). Conversely, RSV infants had also longer duration of hospitalization in comparison with RSV/RV (p = 0.01) and hMPV (p = 0.04). The multivariate analyses showed that the type of virus carried was independently associated with the duration of hospitalization.ConclusionThis study underlined the role of RV in early respiratory diseases, as frequently carried by young infants with a first acute bronchiolitis. RSV caused the more severe disease and conversely RV the lesser severity. No additional effect of dual RSV/RV infection was observed on the severity.

Human Rhinovirus and Disease Severity in Children

“…[2][3][4][5] Indeed, HRV infections are one of the main causes of bronchiolitis in young children and an inducer of wheezing episodes. [6][7][8][9] Factors involved in increased disease severity in HRV infections are contradicting in the literature. Some reports have associated coinfection with a second respiratory viruswith a more severe disease, 10,11 whereas others have not.…”

Human rhinovirus in the lower respiratory tract infections of young children and the possible involvement of a secondary respiratory viral agent

“…Identification of HRV co-infection with other respiratory viruses, such as respiratory syncytial virus (RSV) (Papadopoulos et al 2002, Miller et al 2007, ParanhosBaccalà et al 2008, Marguet et al 2009), is possible because of advances in the molecular detection of HRV (Aberle et al 2005, Jacques et al 2006, Calvo et al 2008. Scientists have questioned whether or not HRV co-infections lead to more severe clinical syndromes, cause longer hospitalisations and affect younger children more frequently (Drews et al 1997, Papadopoulos et al 2002, Calvo et al 2007, 2008, Gerna et al 2009, Midulla et al 2010.…”

Association of Respiratory Viral Infection and Atopy with Severity of Acute Bronchiolitis in Infants

“…3,5,8) 대부분의 환아는 경한 임상 경과를 보이지 만, 3) 1-에서는 입원치료를 요하며 3% [4][5][6] 이 중 는 심한 15% 경과를 거쳐 장기입원 및 인공호흡기 치료를 요하는 경우도 있다. 6) 뿐만 아니라 중증 세기관지염의 경우 반복성 천명이 생길 가능성이 있으며, [1][2][3][4] 소아 천식이 발병할 가능성이 12 배 높다는 보고도 있다.…”

“…[2][3][4][5][6] 최근 감염된 바이러스 종류 및 바이러스 아형에 따라 중 증도가 다르게 나타나고 2,3) 특히 중복 감염이 중증도에 상당 한 영향을 미친다는 보고가 있으며, 4,5) 아토피 가족력이나 [13][14][15][16] 환아의 아토피 소견 15) 및 간접 흡연이 [17][18][19] 중증 세기관 지염과 관련이 있다는 보고도 있다 그러나 일부에서는 세기 .…”

“…관지염의 중증도가 바이러스 [2][3][4][5] 및 아토피 소견과는 무관하 거나 방어적 효과를 나타내며 [18][19][20] 이미 존재하는 폐기능 감 소 15,21) 및 유전적 요인과 관련이 있다고 제시한다. Values are presented as no.…”