World Journal of Pediatrics

, Volume 13, Issue 4, pp 293–299 | Cite as

Etiology and clinical features of viral bronchiolitis in infancy

  • Andrew FretzayasEmail author
  • Maria Moustaki
Review Article



Bronchiolitis is a common lower respiratory tract infection in infancy. The aim of this review is to present the clinical profile of viral bronchiolitis, the different culprit viruses and the disease severity in relation to the viral etiology.

Data sources

Databases including PubMed and Google Scholar were searched for articles about the clinical features of bronchiolitis and its viral etiology. The most relevant articles to the scope of this review were analyzed.


Currently there are two main definitions for bronchiolitis which are not identical, the European definition and the American one. The most common viral pathogen that causes bronchiolitis is respiratory syncytial virus which was identified in 1955; now many other viruses have been implicated in the etiology of bronchiolitis such as rhinovirus, adenovirus, metapneumovirus, and bocavirus. Several studies have attempted to investigate the correlation of bronchiolitis severity with the type of detected virus or viruses. However, the results were not consitent.


For the time being, the diagnosis of bronchiolitis remains clinical. The isolation of the responsible respiratory pathogens does not seem to confer to the prognosis of the disease severity.

Key words

clinical features etiology viral bronchiolitis 


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  1. 1.
    Court SD. The definition of acute respiratory illnesses in children. Postgrad Med J 1973;49:771–776.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    McConnochie KM. Bronchiolitis. What’s in the name? Am J Dis Child 1983;137:11–13.CrossRefPubMedGoogle Scholar
  3. 3.
    American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics 2006;118:1774–1793.CrossRefGoogle Scholar
  4. 4.
    Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014;134:e1474–e1502.CrossRefPubMedGoogle Scholar
  5. 5.
    Nicolai A, Ferrara M, Schiavariello C, Gentile F, Grande ME, Alessandroni C, et al. Viral bronchiolitis in children: a common condition with few therapeutic options. Early Hum Dev 2013;89 Suppl 3:S7–S11.CrossRefPubMedGoogle Scholar
  6. 6.
    Bush A, Thomson AH. Acute bronchiolitis. BMJ 2007;335:1037–1041.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Fitzgerald DA, Kilham HA. Bronchiolitis: assessment and evidence-based management. Med J Aust 2004;180:399–404.PubMedGoogle Scholar
  8. 8.
    Fitzgerald DA. Viral bronchiolitis for the clinician. J Paediatr Child Health 2011;47:160–166.CrossRefPubMedGoogle Scholar
  9. 9.
    Scottish Intercollegiate Guidelines Network (SIGN), 2006. (accessed May 21, 2016).Google Scholar
  10. 10.
    National Institute for Health and Care Excellence (NICE), 2015. (accessed June 1, 2015).Google Scholar
  11. 11.
    Gidaris D, Urquhart D, Anthracopoulos MB. They said it was bronchiolitis; is it going to turn into asthma doctor? Respirology 2014;19:1158–1164.CrossRefPubMedGoogle Scholar
  12. 12.
    Øymar K, Skjerven HO, Mikalsen IB. Acute bronchiolitis in infants, a review. Scand J Trauma Resusc Emerg Med 2014;22:23.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Meissner HC. Viral bronchiolitis in children. N Engl J Med 2016;374:1793–1794.CrossRefPubMedGoogle Scholar
  14. 14.
