Virus Type and Genomic Load in Acute Bronchiolitis: Severity and Treatment Response With Inhaled Adrenaline

Skjerven, Håvard Ove; Megremis, Spyridon; Papadopoulos, Nikolaos G.; Mowinckel, Petter; Carlsen, Kai‐Håkon; Carlsen, Karin C. Lødrup

doi:10.1093/infdis/jiv513

Cited by 48 publications

(55 citation statements)

References 45 publications

(84 reference statements)

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“…Given that RT‐PCR is unable to distinguish infectious virions, we cannot say whether coinfections are simultaneous or a detected virus is left over from a previous infection. Also the viral load and the different viral genotype could influence the clinical presentation, but further studies are needed to clarify whether these two factors are involved in the clinical presentation of bronchiolitis with multiple viral detection. In accordance with our previous findings, in our series infants hospitalized for hRV bronchiolitis alone more frequently had an eosinophil blood cell count higher than 400/mm 3 , and more frequently a higher prevalence of family history for atopy than in co‐infection, but not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Acute bronchiolitis: Influence of viral co‐infection in infants hospitalized over 12 consecutive epidemic seasons

Petrarca

Nenna

Frassanito

et al. 2017

Journal of Medical Virology

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Bronchiolitis is the first lower respiratory tract viral infection manifesting in infants younger than 12 months of age. Our aim was to evaluate clinical and serological differences in infants with bronchiolitis from a single or from multiple viruses. Our secondary aim was to investigate differences in recurrent wheezing episodes after 12-24-36 months of follow-up. We reviewed the clinical records for 486 full-term infants hospitalized for bronchiolitis with at least one virus detected in the nasopharyngeal aspirate. In 431 (88.7%) patients one virus was detected and in 55 (11.3%) infants more than one virus was found. No differences were observed in the length of hospitalization, clinical severity score, O supplementation or admission to the intensive care unit. Single virus was associated with higher serum C-reactive protein (C-RP) than infants with multiple viruses and higher blood neutrophil counts. Respiratory syncytial virus (RSV) was the most frequently detected virus. RSV alone was associated with higher C-RP (P = 0.007), compared to RSV coinfection. Infants with human rhinovirus (hRV) alone had higher white blood cell counts, higher blood neutrophils, and higher serum C-RP levels than hRV co-infection (P = 0.029, P = 0.008, P = 0.008). RSV + hRV, the most frequent co-infection, was associated with lower neutrophil count and lower C-RP levels (P = 0.008, P = 0.016) and less fever (P = 0.012), when comparing RSV versus hRV versus RSV + hRV. No differences were found in the frequency of recurrent wheezing between single versus multiple viruses after bronchiolitis. Our findings suggest that in infants with bronchiolitis multiple viral co-infections can occur, without influence in the clinical severity of the disease. Infants with co-infection seems to mount a lower inflammatory response.

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Section: Discussionmentioning

confidence: 99%

Acute bronchiolitis: Influence of viral co‐infection in infants hospitalized over 12 consecutive epidemic seasons

Petrarca

Nenna

Frassanito

et al. 2017

Journal of Medical Virology

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“…Further studies will be necessary to overcome these limitations and understand the exact associations of clinical symptoms and respiratory virus genotypes. Many studies have reported contradictory results about coinfection and clinical severity between RSV subgroup and genotype [18,19,21,28,[37][38][39][40]. hRV was the most commonly detected virus (47·2%) with RSV among all respiratory viruses in Gyeoggi Province (Table 7).…”

Section: Clinical Symptomsmentioning

confidence: 99%

Molecular and clinical characterization of human respiratory syncytial virus in South Korea between 2009 and 2014

Park

Huh

et al. 2017

Epidemiol. Infect.

