Influence of seasonal variation on severity and outcomes in acute bronchiolitis

Background: Bronchiolitis is a predominant cause of respiratory insufficiency and hospitalization in infants during the first year of their life. Respiratory syncytial virus (RSV) has been the major causative virus; other viruses also cause bronchiolitis. Some are activated in winter while another virus in non-winter seasons. This seasonal trend affects the morbidity in infants. In the Indian context, data regarding seasonal influence on the severity and complications of acute bronchiolitis is less. Hence, this study was undertaken to assess the influence of season on morbidity on mortality in acute bronchiolitis.Methods: Infants or children <2 years of age, with the first episode of acute bronchiolitis diagnosed clinically, were evaluated. Clinical, demographic, radiological and risk factors were recorded and correlated with seasons.Results: The age of the infants was 4.0±2.9 months. Peak occurrence (87.7%) was within six months of age. 78/105 (74.3%) of bronchiolitis occurred during July to December. 22/105 (20.9%) were mild, 43/105 (43.9%) were moderate, and 40/105 (38.9%) were severe. The order of chest X-ray findings are consolidation <atelectasis <normal <pulmonary infiltrates <bilateral Hyperareation. Apnea was seen in 2.9%, Otitis media in 7.6% and seizures in 3.8% of infants. The season did not show statistically significant trend on the severity of bronchiolitis. There were no infant deaths due to bronchiolitis in the present study.Conclusions: In the present study, the season did not show statistically significant trend on the severity of bronchiolitis. Studies with more extensive population are needed to reassess the seasonal effects on morbidity of acute bronchiolitis.

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Rhinovirus Infection and Familial Atopy Predict Persistent Asthma and Sensitisation 7 Years after a First Episode of Acute Bronchiolitis in Infancy

Children ◽

10.3390/children8100850 ◽

2021 ◽

Vol 8 (10) ◽

pp. 850

Author(s):

Julie Magnier ◽

Valérie Julian ◽

Aurélien Mulliez ◽

Alexandra Usclade ◽

Emmanuelle Rochette ◽

...

Keyword(s):

Family History ◽

Persistent Asthma ◽

Respiratory Function Tests ◽

Specific Ige ◽

First Episode ◽

Acute Bronchiolitis ◽

Respiratory Allergies ◽

Asthma Outcome ◽

History Of ◽

Syncytial Virus

Background: We set out to assess the risk factors for asthma outcome in a cohort of infants who experienced their first episode of acute bronchiolitis. Methods: A cohort of 222 infants who were included during a first episode of acute bronchiolitis was prospectively followed. Herein, we present the results of their assessments (symptom history, skin prick tests, specific IgE assay, respiratory function tests) at age seven. Results: Of the 68/222 (30.6%) children assessed at age seven, 15 (22.05%) presented with asthma and were mainly males (p = 0.033), 14 (20%) had respiratory allergies, 17 (25%) presented atopic dermatitis and none had a food allergy. Family history of atopy was associated with asthma and sensitisation to aeroallergens at age seven (p = 0.003, p = 0.007). Rhinovirus (hRV) infection and rhinovirus/respiratory syncytial virus (RSV) co-infection were significantly associated with asthma at age seven (p = 0.035, p = 0.04), but not with the initial severity of bronchiolitis. Eosinophil counts at ages three and seven were significantly higher in the asthmatics (p = 0.01, p = 0.046). Conclusion: Any infant, especially male, presenting a first episode of acute bronchiolitis due to hRV with a family history of atopy should be closely monitored via follow-up due to a higher risk for asthma at school age.

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Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

CJEM ◽

10.1017/cem.2016.7 ◽

2016 ◽

Vol 18 (6) ◽

pp. 443-452 ◽

Cited By ~ 7

Author(s):

Amy C. Plint ◽

Monica Taljaard ◽

Candice McGahern ◽

Shannon D. Scott ◽

Jeremy M. Grimshaw ◽

...

