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What is the clinical relevance of respiratory syncytial virus bronchiolitis?: findings from a multi-center, prospective study

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Abstract

Acute bronchiolitis (AB) is caused primarily by respiratory syncytial virus (RSV). Recent laboratory tools have implicated a variety of other pathogens; however, their clinical relevance has not been clearly defined. The purpose of this study was to determine whether the etiological agents of AB affect its course. A multicenter prospective study was performed in previously healthy children <24 months of age who presented with <4 days duration of AB. Subjects were divided into the following groups: “only RSV,” “also RSV,” “no RSV,” and “no pathogen.” The clinical severity score on admission as well as the overall severity of disease was assessed. RSV was the most common cause of AB (77.5 %). “Only RSV” or “also RSV” patients had a higher clinical score on admission compared to those with “no RSV,” p < 0.001 and p < 0.02, respectively. “Only RSV” and “also RSV” patients had a higher disease severity score when compared to patients with “no RSV,” 5.9 ± 1.4 vs. 5.1 ± 1.5, p < 0.001, and 5.6 ± 1.4 vs. 5.1 ± 1.5, p < 0.02, respectively. Disease severity did not vary as a function of transfer to the pediatric intensive care unit (PICU) or duration of supplemental oxygen, yet, “only RSV” was associated with a longer length of stay (LOS) than “no RSV,” p < 0.02. “Only RSV”-related AB was associated with a more severe initial clinical presentation and a longer LOS. There appears to be little immediate clinical benefit to diagnosing RSV AB to the individual patient, but the application of these diagnostic methods may have significant cost-saving implications and, thus, deserves consideration by medical professionals and health policy analysts.

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References

  1. Hall CB, McBride JT (2005) Bronchiolitis. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, 6th edn. Elsevier Churchill Livingstone, Philadelphia, pp 812–818

    Google Scholar 

  2. Goodman D (2004) Bronchiolitis. In: Behrman RE, Kliegman RM, Jenson HB (eds) Nelson textbook of pediatrics, 17th edn. W.B. Saunders Company, Philadelphia, pp 1415–1417

    Google Scholar 

  3. Centers for Disease Control and Prevention (CDC) (2003) Bronchiolitis-associated outpatient visits and hospitalizations among American Indian and Alaska native children—United States, 1990–2000. MMWR Morb Mortal Wkly Rep 52:707–710

    Google Scholar 

  4. Bordley WC, Viswanathan M, King VJ et al (2004) Diagnosis and testing in bronchiolitis: a systematic review. Arch Pediatr Adolesc Med 158:119–126

    Article  PubMed  Google Scholar 

  5. Jartti T, Jartti L, Peltola V et al (2008) Identification of respiratory viruses in asymptomatic subjects: asymptomatic respiratory viral infections. Pediatr Infect Dis J 27:1103–1107

    Article  PubMed  Google Scholar 

  6. Cosnes-Lambe C, Raymond J, Chalumeau M et al (2008) Pertussis and respiratory syncytial virus infections. Eur J Pediatr 167:1017–1019

    Article  PubMed  Google Scholar 

  7. Miron D, Srugo I, Kra-Oz Z et al (2010) Sole pathogen in acute bronchiolitis: is there a role for other organisms apart from respiratory syncytial virus? Pediatr Infect Dis J 29:e7–e10

    Article  PubMed  Google Scholar 

  8. Semple MG, Cowell A, Dove W et al (2005) Dual infection of infants by human metapneumovirus and human respiratory syncytial virus is strongly associated with severe bronchiolitis. J Infect Dis 191:382–386

    Article  PubMed  Google Scholar 

  9. Jartti T, Lehtinen P, Vuorinen T et al (2004) Persistence of rhinovirus and enterovirus RNA after acute respiratory illness in children. J Med Virol 72:695–699

    Article  PubMed  CAS  Google Scholar 

  10. American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis (2006) Diagnosis and management of bronchiolitis. Pediatrics 118:1774–1793