    Blount RE Jr, Morris JA, Savage RE. Recovery of cytopathogenic agent from chimpanzees with coryza. Proc Soc Exp Biol Med 1956;92:544–549.CrossRefPubMedGoogle Scholar
  15. 15.
    Chanock R, Roizman B, Myers R. Recovery from infants with respiratory illness of a virus related to chimpanzee coryza agent (CCA). I. Isolation, properties and characterization. Am J Hyg 1957;66:281–290.PubMedGoogle Scholar
  16. 16.
    Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L, et al. Diagnosis and testing in bronchiolitis: a systematic review. Arch Pediatr Adolesc Med 2004;158:119–126.CrossRefPubMedGoogle Scholar
  17. 17.
    Stockman LJ, Curns AT, Anderson LJ, Fischer-Langley G. Respiratory syncytial virus-associated hospitalizations among infants and young children in the United States, 1997-2006. Pediatr Infect Dis J 2012;31:5–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Rowe WP, Huebner RJ, Gilmore LK, Parrott RH, Ward TG. Isolation of a cytopathogenic agent from human adenoids undergoing spontaneous degeneration in tissue culture. Proc Soc Exp Biol Med 1953;84:570–573.CrossRefPubMedGoogle Scholar
  19. 19.
    Moro MR, Bonville CA, Suryadevara M, Cummings E, Faddoul D, Kobayaa H, et al. Clinical features, adenovirus types, and local production of inflammatory mediators in adenovirus infections. Pediatr Infect Dis J 2009;28:376–380.CrossRefPubMedGoogle Scholar
  20. 20.
    Rocholl C, Gerber K, Daly J, Pavia AT, Byington CL. Adenoviral infections in children: the impact of rapid diagnosis. Pediatrics 2004;113:e51–e56.CrossRefPubMedGoogle Scholar
  21. 21.
    Chau SK, Lee SL, Peiris MJ, Chan KH, Chan E, Wong W, et al. Adenovirus respiratory infection in hospitalized children in Hong Kong: serotype-clinical syndrome association and risk factors for lower respiratory tract infection. Eur J Pediatr 2014;173:291–301.CrossRefPubMedGoogle Scholar
  22. 22.
    Bamberger E, Srugo I, Abu Raya B, Segal E, Chaim B, Kassis I, et al. What is the clinical relevance of respiratory syncytial virus bronchiolitis?: findings from a multi-center, prospective study. Eur J Clin Microbiol Infect Dis 2012;31:3323–3330.CrossRefPubMedGoogle Scholar
  23. 23.
    Richard N, Komurian-Pradel F, Javouhey E, Perret M, Rajoharison A, Bagnaud A, et al. The impact of dual viral infection in infants admitted to a pediatric intensive care unit associated with severe bronchiolitis. Pediatr Infect Dis J 2008;27:213–217.CrossRefPubMedGoogle Scholar
  24. 24.
    Brand HK, de Groot R, Galama JM, Brouwer ML, Teuwen K, Hermans PW, et al. Infection with multiple viruses is not associated with increased disease severity in children with bronchiolitis. Pediatr Pulmonol 2012;47:393–400.CrossRefPubMedGoogle Scholar
  25. 25.
    Price WH. The isolation of a new virus associated with respiratory clinical disease in humans. Proc Natl Acad Sci U S A 1956;42:892–896.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Calvo C, Pozo F, García-García ML, Sanchez M, Lopez-Valero M, Pérez-Breña P, et al. Detection of new respiratory viruses in hospitalized infants with bronchiolitis: a three-year prospective study. Acta Paediatr 2010;99:883–887.CrossRefPubMedGoogle Scholar
  27. 27.
    Marguet C, Lubrano M, Gueudin M, Le Roux P, Deschildre A, Forget C, et al. In very young infants severity of acute bronchiolitis depends on carried viruses. PLoS One 2009; 4:e4596.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Huguenin A, Moutte L, Renois F, Leveque N, Talmud D, Abely M, et al. Broad respiratory virus detection in infants hospitalized for bronchiolitis by use of a multiplex RT-PCR DNA microarray system. J Med Virol 2012;84:979–985.CrossRefPubMedGoogle Scholar