Keyword(s):

Hospital Admission ◽

First Episode ◽

Upper Respiratory Tract ◽

Community Hospitals ◽

Translation Strategies ◽

Admission Rates ◽

Knowledge Translation Strategies ◽

Respiratory Syncytial Virus Season ◽

Chest X Ray ◽

Syncytial Virus

AbstractObjectivesBronchiolitis is the leading cause of hospital admission for infants, but few studies have examined management of this condition in community hospital settings. We reviewed the management of children with bronchiolitis presenting to community hospitals in Ontario.MethodsWe retrospectively reviewed a consecutive cohort of infants less than 12 months old with bronchiolitis who presented to 28 Ontario community hospitals over a two-year period. Bronchiolitis was defined as first episode of wheezing associated with signs of an upper respiratory tract infection during respiratory syncytial virus season.ResultsOf 543 eligible children, 161 (29.7%, 95% Confidence Interval (CI) 22.3 to 37.0%) were admitted to hospital. Hospital admission rates varied widely (Interquartile Range 0%-40.3%). Bronchodilator use was widespread in the emergency department (ED) (79.7% of patients, 95% CI 75.0 to 84.5%) and on the inpatient wards (94.4% of patients, 95% CI 90.2 to 98.6%). Salbutamol was the most commonly used bronchodilator. At ED discharge 44.7% (95% CI 37.5 to 51.9%) of patients were prescribed a bronchodilator medication. Approximately one-third of ED patients (30.8%, 95% CI 22.7 to 38.8%), 50.3% (95% CI 37.7 to 63.0%) of inpatients, and 23.5% (95% CI 14.4 to 32.7) of patients discharged from the ED were treated with corticosteroids. The most common investigation obtained was a chest x-ray (60.2% of all children; 95% CI 51.9 to 68.5%).ConclusionsInfants with bronchiolitis receive medications and investigations for which there is little evidence of benefit. This suggests a need for knowledge translation strategies directed to community hospitals.

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The chest x-ray in acute bronchiolitis: technical quality, findings, and an assessment of its reliability

Anales de Pediatría (English Edition) ◽

10.1016/j.anpede.2020.03.015 ◽

2021 ◽

Vol 94 (3) ◽

pp. 129-135

Author(s):

Juan Manuel Rius Peris ◽

Ana Isabel Maraña Pérez ◽

Ana Valiente Armero ◽

Jorge Mateo Sotos ◽

Leonor Guardia Nieto ◽

...

Keyword(s):

Acute Bronchiolitis ◽

Technical Quality ◽

X Ray ◽

Chest X Ray

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Gene Expression of Nucleic Acid-Sensing Pattern Recognition Receptors in Children Hospitalized for Respiratory Syncytial Virus-Associated Acute Bronchiolitis

Clinical and Vaccine Immunology ◽

10.1128/cvi.00445-08 ◽

2009 ◽

Vol 16 (6) ◽

pp. 816-823 ◽

Cited By ~ 38

Author(s):

Carolina Scagnolari ◽

Fabio Midulla ◽

Alessandra Pierangeli ◽

Corrado Moretti ◽

Enea Bonci ◽

...

Keyword(s):