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Respiratory syncytial virus (RSV) can cause serious respiratory infections, second only to influenza virus. In order to know RSV's genetic changes we examined 4028 respiratory specimens from local hospital outpatients in Gyeonggi Province, South Korea over six consecutive years by real-time one-step RT-PCR; 183 patients were positive for RSV infection. To investigate the specific distribution of RSV genotypes, we performed partial sequencing of the glycoprotein gene. Of the 131 RSV-A specimens sequenced, 61 (43·3%) belonged to the ON1 genotype, 66 (46·8%) were NA1 genotype, 3 (2·1%) were GA5 genotype, and 1 (0·7%) belonged to the GA1 genotype. Of the 31 RSV-B specimens sequenced, 29 were BA9 genotype (87·9%) and 2 were BA10 genotype (6·1%). The most common clinical symptoms were fever, cough, nasal discharge, and phlegm; multiple logistic regression analysis showed that RSV-positive infection on pediatric patients was strongly associated with cough (OR = 2·8, 95% CI 1·6-5·1) and wheezing (OR = 2·8, 95% CI 1·7-4·4). The ON1 genotype was significantly associated with phlegm (OR = 11·8, 95% CI 3·8-46·7), while the NA1 genotype was associated with the pediatric patients' gender (males, OR = 2·4, 95% CI 1·1-5·4) and presence of chills (OR = 5·1, 95% CI 1·1-27·2). RSV subgroup B was showed association with nasal obstruction (OR = 4·6, 95% CI 1·2-20·0). The majority of respiratory virus coinfections with RSV were human rhinovirus (47·2%). This study contributes to our understanding of the molecular epidemiological characteristics of RSV, which promotes the potential for improving RSV vaccines.

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“…[1] Even among hospitalized children, the two most common etiologic viruses, respiratory syncytial virus (RSV) and rhinovirus, are associated with different short-term clinical outcomes (e.g., hospital length-of-stay, risk of relapse). [4,7–9] In addition, although most hospitalized children have a monophasic illness pattern, they have a wide range of time to recovery. [10] Importantly, beyond these short-term differences, heterogeneity has also been observed in long-term outcomes, such as the risk of developing recurrent wheezing and asthma.…”

Section: Introductionmentioning

confidence: 99%

A clustering approach to identify severe bronchiolitis profiles in children

Dumas

Mansbach

Jartti

et al. 2016

Thorax

121

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Objective Although bronchiolitis is generally considered a single disease, recent studies suggest heterogeneity. We aimed to identify severe bronchiolitis profiles using a clustering approach. Methods We analyzed data from two prospective, multi-center cohorts of children younger than 2 years hospitalized with bronchiolitis, one in the U.S. (2007–2010 winter seasons, n=2,207) and one in Finland (2008–2010 winter seasons, n=408). Severe bronchiolitis profiles were determined by latent class analysis, classifying children based on clinical factors and viral etiology. Results In the U.S. study, four profiles were identified. Profile A (12%) was characterized by history of wheezing and eczema, wheezing at the ED presentation and rhinovirus infection. Profile B (36%) included children with wheezing at the ED presentation, but, in contrast to profile A, most did not have history of wheezing or eczema; this profile had the largest probability of RSV-infection. Profile C (34%) was the most severely ill group, with longer hospital stay and moderate-to-severe retractions. Profile D (17%) had the least severe illness, including non-wheezing children with shorter length-of-stay. Two of these profiles (A and D) were replicated in the Finnish cohort; a third group (“BC”) included Finnish children with characteristics of profiles B and/or C in the U.S. population. Conclusion Several distinct clinical profiles (phenotypes) were identified by a clustering approach in two multicenter studies of children hospitalized for bronchiolitis. The observed heterogeneity has important implications for future research on the etiology, management and long-term outcomes of bronchiolitis, such as future risk of childhood asthma.

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Virus Type and Genomic Load in Acute Bronchiolitis: Severity and Treatment Response With Inhaled Adrenaline

Abstract: NCT00817466 and EudraCT 2009-012667-34.

Cited by 48 publications

References 45 publications

Acute bronchiolitis: Influence of viral co‐infection in infants hospitalized over 12 consecutive epidemic seasons

Acute bronchiolitis: Influence of viral co‐infection in infants hospitalized over 12 consecutive epidemic seasons

Molecular and clinical characterization of human respiratory syncytial virus in South Korea between 2009 and 2014

A clustering approach to identify severe bronchiolitis profiles in children

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