  29. 29.
    Midulla F, Scagnolari C, Bonci E, Pierangeli A, Antonelli G, De Angelis D, et al. Respiratory syncytial virus, human bocavirus and rhinovirus bronchiolitis in infants. Arch Dis Child 2010;95:35–41.CrossRefPubMedGoogle Scholar
  30. 30.
    Ricart S, Marcos MA, Sarda M, Anton A, Muñoz-Almagro C, Pumarola T, et al. Clinical risk factors are more relevant than respiratory viruses in predicting bronchiolitis severity. Pediatr Pulmonol 2013;48:456–463.CrossRefPubMedGoogle Scholar
  31. 31.
    Papadopoulos NG, Moustaki M, Tsolia M, Bossios A, Astra E, Prezerakou A, et al. Association of rhinovirus infection with increased disease severity in acute bronchiolitis. Am J Respir Crit Care Med 2002;165:1285–1289.CrossRefPubMedGoogle Scholar
  32. 32.
    Mansbach JM, Piedra PA, Teach SJ, Sullivan AF, Forgey T, Clark S, et al. Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis. Arch Pediatr Adolesc Med 2012;166:700–706.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Midulla F, Pierangeli A, Cangiano G, Bonci E, Salvadei S, Scagnolari C, et al. Rhinovirus bronchiolitis and recurrent wheezing: 1-year follow-up. Eur Respir J 2012;39:396–402.CrossRefPubMedGoogle Scholar
  34. 34.
    Jartti T, Korppi M. Rhinovirus-induced bronchiolitis and asthma development. Pediatr Allergy Immunol 2011;22:350–355.CrossRefPubMedGoogle Scholar
  35. 35.
    van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de Groot R, Fouchier RA, et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 2001;7:719–724.CrossRefPubMedGoogle Scholar
  36. 36.
    Xepapadaki P, Psarras S, Bossios A, Tsolia M, Gourgiotis D, Liapi-Adamidou G, et al. Human Metapneumovirus as a causative agent of acute bronchiolitis in infants. J Clin Virol 2004;30:267–270.CrossRefPubMedGoogle Scholar
  37. 37.
    Bouscambert-Duchamp M, Lina B, Trompette A, Moret H, Motte J, Andréoletti L. Detection of human metapneumovirus RNA sequences in nasopharyngeal aspirates of young Frenchchildren with acute bronchiolitis by real-time reverse transcriptase PCR and phylogenetic analysis. J Clin Microbiol 2005;43:1411–1414.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Chen YW, Huang YC, Ho TH, Huang CG, Tsao KC, Lin TY. Viral etiology of bronchiolitis among pediatric inpatients in northern Taiwan with emphasis on newly identified respiratory viruses. J Microbiol Immunol Infect 2014;47:116–121.CrossRefPubMedGoogle Scholar
  39. 39.
    Allander T, Tammi MT, Eriksson M, Bjerkner A, Tiveljung-Lindell A, Andersson B. Cloning of a human parvovirus by molecular screening of respiratory tract samples. Proc Natl Acad Sci U S A 2005;102:12891–12896.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Pierangeli A, Scagnolari C, Trombetti S, Grossi R, Battaglia M, Moretti C, et al. Human bocavirus infection in hospitalized children in Italy. Influenza Other Respir Viruses 2008;2:175–179.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Milder E, Arnold JC. Human metapneumovirus and human bocavirus in children. Pediatr Res 2009;65:78R–83R.CrossRefPubMedGoogle Scholar
  42. 42.
    Miron D, Srugo I, Kra-Oz Z, Keness Y, Wolf D, Amirav I, et al. Sole pathogen in acute bronchiolitis: is there a role for other organisms apart from respiratory syncytial virus? Pediatr Infect Dis J 2010;29:e7–e10.CrossRefPubMedGoogle Scholar
