Bronchoalveolar lavage cellularity in infants with severe respiratory syncytial virus bronchiolitis

Aim: To examine over time, the cellular response within the lungs of infants ventilated with respiratory syncytial virus (RSV) bronchiolitis and to compare this response in infants born at term with those born preterm. Methods: Non-bronchoscopic bronchoalveolar lavage (BAL) samples were taken from 47 infants (24 born at term and 23 born preterm) who were ventilated for RSV positive bronchiolitis and 10 control infants. BAL cellularity and differential cell counts were calculated using standard techniques. Results: Total cellularity in BAL over the first four days of ventilation in infants with RSV bronchiolitis was greater in term infants (median 2.2 (IQR 4.27) x 10⁶ cells/ml) compared with preterm infants (0.58 (1.28) x 10⁶ cells/ml). The magnitude of the cellular response in preterm infants with bronchiolitis was similar to that in the control group measured on day 1 (0.62 (0.77) x 10⁶ cells/ml). BAL cellularity decreased progressively from the time of intubation in term infants, but remained relatively constant in preterm infants up to seven days after intubation. Conclusions: There are differences in the magnitude and type of pulmonary cellular response in term and preterm infants ventilated with RSV bronchiolitis. The cellular response in term infants with bronchiolitis differs from that in a control group of infants. These differences may reflect variations in cellular recruitment in the lung and/or variations in airway calibre.     

Severe bronchiolitis and respiratory syncytial virus among young children in Hawaii

BACKGROUND: Lower respiratory tract infections are a leading cause of hospitalization and mortality among children worldwide. Our objective was to describe the incidence and epidemiology of severe bronchiolitis, respiratory syncytial virus (RSV), and pneumonia among children in Hawaii. METHODS: Retrospective analysis of the patient-linked hospital discharge data associated with bronchiolitis, RSV, and pneumonia among Hawaii residents younger than 5 years of age during 1997 through 2004 using the Hawaii State Inpatient Database. RESULTS: During 1997 through 2004, the average annual incidence rates for bronchiolitis, RSV, and pneumonia were 3.8, 2.7, and 6.8 per 1000 children younger than 5 years, respectively. The incidence of each condition was higher for infants younger than 1 year (15.1, 9.8, and 15.9 per 1000 infants, respectively) than the incidence for children 1-4 years of age, and higher for boys compared with girls. The incidence of each condition was highest among Native Hawaiian and other Pacific Islander children compared with children of other race groups living in Hawaii. Most hospitalizations occurred during the months of October through February. Estimated median hospital charges were $4806 (bronchiolitis), $5465 (RSV) and $5240 (pneumonia), with overall average annual charges of $11.5 million. CONCLUSION: The incidence and hospitalization rates for bronchiolitis, RSV, and pneumonia among children younger than 5 years of age in Hawaii were low; the corresponding hospitalization rates were lower than those for the general U.S. population. However, the hospitalization rates for each condition among Hawaiian and other Pacific Islander children were much higher than those for other race groups or for the U.S. population.     

Bronchoalveolar lavage cellularity in infants with severe respiratory syncytial virus bronchiolitis.

Aim: To examine over time, the cellular response within the lungs of infants ventilated with respiratory syncytial virus (RSV) bronchiolitis and to compare this response in infants born at term with those born preterm. METHODS: Non-bronchoscopic bronchoalveolar lavage (BAL) samples were taken from 47 infants (24 born at term and 23 born preterm) who were ventilated for RSV positive bronchiolitis and 10 control infants. BAL cellularity and differential cell counts were calculated using standard techniques. RESULTS: Total cellularity in BAL over the first four days of ventilation in infants with RSV bronchiolitis was greater in term infants (median 2.2 (IQR 4.27) x 10(6) cells/ml) compared with preterm infants (0.58 (1.28) x 10(6) cells/ml). The magnitude of the cellular response in preterm infants with bronchiolitis was similar to that in the control group measured on day 1 (0.62 (0.77) x 10(6) cells/ml). BAL cellularity decreased progressively from the time of intubation in term infants, but remained relatively constant in preterm infants up to seven days after intubation. CONCLUSIONS: There are differences in the magnitude and type of pulmonary cellular response in term and preterm infants ventilated with RSV bronchiolitis. The cellular response in term infants with bronchiolitis differs from that in a control group of infants. These differences may reflect variations in cellular recruitment in the lung and/or variations in airway calibre.     

