South African guideline for the diagnosis, management and prevention of acute viral bronchiolitis in children

BackgroundPneumonia is considered the major cause of mortality among children with acute respiratory disease in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the magnitude of asthma and pneumonia among “under-fives” with cough and difficulty breathing, based on stringent clinical criteria. We also describe the treatment for children with acute respiratory symptoms in Mulago Hospital.MethodsWe enrolled 614 children aged 2–59 months with cough and difficulty breathing. Interviews, physical examination, blood and radiological investigations were done. We defined asthma according to Global Initiative for Asthma guidelines. Pneumonia was defined according to World Health Organization guidelines, which were modified by including fever and white cell count, C-reactive protein, blood culture and chest x-ray. Children with asthma or bronchiolitis were collectively referred to as “asthma syndrome” due to challenges of differentiating the two conditions in young children. Three pediatricians reviewed each participant’s case report post hoc and made a diagnosis according to the study criteria.ResultsOf the 614 children, 41.2% (95% CI: 37.3–45.2) had asthma syndrome, 27.2% (95% CI: 23.7–30.9) had bacterial pneumonia, 26.5% (95% CI: 23.1–30.2) had viral pneumonia, while 5.1% (95% CI: 3.5–7.1) had other diagnoses including tuberculosis. Only 9.5% of the children with asthma syndrome had been previously diagnosed as asthma. Of the 253 children with asthma syndrome, 95.3% (95% CI: 91.9–97.5) had a prescription for antibiotics, 87.7% (95% CI: 83.1–91.5) for bronchodilators and 43.1% (95% CI: 36.9–49.4) for steroids. ConclusionAlthough reports indicate that acute respiratory symptoms in children are predominantly due to pneumonia, asthma syndrome contributes a significant proportion. Antibiotics are used irrationally due to misdiagnosis of asthma as pneumonia. There is need for better diagnostic tools for childhood asthma and pneumonia in Uganda.

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“…This was based on the South African guidelines for diagnosis, management and prevention of acute viral bronchiolitis [18]. …”

Section: Methodsmentioning

confidence: 99%

Asthma and Pneumonia among Children Less Than Five Years with Acute Respiratory Symptoms in Mulago Hospital, Uganda: Evidence of Under-Diagnosis of Asthma

et al. 2013

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“…RSV is known to be the most common cause of moderate or severe bronchiolitis. [18] Only three children had confirmed PCP infection on tracheal aspirate analysis. Two of the 3 were HIV-exposed and 1 was HIVunexposed.…”

Section: Discussionmentioning

confidence: 99%

An audit of primary medical conditions in children admitted to the paediatric intensive care unit of Charlotte Maxeke Johannesburg Academic Hospital

2016

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“…In SA, the peak in RSV season varies slightly by province, with onset of the epidemic usually in KwaZulu-Natal in December -January, in Gauteng in February -March, and followed by the Western Cape in March. [24] In 2009 and 2010, the SARI programme reported seasonality for RSV, influenza A and B viruses, enterovirus, hMPV, and PIV type 3. RSV circulation was evident from February to June, before the influenza season, which occurred from May to September.…”

Section: Seasonalitymentioning

confidence: 99%

Acute viral bronchiolitis in South Africa: Viral aetiology and clinical epidemiology

et al. 2016

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DefinitionBronchiolitis is a viral-induced lower respiratory tract infection (LRTI) that occurs predominantly in children <2 years of age, particularly infants.[1] Causative organismsThe most frequent cause of severe bronchiolitis is respiratory syncytial virus (RSV) infection, with other respiratory viruses (para-influenza virus (PIV), influenza virus, human metapneumovirus (hMPV) and measles virus) being less common or for which definitive attribution is yet to be established (e.g. rhinovirus (RV), bocavirus and coronavirus) ( Table 1). EpidemiologyEpidemiological studies on bronchiolitis often include all children presenting with physician-diagnosed LRTI, and may overestimate the true incidence of bronchiolitis alone.In a prospective, hospital-based surveillance study of 8 723 child ren under-5 with physician-diagnosed LRTI, from five sites in four provinces in South Africa (SA), from 2009 to 2012 (severe acute respiratory illness (SARI) programme), the overall prevalence of respiratory viruses was 78%. The viruses that were isolated included RV in 37%, RSV in 26%, adenovirus in 26%, influenza virus in 7% and hMPV in 5%.[2] In 2009 and 2010, this surveillance study evalua ted respiratory viruses by a 10-plex real-time reverse-transcription polymerase chain reaction (rRT-PCR).[3] Respiratory viral co-infections among cases enrolled indicated 39.6% with single viral infections, while 17.4% had ≥2 viral co-infections. RVMany studies show RV to be associated with bronchiolitis; however, the high prevalence of RV in healthy asymptomatic children limits definitive attribution of its role in the pathogenesis of bronchio litis. Early studies have suggested that oxygen saturation is generally not as low in children with RVassociated bronchiolitis as in those with RSV-associated bronchio litis.[4] However, more recent studies suggest that RV may be more sinister.[5] All three types of RV have been identified in SA, although RV-A and RV-C are more common than RV-B. RV is associated with symptomatic respiratory illness; however, there is no association between RV type and disease severity. [6] RV-D has subsequently been identified. [7] Bronchiolitis is a viral-induced lower respiratory tract infection that occurs predominantly in children <2 years of age, particularly infants. Many viruses have been proven or attributed to cause bronchiolitis, including and most commonly the respiratory syncytial virus (RSV) and rhinovirus. RSV is responsible for more severe disease and complications (including hospitalisation) in bronchiolitis patients. Whereas bronchiolitis is exclusively due to respiratory viral infections, with little evidence of bacterial co-infection, the former could nevertheless predispose to superimposed bacterial infections. Although data support an interaction between RSV and pneumococcal superimposed infections, it should be noted that this specifically refers to children who are hospitalised with RSV-associated pneumonia, and not to children with bronchiolitis or milder outpatient RSV-associated illness. As...

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South African guideline for the diagnosis, management and prevention of acute viral bronchiolitis in children

Cited by 29 publications

References 45 publications

Asthma and Pneumonia among Children Less Than Five Years with Acute Respiratory Symptoms in Mulago Hospital, Uganda: Evidence of Under-Diagnosis of Asthma

Asthma and Pneumonia among Children Less Than Five Years with Acute Respiratory Symptoms in Mulago Hospital, Uganda: Evidence of Under-Diagnosis of Asthma

An audit of primary medical conditions in children admitted to the paediatric intensive care unit of Charlotte Maxeke Johannesburg Academic Hospital

Acute viral bronchiolitis in South Africa: Viral aetiology and clinical epidemiology

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