Gene Expression ◽

Pattern Recognition ◽

Viral Load ◽

Respiratory Syncytial Virus ◽

Pattern Recognition Receptors ◽

Mrna Levels ◽

Acute Bronchiolitis ◽

Expression Levels ◽

Rsv Infection ◽

Syncytial Virus

ABSTRACT Given the critical role of pattern recognition receptors (PRRs) in acid nucleic recognition in the initiation of innate immunity and the orchestration of adaptive immunity, the aim of this study was to determine whether any heterogeneity of PRR expression in the airway tracts of infants with respiratory syncytial virus (RSV) infection might explain the broad clinical spectrum of RSV-associated bronchiolitis in infants. For this purpose, the levels of melanoma differentiation-associated protein-5 (MDA-5), retinoic acid inducible gene-1 (RIG-1), and Toll-like receptor 3 (TLR-3), TLR-7, TLR-8, and TLR-9 mRNAs were evaluated, using TaqMan quantitative reverse transcription-PCR, in cells from nasopharyngeal washes collected from 157 infants suffering from acute bronchiolitis whether or not they were associated with respiratory viruses. High interindividual variability was observed in both virus-positive and -negative infants; however, the relative gene expression levels of MDA-5, RIG-1, TLR-7, and TLR-8 were significantly higher in the virus-infected group, whereas the expression levels of TLR-3 and TLR-9 were not significantly different. The differences in the gene expression of MDA-5, RIG-1, TLR-7, and TLR-8 were more evident in infants with RSV infection than in those with bocavirus or rhinovirus infection. In RSV-infected infants, PRR-mRNA levels also were analyzed in relation to interferon protein levels, viral load, clinical severity, days of hospitalization, age, and body weight. A significant positive correlation was observed only between RSV viral load and RIG-1 mRNA levels. These findings provide the first direct evidence that, in infants with respiratory virus-associated bronchiolitis, especially RSV, there are substantial changes in PRR gene expression; this likely is an important determinant of the clinical outcome of bronchiolitis.

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Respiratory Syncytial Virus Epidemiology in a Birth Cohort from Kilifi District, Kenya: Infection during the First Year of Life

The Journal of Infectious Diseases ◽

10.1086/425040 ◽

2004 ◽

Vol 190 (10) ◽

pp. 1828-1832 ◽

Cited By ~ 53

Author(s):

D. James Nokes ◽

Emelda A. Okiro ◽

Mwanajuma Ngama ◽

Lisa J. White ◽

Rachel Ochola ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Birth Cohort ◽

First Year ◽

Syncytial Virus ◽

First Year Of Life

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Does respiratory syncytial virus subtype influences the severity of acute bronchiolitis in hospitalized infants?

Respiratory Medicine ◽

10.1016/j.rmed.2004.01.009 ◽

2004 ◽

Vol 98 (9) ◽

pp. 879-882 ◽

Cited By ~ 50

Author(s):

Nikolaos G Papadopoulos ◽

Dimitrios Gourgiotis ◽

Artem Javadyan ◽

Apostolos Bossios ◽

Konstantina Kallergi ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Acute Bronchiolitis ◽

Syncytial Virus ◽

Virus Subtype

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Respiratory symptoms and lung function in patients treated for pulmonary tuberculosis in Malawi: a prospective cohort study

Thorax ◽

10.1136/thoraxjnl-2021-217190 ◽

2021 ◽

pp. thoraxjnl-2021-217190

Author(s):

Rebecca Nightingale ◽

Beatrice Chinoko ◽

Maia Lesosky ◽

Sarah J Rylance ◽

Bright Mnesa ◽

...

Keyword(s):

Lung Function ◽

Pulmonary Tuberculosis ◽

Respiratory Symptoms ◽

Treatment Completion ◽

First Year ◽

Tb Treatment ◽

Effective Interventions ◽

Hiv Coinfection ◽

History Of ◽

Chest X Ray

RationalePulmonary tuberculosis (PTB) can cause post-TB lung disease (PTLD) associated with respiratory symptoms, spirometric and radiological abnormalities. Understanding of the predictors and natural history of PTLD is limited.ObjectivesTo describe the symptoms and lung function of Malawian adults up to 3 years following PTB-treatment completion, and to determine the evolution of PTLD over this period.MethodsAdults successfully completing PTB treatment in Blantyre, Malawi were followed up for 3 years and assessed using questionnaires, post-bronchodilator spirometry, 6 min walk tests, chest X-ray and high-resolution CT. Predictors of lung function at 3 years were identified by mixed effects regression modelling.Measurement and main resultsWe recruited 405 participants of whom 301 completed 3 years follow-up (mean (SD) age 35 years (10.2); 66.6% males; 60.4% HIV-positive). At 3 years, 59/301 (19.6%) reported respiratory symptoms and 76/272 (27.9%) had abnormal spirometry. The proportions with low FVC fell from 57/285 (20.0%) at TB treatment completion to 33/272 (12.1%), while obstruction increased from and 41/285 (14.4%) to 43/272 (15.8%) at 3 years. Absolute FEV1 and FVC increased by mean 0.03 L and 0.1 L over this period, but FEV1 decline of more than 0.1 L was seen in 73/246 (29.7%). Higher spirometry values at 3 years were associated with higher body mass index and HIV coinfection at TB-treatment completion.ConclusionSpirometric measures improved over the 3 years following treatment, mostly in the first year. However, a third of PTB survivors experienced ongoing respiratory symptoms and abnormal spirometry (with accelerated FEV1 decline). Effective interventions are needed to improve the care of this group of patients.