Long-term effects of respiratory syncytial virus (RSV) bronchiolitis in infants and young children: a quantitative review

One of the major questions regarding long-term side effects of bronchiolitis by respiratory syncytial virus (RSV) is whether or not it induces asthma in later life. In this quantitative review, the data of 10 controlled studies are analysed. METHODS: Follow-up studies of RSV bronchiolitis published between January 1978 and December 1998 were identified through a MEDLINE search. Studies were selected if (i) postnatal age at the time of the initial illness was below 12 mo, (ii) all children were hospitalized for RSV bronchiolitis, (iii) the diagnosis RSV was virologically confirmed in all cases, and (iv) a control group was used. RESULTS: Six studies met all selection criteria. Up to 5 y of follow-up after RSV bronchiolitis in infancy, 40% of children reported wheezing as compared to only 11% in the control group (p <0.001). Between 5 and 10 y of follow-up 22% of the bronchiolitis group reported wheezing against 10% of the control group (p = 0.19). The incidence of recurrent wheezing as defined by three or more wheezing episodes also decreased with increasing years of follow-up: at 5 or more years of follow-up the difference between the RSV group and the control group was no longer significant. Furthermore, the presence of either a personal and/or a family history of either atopy and/or asthma did not differ between the two groups. CONCLUSIONS: Wheezing is common after RSV bronchiolitis in infancy. It may persist for > or = 5 y of follow-up. However, no significant difference between the RSV bronchiolitis and the control group was observed regarding recurrent wheezing by 5 y of follow-up. No significant difference between the RSV bronchiolitis and the control group were found regarding a personal history of atopy, a family history of atopy and/or asthma. Therefore it seems unlikely that RSV bronchiolitis is a cause of atopic asthma in later life.     

呼吸道合胞病毒毛细支气管炎患儿T细胞亚群检测的临床价值

目的：呼吸道合胞病毒(RSV)感染所致的毛细支气管炎日后发展为哮喘的机率很高,由于哮喘患儿机体存在明显的免疫功能紊乱,而RSV毛细支气管炎在这方面的研究不多,为此该研究探讨毛细支气管炎患儿T细胞亚群的变化及其临床意义。方法：采用流式细胞术对21例RSV毛细支气管炎患儿及20例正常儿童T细胞亚群进行检测。结果：RSV毛细支气管炎组与对照组外周血T细胞亚群CD4,CD8差异无显著性(P>0.05),CD4/CD8比值RSV毛细支气管炎组高于对照组,差异有显著性(P<0.05)。结论：RSV毛细支气管炎患儿存在与哮喘相似的T细胞亚群变化相关的免疫功能紊乱,提示两者在发病机制上存在一定的联系。     

Production of interferon in respiratory syncytial virus bronchiolitis.

Production of interferon alfa in vitro was significantly reduced during acute respiratory syncytial virus bronchiolitis but subsequently returned to normal. Nasopharyngeal and endotracheal interferon alfa were detected intermittently and in low concentrations. The degree of impairment of in vitro production and poor in vivo production of interferon alfa suggest the need for a therapeutic trial of nebulised or systemic interferon in acute bronchiolitis.     

呼吸道合胞病毒毛细支气管炎患儿尿白三烯测定及临床意义

目的 探讨呼吸道合胞病毒(RSV)毛细支气管炎(毛支)患儿尿白三烯E4(LTE4)的临床意义.方法 采用竞争性酶联免疫吸附试验技术检测20例健康婴儿和30例RSV毛支患儿急性期和恢复期的尿LTE4水平;采用潮气分析测定急性期患儿呼吸频率(RR)、达峰时间比(tPTEF/tE)及达峰容积比(vPTEF/vE),分析其与尿LTE4水平的相关性.结果 RSV毛支患儿急性期的尿LTE4比恢复期、正常健康组明显增高(P＜0.01),恢复期与正常健康组相比差异无统计学意义(P＞0.05);急性期毛支患儿潮气肺功能中RR增快、tPTEF/tE和vPTEF/vE下降,与正常健康组比较,差异有统计学意义(P＜0.0001);急性期尿LTE4浓度与RR呈正相关(r=0.4376,P=0.0126),与tPTEF/tE和vPTEF/vE呈负相关(r=-0.6895,-0.6636,P均＜0.001).结论 RSV毛支患儿尿LTE4增高,与肺功能指标呈负相关;尿LTE4浓度可作为RSV毛支临床诊治的非创伤性炎性指标.     