  43. 43.
    van der Hoek L, Pyrc K, Jebbink MF, Vermeulen-Oost W, Berkhout RJ, Wolthers KC, et al. Identification of a new human coronavirus. Nat Med 2004;10:368–373.CrossRefPubMedGoogle Scholar
  44. 44.
    Lee J, Storch GA. Characterization of human coronavirus OC43 and human coronavirus NL63 infections among hospitalized children <5 years of age. Pediatr Infect Dis J 2014;33:814–820.CrossRefPubMedGoogle Scholar
  45. 45.
    Han TH, Chung JY, Kim SW, Hwang ES. Human coronavirus-NL63 infections in Korean children, 2004-2006. J Clin Virol 2007;38:27–31.CrossRefPubMedGoogle Scholar
  46. 46.
    Boivin G, Baz M, Côté S, Gilca R, Deffrasnes C, Leblanc E, et al. Infections by human coronavirus-NL in hospitalized children. Pediatr Infect Dis J 2005;24:1045–1048.CrossRefPubMedGoogle Scholar
  47. 47.
    Woo PC, Lau SK, Chu CM, Chan KH, Tsoi HW, Huang Y, et al. Characterization and complete genome sequence of a novel coronavirus, coronavirus HKU1, from patients with pneumonia. J Virol 2005;79:884–895.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Lau SK, Woo PC, Yip CC, Tse H, Tsoi HW, Cheng VC, et al. Coronavirus HKU1 and other coronavirus infections in Hong Kong. J Clin Microbiol 2006;44:2063–2071.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Bosis S, Esposito S, Niesters HG, Tremolati E, Pas S, Principi N, et al. Coronavirus HKU1 in an Italian pre-term infant with bronchiolitis. J Clin Virol 2007;38:251–253.CrossRefPubMedGoogle Scholar
  50. 50.
    Cosnes-Lambe C, Raymond J, Chalumeau M, Pons-Catalano C, Moulin F, de Suremain N, et al. Pertussis and respiratory syncytial virus infections. Eur J Pediatr 2008;167:1017–1019.CrossRefPubMedGoogle Scholar
  51. 51.
    Nuolivirta K, Koponen P, He Q, Halkosalo A, Korppi M, Vesikari T, et al. Bordetella pertussis infection is common in nonvaccinated infants admitted for bronchiolitis. Pediatr Infect Dis J 2010;29:1013–1015.PubMedGoogle Scholar
  52. 52.
    Pientong C, Ekalaksananan T, Teeratakulpisarn J, Tanuwattanachai S, Kongyingyoes B, Limwattananon C. Atypical bacterial pathogen infection in children with acute bronchiolitis in northeast Thailand. J Microbiol Immunol Infect 2011;44:95–100.CrossRefPubMedGoogle Scholar
  53. 53.
    Mulholland EK, Olinsky A, Shann FA. Clinical findings and severity of acute bronchiolitis. Lancet 1990;335:1259–1261.CrossRefPubMedGoogle Scholar
  54. 54.
    Marlais M, Evans J, Abrahamson E. Clinical predictors of admission in infants with acute bronchiolitis. Arch Dis Child 2011;96:648–652.CrossRefPubMedGoogle Scholar
  55. 55.
    Ricart S, Rovira N, Garcia-Garcia JJ, Pumarola T, Pons M, Muñoz-Almagro C, et al. Frequency of apnea and respiratory viruses in infants with bronchiolitis. Pediatr Infect Dis J 2014;33:988–990.CrossRefPubMedGoogle Scholar
  56. 56.
    Schroeder AR, Mansbach JM, Stevenson M, Macias CG, Fisher ES, Barcega B, et al. Apnea in children hospitalized with bronchiolitis. Pediatrics 2013;132:e1194–e1201.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Ralston S, Hill V. Incidence of apnea in infants hospitalized with respiratory syncytial virus bronchiolitis: a systematic review. J Pediatr 2009;155:728–733.CrossRefPubMedGoogle Scholar
  58. 58.
    Shaw KN, Bell LM, Sherman NH. Outpatient assessment of infants with bronchiolitis. Am J Dis Child 1991;145:151–155.PubMedGoogle Scholar
  59. 59.