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Retrospective Review of Clinical and Chest X-Ray Findings in Children Admitted to a Community Hospital for Respiratory Syncytial Virus Infection

Clinical Pediatrics ◽

10.1177/0009922818795902 ◽

2018 ◽

Vol 57 (14) ◽

pp. 1686-1692 ◽

Cited By ~ 1

Author(s):

Denver Niles ◽

Brett Larsen ◽

Arvind Balaji ◽

Dana Delaney ◽

Elizabeth Campos ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Pediatric Intensive Care ◽

Clinical Findings ◽

X Rays ◽

Radiological Findings ◽

X Ray ◽

Severe Group ◽

Rsv Infection ◽

Chest X Ray ◽

Syncytial Virus

Introduction. We performed a retrospective study to evaluate demographics, clinical course, outcome, and radiological findings of children with respiratory syncytial virus (RSV) infection. Methods. Four hundred patients admitted between October 2013 and May 2016 were enrolled. Clinical and radiographic trends were evaluated for association with severity of RSV presentation. Severity was defined as hospitalization >2 days, pediatric intensive care unit admission, or need for mechanical ventilation. Results. Common clinical findings included fever (78.5%), coughing (97%), rhinorrhea/congestion (93%), and hypoxia (44.8%). Hypoxia was seen in 64.7% of the severe group compared with 32.0% in the nonsevere group ( P < .001). Airspace opacification was seen in 49.2% of chest X-rays of the severe group compared with 26.4% in the nonsevere group ( P < .001). Conclusion. Higher incidence of hypoxia or airspace opacification on chest X-ray may be predictors of poorer outcomes for patients with RSV infection.

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Atopy predisposing to acute bronchiolitis during an epidemic of respiratory syncytial virus.

BMJ ◽

10.1136/bmj.284.6322.1070 ◽

1982 ◽

Vol 284 (6322) ◽

pp. 1070-1072 ◽

Cited By ~ 48

Author(s):

I Laing ◽

F Reidel ◽

P L Yap ◽

H Simpson

Keyword(s):

Respiratory Syncytial Virus ◽

Acute Bronchiolitis ◽

Syncytial Virus

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Duration of untreated psychosis and need for admission in patients who engage with mental health services in the prodromal phase

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.150623 ◽

2015 ◽

Vol 207 (2) ◽

pp. 130-134 ◽

Cited By ~ 45

Author(s):

Lucia R. Valmaggia ◽

Majella Byrne ◽

Fern Day ◽

Matthew R. Broome ◽

Louise Johns ◽

...

Keyword(s):

Minority Group ◽

First Episode Psychosis ◽

First Episode ◽

First Year ◽

Compulsory Treatment ◽

Duration Of Untreated Psychosis ◽

Short Term ◽

Prodromal Phase ◽

Episode Psychosis ◽

Poor Outcomes

BackgroundIt is unknown whether prodromal services improve outcomes in those who go on to develop psychosis, and whether these patients are demographically different from the overall first-episode population.AimsTo compare sociodemographic features, duration of untreated psychosis, hospital admission and frequency of compulsory treatment in the first year after the onset of psychosis in patients who present to prodromal services with patients who did not present to services until the first episode of psychosis.MethodWe compared two groups of patients with first-episode psychosis: one who made transition after presenting in the prodromal phase and the other who had presented with a first episode.ResultsThe patients who had presented before the first episode were more likely to be employed and less likely to belong to an ethnic minority group. They had a shorter duration of untreated psychosis, and were less likely to have been admitted to hospital and to have required compulsory treatment.ConclusionsPatients who develop psychosis after being engaged in the prodromal phase have a better short-term clinical outcome than patients who do not present until the first episode. Patients who present during first episodes may be more likely to have sociodemographic features associated with relatively poor outcomes.

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