Epidemiological and genetic characteristics associated with the severity of acute viral bronchiolitis by respiratory syncytial virus

Objectiveto assess the epidemiological and genetic factors associated with severity of acute viral bronchiolitis (AVB) by respiratory syncytial virus (RSV).Data sourcethe key words “bronchiolitis”, “risk factor”, “genetics” and “respiratory syncytial virus”, and all combinations among them were used to perform a search in the PubMed, SciELO, and Lilacs databases, of articles published after the year 2000 that included individuals younger than 2 years of age.Data synthesisa total of 1,259 articles were found, and their respective summaries were read. Of these, 81 were selected, which assessed risk factors for the severity of AVB, and were read in full; the 60 most relevant studies were included. The epidemiologic factors associated with AVB severity by RSV were prematurity, passive smoking, young age, lack of breastfeeding, chronic lung disease, congenital heart disease, male gender, ethnicity, viral coinfection, low weight at admission, maternal smoking during pregnancy, atopic dermatitis, mechanical ventilation in the neonatal period, maternal history of atopy and/or asthma during pregnancy, season of birth, low socioeconomic status, Down syndrome, environmental pollution, living at an altitude > 2,500 meters above sea level, and cesarean section birth. Conversely, some children with severe AVB did not present any of these risk factors. In this regard, recent studies have verified the influence of genetic factors on the severity of AVB by RSV. Polymorphisms of the TLRs, RANTES, JUN, IFNA5, NOS2, CX3CR1, ILs, and VDR genes have been shown to be associated with more severe evolution of AVB by RSV.Conclusionthe severity of AVB by RSV is a phenomenon that depends on the varying degrees of interaction among epidemiological, environmental, and genetic variables.     

Apnoea and bronchiolitis due to respiratory syncytial virus

ABSTRACT. A study was made of 146 children admitted to hospital with bronchiolitis due to respiratory syncytial virus. Fifteen subjects (10%) had apnoea. Six of the 16 infants (38%) less than two months of age had apnoea, compared with nine of 130 children (6.9%) over two months old (P<0.001). Nine of the 28 infants (32%) who were preterm had apnoea compared with six of 118 children (5.1%) over 37 weeks gestation (P<0.001).
Both early chronological age and prematurity are risk factors for the development of apnoea in children with RSV bronchiolitis.     

Airway eicosanoids in acute severe respiratory syncytial virus bronchiolitis

We prospectively studied the levels of eicosanoids in intubated patients with severe bronchiolitis and compared them to electively intubated non-infected infants. LeukotrieneE(4) (LTE(4)), leukotrieneB(4) (LTB(4)), and prostaglandinE(2) (PGE(2)) levels were significantly increased (P <.01) from endotracheal (ET) aspirates of infants with bronchiolitis compared with controls, as were urinary LTE(4) levels (P <.001). We conclude that eicosanoids are increased in the tracheal aspirates and urine of children with bronchiolitis.     

Siamese twins in the United Arab Emirates

In the years 1985–1992, ten pairs of conjoined twins were born in the United Arab Emirates (UAE): one dicephalus, two teratopagi, and seven thoraco- omphalopagi, one of which was still-born and three who were cared for in other hospitals. The first pair of thoraco-omphalopagus twins died of acute lymphoblastic leukaemia 6 months after successful separation. The management of the third set of twins gave rise to moral and ethical problems often encountered in such situations, while one of the teratopagi was a unique case of a parasite projecting from the mouth of the normal twin. Accepted: 15 March 1997     

Association of cytokine responses with disease severity in infants with respiratory syncytial virus infection

Aim: To explore the relationship between cytokine responses and severity of respiratory syncytial virus (RSV) infection in infants. Methods: Intracellular interleukin-4 (IL-4) and interferon- γ (IFN- γ) expression in peripheral blood CD3 + and CD8 + lymphocytes was measured by four-colour flow cytometry. Serum IL-12, IL-4 and IFN- γ levels were also determined by enzyme-linked immunosorbent assay. Results: The frequency of IL-4 and IFN- γ expression in CD3 + CD8 - cells was the same in RSV-infected, non-RSV-infected and control infants and in those with RSV bronchiolitis or RSV pneumonia, indicating that no Th2 predominance exists in the acute phase of RSV infection and RSV bronchiolitis. Furthermore, RSV-infected infants had a more frequent IFN- γ expression in CD3 + CD8 + cells than controls, and they also showed a much lower serum IL-4/ IFN- γ ratio because of decreased IL-4 and elevated IFN- γ, the latter being most prominent in RSV bronchiolitis. The serum IL-12 level in RSV-infected infants was the same as in control infants, while those with non-RSV infections had a much higher level. Serum IL-12, IFN- γ and frequency of IFN- γ expression in CD3 + CD8 + cells in mild RSV infection were much higher than in controls, while no difference existed between severe cases and controls.

