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Abstract
Purpose
We investigated the influence of respiratory virus and atopic characteristics on the severity of bronchiolitis.
Methods
Four hundred and eighteen infants <2-years-old and hospitalized at Daegu Fatima Hospital with bronchiolitis from March 2007 to February 2010 were evaluated. They were detected for specific respiratory viruses in nasopharyngeal aspirates by multiplex reverse transcription-polymerase chain reaction. Clinical severity score, based on respiratory rate, wheezing, chest retraction, and oxygen saturation was assessed at admission. According to the scores, all patients were divided into a mild to moderate bronchiolitis group and a severe group. Clinical data related to host factors, including atopic characteristics and respiratory viruses, were compared among individual groups. Multivariate logistic regression analyses were performed to identify independent risk factors for severe bronchiolitis.
Results
A single virus was identified in 365 infants (87%) and multiple viruses in 53 (13%). Respiratory syncytial virus (RSV) was the most common virus detected (51%). RSV and rhinovirus were the viruses most frequently identified in mixed infections in infants hospitalized with bronchiolitis. Infants with coinfections were 3.28 times (95% confidence interval, 1.36 to 7.89) more at risk for severe bronchiolitis than those with a single infection. Host factors associated with more severe bronchiolitis included male gender, younger age, prematurity, and chronic cardiorespiratory illness. Type of viruses, personal and family history of atopy, and passive smoking were not significantly associated with bronchiolitis severity.
References
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Table 1.
Clinical Severity Score (Modified from Tal A, Bavilski C, Yohai D, Bearman JE, Gorodischer R, Moses SW. Pediatrics 1983;71:13–8, with permission of American Academy of Pediatrics) [42].
| Parameters | 0 | 1 | 2 | 3 |
|---|---|---|---|---|
| Respiratory rate (breaths/min) | <30 | 31–45 | 46–60 | >60 |
| Wheezing | None∗ | Terminal expiratory or heard only with stethoscope | Entire expiration or on expiration without stethoscope | Inspiration and expiration without stethoscope |
| Chest retraction | None | Intercostal only | Tracheosternal | Severe with nasal flaring |
| TcSaO2 (%) | 99 ≥ | 96–98 | 93–95 | <93 |
Table 2.
Demographic Features of Studied Subjects
| Mild to moderate (n=378) | Severe (n=40) | Total (n=418) | P -Value∗ | |
|---|---|---|---|---|
| Age, mo | 0.000 | |||
| 3 | 35 (9.3) | 12 (30.0) | 47 (11.2) | |
| 3–6 | 109 (28.9) | 19 (47.5) | 128 (30.6) | |
| 7–12 | 99 (26.2) | 5 (12.5) | 104 (24.9) | |
| 13–24 | 135 (35.7) | 4 (10.0) | 139 (33.3) | |
| Sex | 0.018 | |||
| Male | 241 (63.8) | 33 (82.5) | 274 (65.6) | |
| Female | 137 (36.2) | 7 (17.5) | 144 (34.4) | |
| Season | 0.184 | |||
| Spring | 55 (14.6) | 9 (22,5) | 64 (15.3) | |
| Summer | 54 (14.3) | 3 (7.5) | 57 (13.6) | |
| Autumn | 115 (30.4) | 13 (32.5) | 128 (30.6) | |
| Winter | 154 (40.7) | 15 (37.5) | 169 (40.4) |
Table 3.
Birth History and Preexisting Disease of Studied Subjects
| Variable | Mild to moderate (n=378) | Severe (n=40) | Total (n=418) | P -Value∗ |
|---|---|---|---|---|
| Gestational age, wk | ||||
| 32 ˂ | 9 (2.4) | 7 (17.5) | 16 (3.8) | 0.000 |
| 32–36 | 28 (7.4) | 8 (20.0) | 36 (8.6) | |
| 37 ≥ | 341 (90.2) | 25 (62.5) | 366 (87.6) | |
| Birth weight, gm | ||||
| 2,500 ˂ | 24 (6.3) | 12 (30.0) | 36 (8.6) | 0.000 |
| 2,500 ≥ | 354 (93.7) | 28 (70.0) | 382 (91.4) | |
| Delivery method | ||||
| C-sec | 145 (38.4) | 20 (50.0) | 165 (39.5) | 0.152 |
| NVD | 233 (61.6) | 20 (50.0) | 253 (60.5) | |
| CLD | 8 (2.1) | 9 (22.5) | 17 (4.1) | 0.000 |
| CHD | 8 (2.1) | 3 (7.5) | 11 (2.6) | 0.043 |
| ND | 2 (0.5) | 0 (0.0) | 2 (0.5) | 0.645 |
Table 4.
