Acute bronchiolitis: a prospective study.

Patrícia Mação, Andrea Dias, Lúcia Azevedo, Arminda Jorge, Carlos Rodrigues

Abstract


Bronchiolitis is the most common lower respiratory infection in children under 2 years old. Respiratory syncytial virus (RSV) is the most frequently involved etiologic agent.To identify different viruses causing bronchiolitis and try to correlate them with demographic and clinical variables. To analyze diagnostic and therapeutic approache.We conducted a prospective study, between November 2008 and March 2009 (5 months), including children < 2 years with bronchiolitis. Screening for RSV, parainfluenza 1-3 and adenovirus used immunofluorescence tests and screening for influenza A and B, human metapneumovirus (MPvh), human bocavirus (hBoV) and RSV used polymerase chain reaction (PCR) techniques. Data were analysed by using SPSS®.We included 78 children with 8.5 months mean age (83% < 12 months), 60% were male. The average duration of the disease was 15+5 days. Were on antibiotics 19.2%, because of concomitant acute otitis media (10.2%) or bacterial pneumonia (9%). 53% required hospital admission and the average length of stay was 7 days. Along hospitalization 95% of children required supplemental oxygen, 61% intravenous rehydration and 22% chest physiotherapy. Viral testing was positive in 59/75 children: RSV (69.3%), BoVh (22.7%), MPVh (4%), parainfluenza 3 (27%) and influenza A (2.6%). Co-infection with two viruses was detected in 23% of children. In 88% of children with positive samples for BoVh it has been detected RSV infection simultaneously. Children with co-infection (RSV + BoVh) required more often hospitalization compared with children infected with RSV alone (80% vs 60%, p=0.028), without significant differences in oxygen supplementation need and length of disease.RSV was the main etiologic agent and oxygen supplementation requirement justified the majority of hospitalizations. There was a high rate of co-infection with RSV and BoVh, but without longer disease. BoVh infection alone was uncommon.

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