    Corneli HM, Zorc JJ, Holubkov R, Bregstein JS, Brown KM, Mahajan P, et al. Bronchiolitis: clinical characteristics associated with hospitalization and length of stay. Pediatr Emerg Care 2012;28:99–103.CrossRefPubMedGoogle Scholar
  60. 60.
    El-Radhi AS, Barry W, Patel S. Association of fever and severe clinical course in bronchiolitis. Arch Dis Child 1999;81:231–234.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Melendez E, Harper MB. Utility of sepsis evaluation in infants 90 days of age or younger with fever and clinical bronchiolitis. Pediatr Infect Dis J 2003;22:1053–1056.CrossRefPubMedGoogle Scholar
  62. 62.
    Ralston S, Hill V, Waters A. Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review. Arch Pediatr Adolesc Med Med 2011;165:951–956.CrossRefGoogle Scholar
  63. 63.
    Wood DW, Downes JJ, Lecks HI. A clinical scoring system for the diagnosis of respiratory failure. Preliminary report on childhood status asthmaticus. Am J Dis Child 1972;123:227–228.PubMedGoogle Scholar
  64. 64.
    Tal A, Bavilski C, Yohai D, Bearman JE, Gorodischer R, Moses SW. Dexamethasone and salbutamol in the treatment of acute wheezing in infants. Pediatrics 1983;71:13–18.PubMedGoogle Scholar
  65. 65.
    Lowell DI, Lister G, Von Koss H, McCarthy P. Wheezing in infants: the response to epinephrine. Pediatrics 1987;79:939–945.PubMedGoogle Scholar
  66. 66.
    Wang EE, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev Respir Dis 1992;145:106–109.CrossRefPubMedGoogle Scholar
  67. 67.
    Liu LL, Gallaher MM, Davis RL, Rutter CM, Lewis TC, Marcuse EK. Use of a respiratory clinical score among different providers. Pediatr Pulmonol 2004;37:243–248.CrossRefPubMedGoogle Scholar
  68. 68.
    Semple MG, Cowell A, Dove W, Greensill J, McNamara PS, Halfhide C, et al. Dual infection of infants by human metapneumovirus and human respiratory syncytial virus is strongly associated with severe bronchiolitis. J Infect Dis 2005;191:382–386.CrossRefPubMedGoogle Scholar
  69. 69.
    Scagnolari C, Midulla F, Selvaggi C, Monteleone K, Bonci E, Papoff P, et al. Evaluation of viral load in infants hospitalized with bronchiolitis caused by respiratory syncytial virus. Med Microbiol Immunol 2012;201:311–317.CrossRefPubMedGoogle Scholar
  70. 70.
    Fodha I, Vabret A, Ghedira L, Seboui H, Chouchane S, Dewar J, et al. Respiratory syncytial virus infections in hospitalized infants: association between viral load, virus subgroup, and disease severity. J Med Virol 2007;79:1951–1958.CrossRefPubMedGoogle Scholar
  71. 71.
    Buckingham SC, Bush AJ, Devincenzo JP. Nasal quantity of respiratory syncytical virus correlates with disease severity in hospitalized infants. Pediatr Infect Dis J 2000;19:113–117.CrossRefPubMedGoogle Scholar
  72. 72.
    Wright PF, Gruber WC, Peters M, Reed G, Zhu Y, Robinson F, et al. Illness severity, viral shedding, and antibody responses in infants hospitalized with bronchiolitis caused by respiratory syncytial virus. J Infect Dis 2002;185:1011–1018.CrossRefPubMedGoogle Scholar
  73. 73.
    Houben ML, Coenjaerts FE, Rossen JW, Belderbos ME, Hofland RW, Kimpen JL, et al. Disease severity and viral load are correlated in infants with primary respiratory syncytial virus infection in the community. J Med Virol 2010;82:1266–1271.CrossRefPubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.3rd Department of Pediatrics, “Attikon” University HospitalAthens University, School of MedicineAthensGreece

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