Respiratory Syncytial Virus in Saudi Patients Admitted to Hospital with Bronchiolitis: Use of Direct Fluorescent Antibody Tests as a Rapid Diagnostic Tool

Abstract

: [90][91][92] Bronchiolitis is a major cause of morbidity and occasional mortality in young infants and children all over the world. Respiratory syncytial virus (RSV) is the major etiologic agent responsible for this condition. The illness is more severe in patients with bronchopulmonary dysplasia and congenital heart diseases, especially with pulmonary hypertension and preterm infants. Early treatment with ribavirin is recommended in infants with underlying immunodeficiency and complicated heart disease (including pulmonary hypertension) and should be considered in infants who are severely ill with PaCO 2 less than 65 mmHg (American Academy of Pediatrics).1 Recently, RSVspecific immunoglobulin (RSVIG) was found to be effective in ameliorating RSV infections when used prophylactically in patients with bronchopulmonary dysplasia (BPD), congenital heart disease and prematurity. 2,3 RSVIG may also have therapeutic effectiveness in those high-risk infants.1 Early diagnosis is also required to institute infection control measures. It is thus desirable that early and accurate diagnosis of RSV infection be made if these therapeutic modalities are to be employed early to obtain maximum benefit. In this study, we compared the efficacy of direct fluorescent antibody (DFA) technique as a rapid and reliable diagnostic tool to isolation of the virus in cell culture. We also describe the magnitude of bronchiolitis as experienced in a pediatric hospital in Saudi Arabia, as well as the significance of RSV as its main etiologic agent compared to the Western experiences. Patients and MethodsDuring the year 1413H, 485 patients were admitted to Suleimania Children's Hospital in Riyadh City with the clinical diagnosis of bronchiolitis. During the study period of the winter season of the same year, from 19.4.1413H to 8.8.1413H, which is considered the peak season for RSV infection in this part of the world, 4 all patients with bronchiolitis were screened for eligibility to be enrolled in the study, as per the following criteria: 1) age below two years; 2) presence of wheezing-audible and/or on auscultation; 3) no previous history of wheezing; 4) no chronic pulmonary disease such as cystic fibrosis or BPD; 5) no congenital heart disease; 6) no significant radiological consolidation. The diagnosis was made on the history of cough and/or wheezes, tachypnea, retractions, and wheezing and crackles on auscultation. As the diagnosis of bronchiolitis is essentially clinical, based on history and clinical findings, we chose the above diagnostic criteria. Hyperinflation on the chest film is also an important pointer to the diagnosis, but it was not done in all patients. The eligibility criteria were devised to exclude, as much as possible, other causes of wheezing in infancy to avoid the error of overdiagnosing bronchiolitis. Patients with radiologic consolidation were excluded because young children with pneumonia may also wheeze, thus questioning the diagnosis of bronchiolitis in those patients. The hospital scientific committee approved th...

An overview of respiratory syncytial virus infections in Saudi Arabia

“…Other investigations reported 80-88% of bronchiolitis due to RSV in children less than 6 months of age [32,38]. Another study also confirmed that RSV was mostly associated with bronchiolitis in the pediatric patients from this region [37].…”

“…Fifty four percent of the cases were positive for RSV [36]. Another study included ALRI patients less than 2 years of age and detected RSV in 70% of the samples by DFA and culture [37]. RSV accounted for 79% of the ALRI cases (less than 5 years of age) in hospitalized children in another study from Riyadh during 1993-96 [38].…”

Bronchiolitis in Infants; Five Years’ Experience of a Teaching Hospital

“…8 Another study conducted in Riyadh, which included 485 ALRI patients under the age of 2, detected RSV in 70% of the samples. 9 RSV accounted for 79% of the total 1429 ALRI cases in children under the age of 5 who were hospitalized in another study from Riyadh between 1993 and 1996. 10 Out of 256 sample cases hospitalized with 11 In the case of children admitted for ALRI from Abha during 1997-2001, RSV was found to be positive in 40% of the 51 cases.…”