    Article  Google Scholar 

  11. Gröndahl B, Puppe W, Hoppe A et al (1999) Rapid identification of nine microorganisms causing acute respiratory tract infections by single-tube multiplex reverse transcription-PCR: feasibility study. J Clin Microbiol 37:1–7

    PubMed  Google Scholar 

  12. Xu W, McDonough MC, Erdman DD (2000) Species-specific identification of human adenoviruses by a multiplex PCR assay. J Clin Microbiol 38:4114–4120

    PubMed  CAS  Google Scholar 

  13. Maertzdorf J, Wang CK, Brown JB et al (2004) Real-time reverse transcriptase PCR assay for detection of human metapneumoviruses from all known genetic lineages. J Clin Microbiol 42:981–986

    Article  PubMed  CAS  Google Scholar 

  14. Deffernez C, Wunderli W, Thomas Y et al (2004) Amplicon sequencing and improved detection of human rhinovirus in respiratory samples. J Clin Microbiol 42:3212–3218

    Article  PubMed  CAS  Google Scholar 

  15. Lu X, Chittaganpitch M, Olsen SJ et al (2006) Real-time PCR assays for detection of bocavirus in human specimens. J Clin Microbiol 44:3231–3235

    Article  PubMed  CAS  Google Scholar 

  16. Lichtinghagen R, Diedrich-Glaubitz R, von Hörsten B (1994) Identification of Bordetella pertussis in nasopharyngeal swabs using the polymerase chain reaction: evaluation of detection methods. Eur J Clin Chem Clin Biochem 32:161–167

    PubMed  CAS  Google Scholar 

  17. Wilkesmann A, Schildgen O, Eis-Hübinger AM et al (2006) Human metapneumovirus infections cause similar symptoms and clinical severity as respiratory syncytial virus infections. Eur J Pediatr 165:467–475

    Article  PubMed  Google Scholar 

  18. Marguet C, Lubrano M, Gueudin M et al (2009) In very young infants severity of acute bronchiolitis depends on carried viruses. PLoS One 4(2):e4596

    Article  PubMed  Google Scholar 

  19. Calvo C, García-García ML et al (2007) Role of rhinovirus in hospitalized infants with respiratory tract infections in Spain. Pediatr Infect Dis J 26:904–908

    Article  PubMed  Google Scholar 

  20. Papadopoulos NG, Moustaki M, Tsolia M et al (2002) Association of rhinovirus infection with increased disease severity in acute bronchiolitis. Am J Respir Crit Care Med 165:1285–1289

    Article  PubMed  Google Scholar 

  21. Mansbach JM, McAdam AJ, Clark S et al (2008) Prospective multicenter study of the viral etiology of bronchiolitis in the emergency department. Acad Emerg Med 15:111–118

    Article  PubMed  Google Scholar 

  22. Allander T, Tammi MT, Eriksson M et al (2005) Cloning of a human parvovirus by molecular screening of respiratory tract samples. Proc Natl Acad Sci USA 102:12891–12896

    Article  PubMed  CAS  Google Scholar 

  23. Allander T, Jartti T, Gupta S et al (2007) Human bocavirus and acute wheezing in children. Clin Infect Dis 1(44):904–910

    Article  Google Scholar 

  24. Jacques J, Moret H, Renois F et al (2008) Human bocavirus quantitative DNA detection in French children hospitalized for acute bronchiolitis. J Clin Virol 43:142–147

    Article  PubMed  CAS  Google Scholar 

  25. Korppi M, Hiltunen J (2007) Pertussis is common in nonvaccinated infants hospitalized for respiratory syncytial virus infection. Pediatr Infect Dis J 26:316–318

    Article  PubMed  Google Scholar 

  26. Greenberg D, Bamberger E, Ben-Shimol S et al (2007) Pertussis is under diagnosed in infants hospitalized with lower respiratory tract infection in the pediatric intensive care unit. Med Sci Monit 13:CR475–CR480