Atopic Family History and Past History of Studied Subjects
| Mild to moderate (n=378) | Severe (n=40) | Total (n=418) | P -Value∗ | |
|---|---|---|---|---|
| Family Hx. of atopy | 183 (48.4) | 14 (35.0) | 197 (47.1) | 0.594 |
| Personal Hx. of AD | 142 (37.6) | 10 (25.0) | 152 (36.4) | 0.116 |
| Previous wheezing episodes | ||||
| 1st | 234 (61.9) | 29 (72.5) | 263 (62.9) | 0.187 |
| 2nd | 83 (22.0) | 7 (17.5) | 90 (21.5) | 0.514 |
| 3rd ≥ | 61 (16.1) | 4 (10.0) | 65 (15.6) | 0.308 |
| Passive smokers | 177 (46.8) | 25 (62.5) | 202 (48.3) | 0.059 |
Table 5.
Viral Prevalence in Studied Subjects
| Variable | Mild to moderate (n=378) | Severe (n=40) | Total (n=418) | P -value∗ |
|---|---|---|---|---|
| RSV A, B | 190 (50.2) | 21 (52.5) | 211 (50.5) | 0.883 |
| PIV 1,2,3 | 40 (10.6) | 2 (5.0) | 42 (10.0) | 0.460 |
| RV | 33 (8.7) | 2 (5.0) | 35 (8.4) | 0.338 |
| MPV | 23 (6.1) | 1 (2.5) | 24 (5.7) | 0.453 |
| ADV | 21 (5.6) | 1 (2.5) | 22 (5.3) | 0.315 |
| IF A, B | 16 (4.2) | 0 (0.0) | 16 (3.8) | 0.398 |
| CoV | 15 (4.0) | 0 (0.0) | 15 (3.6) | 0.344 |
| Dual Pathogens | 40 (10.6) | 13 (32.5) | 53 (12.7) | 0.000 |
Table 6.
Viral Distribution of Detected Dual Infection Cases
| Primary viral agent | Associated virus | Mild to moderate (n=40) | Severe (n=13) | Total (n=53) | P -Value∗ |
|---|---|---|---|---|---|
| RSV A, B | RV | 10 (25.0) | 3 (23.1) | 13 (24.5) | 0.571 |
| CoV | 8 (20.0) | 3 (23.1) | 11 (20.8) | ||
| ADV | 5 (12.5) | 3 (23.1) | 9 (17.0) | ||
| IF A, B | 2 (5.0) | 1 (7.7) | 3 (5.7) | ||
| PIV 1,2,3 | 1 (2.5) | 0 (0.0) | 1 (1.9) | ||
| RV | PIV 1,2,3 | 4 (10.0) | 2 (15.4) | 6 (11.3) | |
| ADV | 3 (7.5) | 0 (0.0) | 3 (5.7) | ||
| CoV | 0 (0.0) | 1 (7.7) | 1 (1.9) | ||
| PIV 1,2,3 | CoV | 4 (10.0) | 0 (0.0) | 4 (7.5) | |
| IF A, B | 2 (5.0) | 0 (0.0) | 2 (3.8) | ||
| ADV | 3 (7.5) | 0 (0.0) | 3 (5.7) |
Table 7.
Atopic Laboratory Findings of Studied Subjects
| Mild to moderate (n=378) | Severe (n=40) | Total (n=418) | P -Value∗ | |
|---|---|---|---|---|
| Eosinophilia 4% ≥ | 30 (7.9) | 4 (10.0) | 34 (8.1) | 0.650 |
| Serum ECP, g/L (mean SD) μ ± | 14.04 18.87 ± | 17.86 14.53 ± | 14.27 18.63 ± | 0.457 |
| Log IgE (M SD) ± | 2.35 0.68 ± | 1.81 0.61 ± | 2.30 0.69 ± | 0.000 |
| Serum IgE 47 IU/mL ≥ | 94 (24.9) | 2 (5.0) | 96 (23.0) | 0.004 |
| Specific IgE, IU/mL | ||||
| Food | 76 (20.1) | 10 (25.0) | 86 (20.6) | 0.467 |
| Inhalants | 30 (7.9) | 4 (10.0) | 34 (8.1) | 0.650 |
| Mixed | 10 (2.4) | 1 (0.2) | 11 (2.6) | 0.843 |
Table 8.
Univariate and Multivariate Logistic Regression Analysis of Risk Factors of Severe Bronchiolitis
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