Conclusion: Type 2 cytokine predominance was not found in the acute phase of RSV infection and RSV bronchiolitis, but both were accompanied by enhanced production of IFN- γ and a much higher serum IFN- γ level than in healthy controls, especially in those with RSV bronchiolitis, suggesting a role in causing airway obstruction. IFN- γ and IL-12 may also play a protective role in RSV infections by diminishing viral replication, and high levels of IL-12 and IFN- γ may be associated with lessening of the severity of infection.     

呼吸道合胞病毒毛细支气管炎患儿炎症递质的变化

目的研究气道炎症递质鼻咽分泌物嗜酸粒细胞阳离子蛋白(NPS-ECP)和尿白三烯E4(LTE4)在呼吸道合胞病毒(RSV)毛细支气管炎患儿体内的变化。方法 120例RSV检测阳性毛细支气管炎住院患儿,分为特应性组和非特应性组;同时选取30名健康体检儿童作为对照组。以酶联免疫吸附试验(ELISA)检测尿LTE4浓度,UniCAP100变态反应检测仪检测患儿鼻咽分泌物中ECP浓度,比较各组间的差异。结果特应性组尿LTE4水平为(172.21±67.29)pg/ml,高于非特应性组的(78.21±28.78)pg/ml和正常对照组的(44.22±16.14)pg/ml,三组间差异有统计学意义(F=97.33,P0.01);两两比较差异也均有统计学意义(P均0.01)。RSV毛细支气管炎患儿尿LTE4与血浆IgE、鼻咽分泌物ECP水平均呈显著正相关(r=0.57、0.49,P均0.01)。结论尿LTE4和鼻咽分泌物ECP可为RSV毛细支气管患儿的治疗和预后提供参考。     

Breastfeeding reduces the severity of respiratory syncytial virus infection among young infants: A multi‐center prospective study

Background: The objective of this study was to evaluate the effects of breastfeeding on the severity of respiratory syncytial virus infection in early infancy. Methods: A rapid test for respiratory syncytial virus (RSV) was administered by 16 general pediatricians from May 2002 to April 2005 in infants undergoing medical checkups for the common cold, all of whom were 100 days old or younger and had birthweights of more than 2500 g without underlying disease. Infants were divided into three groups: the Full breastfeeding group, the Partial group, and the Token group. RSV‐positive cases were followed up for 10 days after the initial diagnosis and the following three points were investigated: (i) the incidence of hospitalization; (ii) the duration of hospitalization; and (iii) the incidence of requiring oxygen therapy. Results: RSV antigen was detected in 203 of the total of 892 cases, and these were diagnosed as cases of RSV infectious disease. Although there were no significant differences in the hospitalization rate among the three groups, there were significant differences in the duration of hospitalization and the rate of requiring oxygen therapy. Multivariate logistic regression revealed that the requirement of oxygen therapy was significantly lower in the Full breastfeeding group (P= 0.032; odds ratio, 0.256; 95% confidence interval, 0.074–0.892). Conclusions: Breastfeeding reduces the severity of respiratory syncytial virus infection in early infancy.     

Local variability in respiratory syncytial virus disease severity

Respiratory syncytial virus (RSV) lower respiratory tract infections are considered to be a serious disease in centres such as the Sophia Children''s Hospital (Rotterdam, the Netherlands), but as more benign infections in others such as the Geneva Children''s Hospital (Switzerland). To assess the clinical severity of RSV infections at the two sites, 151 infants primarily admitted with a virologically confirmed RSV infection were studied prospectively (1994-5) and retrospectively (1993-4) (55 infants in Geneva and 96 in Rotterdam). Parameters of RSV morbidity which were more severe in Rotterdam during the two winter seasons were apnoea (1.8 v 23.9%), the rate of admission to the intensive care unit (3.6 v 28.1%), mechanical ventilation (0 v 7.3%), and length of stay in hospital (6.8 v 9.1 days). In Geneva higher respiratory rates (59.2 v 51.2), more wheezing (65.5 v 28.8%), and more retractions (81.8 v 63.3%) were recorded. Fewer infants younger than 4 months (54.9 v 68.7%), but more breast fed infants (94.1 v 38.5%), were admitted in Geneva, although the morbidity parameters remained different after correction for these two variables in multivariate analyses. Thus unidentified local factors influence the pattern and severity of RSV infection and may affect the results of multicentre prophylactic and therapeutic studies.