    PubMed  Google Scholar 

  27. van den Hoogen BG, de Jong JC, Groen J et al (2001) A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 7:719–724

    Article  PubMed  Google Scholar 

  28. van den Hoogen BG, Bestebroer TM, Osterhaus AD et al (2002) Analysis of the genomic sequence of a human metapneumovirus. Virology 295:119–132

    Article  PubMed  Google Scholar 

  29. Boivin G, Abed Y, Pelletier G et al (2002) Virological features and clinical manifestations associated with human metapneumovirus: a new paramyxovirus responsible for acute respiratory-tract infections in all age groups. J Infect Dis 186:1330–1334

    Article  PubMed  Google Scholar 

  30. Jartti T, van den Hoogen B, Garofalo RP et al (2002) Metapneumovirus and acute wheezing in children. Lancet 360:1393–1394

    Article  PubMed  Google Scholar 

  31. Estrada B, Carter M, Barik S et al (2007) Severe human metapneumovirus infection in hospitalized children. Clin Pediatr (Phila) 46:258–262

    Article  Google Scholar 

  32. Gray GC, Capuano AW, Setterquist SF et al (2006) Multi-year study of human metapneumovirus infection at a large US Midwestern Medical Referral Center. J Clin Virol 37:269–276

    Article  PubMed  Google Scholar 

  33. García-García ML, Calvo C, Pérez-Breña P et al (2006) Prevalence and clinical characteristics of human metapneumovirus infections in hospitalized infants in Spain. Pediatr Pulmonol 41:863–871

    Article  PubMed  Google Scholar 

  34. Richard N, Komurian-Pradel F, Javouhey E et al (2008) The impact of dual viral infection in infants admitted to a pediatric intensive care unit associated with severe bronchiolitis. Pediatr Infect Dis J 27:213–217

    Article  PubMed  Google Scholar 

  35. Jartti T, Lehtinen P, Vuorinen T et al (2009) Bronchiolitis: age and previous wheezing episodes are linked to viral etiology and atopic characteristics. Pediatr Infect Dis J 28:311–317

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors thank Zipi Kra-Oz, Ph.D. (Clinical Virology Laboratory, Rambam Health Care Campus, Haifa), Yoram Keness, Ph.D. (Clinical Microbiology Laboratory, HaEmek Medical Center, Afula), Tal Almagor, M.D. (Pediatrics Department A, HaEmek Medical Center, Afula), and Dana Wolf, M.D. (Clinical Virology Laboratory, Hadassah Medical Center, Jerusalem), Israel, for their diligent work in determining the etiological agent(s) of bronchiolitis.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Pediatrics Department, Bnai Zion Medical Center, Golomb St. 47, Haifa, 31048, Israel

    E. Bamberger, I. Srugo, B. Abu Raya, E. Segal, B. Chaim & A. Kugelman

  2. Infectious Disease Division, Meyer Children’s Hospital, Rambam Health Care Campus, Haifa, Israel

    I. Kassis

  3. Pediatric Infectious Disease Unit, HaEmek Medical Center, Afula, Israel

    D. Miron

  4. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    E. Bamberger, I. Srugo, B. Abu Raya, E. Segal, B. Chaim, I. Kassis, A. Kugelman & D. Miron

Authors
  1. E. Bamberger
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  2. I. Srugo
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  3. B. Abu Raya
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  4. E. Segal
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  5. B. Chaim
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  6. I. Kassis
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  7. A. Kugelman
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  8. D. Miron
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Corresponding author

Correspondence to B. Abu Raya.

Appendix

Appendix

Table 5 Clinical severity score at admission
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Table 6 Disease severity score
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Bamberger, E., Srugo, I., Abu Raya, B. 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 31, 3323–3330 (2012). https://doi.org/10.1007/s10096-012-1699-2

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  • DOI: https://doi.org/10.1007/s10096-012-1699-2

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