Bronchiolitis

Kou, Maybelle; Hwang, Vivian; Ramkellawan, Nadira

doi:10.1016/j.emc.2017.12.006

Cited by 25 publications

(17 citation statements)

References 53 publications

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“…Although advances in the treatment of respiratory infections have been made, management of viral infections in this population remains a challenge (Ljungman et al, 2001; Casper et al, 2010; Chemaly et al, 2014; Waghmare et al, 2016; Shahani et al, 2017). Treatment is primarily supportive and includes, fluid replacement, oxygen for hypoxia and mechanical ventilation if necessary (Meissner, 2016; Kou et al, 2018). Bronchodilators may provide some benefit (Meissner, 2016; Kou et al, 2018).…”

Section: Treatmentmentioning

confidence: 99%

“…Treatment is primarily supportive and includes, fluid replacement, oxygen for hypoxia and mechanical ventilation if necessary (Meissner, 2016; Kou et al, 2018). Bronchodilators may provide some benefit (Meissner, 2016; Kou et al, 2018). Given the significant mortality rate in immunocompromised host, antiviral therapy should be considered when available (Casper et al, 2010; Renaud and Englund, 2012; Hirsch et al, 2013; Waghmare et al, 2016; Shahani et al, 2017).…”

Section: Treatmentmentioning

confidence: 99%

“…Respiratory viruses represent the most common infections in children (Tregoning and Schwarze, 2010; Meissner, 2016; Kou et al, 2018). In healthy children, they usually cause upper respiratory tract infections (URTI) with a benign, self-limited course (Tregoning and Schwarze, 2010; Meissner, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Respiratory Viral Infections in Patients With Cancer or Undergoing Hematopoietic Cell Transplant

2018

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Survival rates for pediatric cancer have steadily improved over time but it remains a significant cause of morbidity and mortality among children. Infections are a major complication of cancer and its treatment. Community acquired respiratory viral infections (CRV) in these patients increase morbidity, mortality and can lead to delay in chemotherapy. These are the result of infections with a heterogeneous group of viruses including RNA viruses, such as respiratory syncytial virus (RSV), influenza virus (IV), parainfluenza virus (PIV), metapneumovirus (HMPV), rhinovirus (RhV), and coronavirus (CoV). These infections maintain a similar seasonal pattern to those of immunocompetent patients. Clinical manifestations vary significantly depending on the type of virus and the type and degree of immunosuppression, ranging from asymptomatic or mild disease to rapidly progressive fatal pneumonia Infections in this population are characterized by a high rate of progression from upper to lower respiratory tract infection and prolonged viral shedding. Use of corticosteroids and immunosuppressive therapy are risk factors for severe disease. The clinical course is often difficult to predict, and clinical signs are unreliable. Accurate prognostic viral and immune markers, which have become part of the standard of care for systemic viral infections, are currently lacking; and management of CRV infections remains controversial. Defining effective prophylactic and therapeutic strategies is challenging, especially considering, the spectrum of immunocompromised patients, the variety of respiratory viruses, and the presence of other opportunistic infections and medical problems. Prevention remains one of the most important strategies against these viruses. Early diagnosis, supportive care and antivirals at an early stage, when available and indicated, have proven beneficial. However, with the exception of neuraminidase inhibitors for influenza infection, there are no accepted treatments. In high-risk patients, pre-emptive treatment with antivirals for upper respiratory tract infection (URTI) to decrease progression to LRTI is a common strategy. In the future, viral load and immune markers may prove beneficial in predicting severe disease, supporting decision making and monitor treatment in this population.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Respiratory Viral Infections in Patients With Cancer or Undergoing Hematopoietic Cell Transplant

2018

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“…19) There is currently no effective treatment for RSV infection, and management primarily remains supportive, including oxygen supplementation, fluid administration, and respiratory management. [20][21][22][23] Palivizumab (Synagis ® ) was initially expected as an effective drug for the treatment of severe respiratory tract inflammation caused by RSV; however, palivizumab was found to not exert significant efficacy, and has been used as a preventive therapy in premature infants and children, who are at a high risk for RSV infection, with underlying diseases of the heart and lungs. 20,21,[24][25][26][27] On the other hand, ribavirin is a synthetic guanosine nucleoside analogue and is an antiviral agent with a broad range of antiviral and immunomodulatory effects on DNA or RNA viruses.…”

Section: Introductionmentioning

confidence: 99%

“…[20][21][22][23] Palivizumab (Synagis ® ) was initially expected as an effective drug for the treatment of severe respiratory tract inflammation caused by RSV; however, palivizumab was found to not exert significant efficacy, and has been used as a preventive therapy in premature infants and children, who are at a high risk for RSV infection, with underlying diseases of the heart and lungs. 20,21,[24][25][26][27] On the other hand, ribavirin is a synthetic guanosine nucleoside analogue and is an antiviral agent with a broad range of antiviral and immunomodulatory effects on DNA or RNA viruses. [28][29][30][31][32][33][34] However, the usefulness of ribavirin is limited by its high cost, by the demonstration of its no benefit for decreasing the rate of hospitalization or mortality, and by its relatively high toxicity for health care workers.…”

Section: Introductionmentioning

confidence: 99%

Design and Synthesis of 2-(1-Alkylaminoalkyl)pyrazolo[1,5-a]pyrimidines as New Respiratory Syncytial Virus Fusion Protein Inhibitors

et al. 2020

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Respiratory syncytial virus (RSV) is one of the most common causes of lower respiratory tract infections and a significant pathogen for both adults and children. Although two drugs have been approved for the treatment of RSV infections, the low therapeutic index of these drugs have led pharmaceutical companies to develop safe and effective small-molecule anti-RSV drugs. The pyrazolo[1,5-a]pyrimidine series of compounds containing a piperidine ring at the 2-position of the pyrazolo[1,5-a]pyrimidine scaffold are known as candidate RSV fusion (F) protein inhibitor drugs, such as presatovir and P3. The piperidine ring has been revealed to facilitate the formation of an appropriate dihedral angle between the pyrazolo[1,5-a]pyrimidine scaffold and the plane of the amide bond for exertion of anti-RSV activity. A molecular-dynamic study on newly designed compounds with an acyclic chain instead of the piperidine ring proposed and demonstrated a new series of pyrazolo[1,5-a]pyrimidine derivatives, such as 9c with a 1-methyaminopropyl moiety, showing similar dihedral angle distributions to those in presatovir. Compound 9c exhibited potent anti-RSV activity with an EC 50 value of below 1 nM, which was similar to that of presatovir. A subsequent optimization study on the benzene ring of 9c led to the potent RSV F protein inhibitor 14f with an EC 50 value of 0.15 nM. The possibility of improving the biological properties of anti-RSV agents by modification at the 7-position of pyrazolo[1,5-a]pyrimidine is also discussed.

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Impact of the publication of the Italian guidelines for bronchiolitis on the management of hospitalized children in Pisa, Italy

Abbate

Depietri

Tinelli

et al. 2023

Pediatric Pulmonology

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Bronchiolitis represents one of the major causes of hospitalization and mortality in children younger than 1 year, but its management continues to be heterogenous both in those who are hospitalized and in those who are not. To assess the impact of the publication of the Italian guidelines on bronchiolitis in October 2014, we analyzed data from children aged ≤12 months admitted for bronchiolitis at the University Hospital of Pisa from January 2010 to December 2019, dividing them into two groups based on whether admission was either preceding (Group 1) or following (Group 2) the publication of the guidelines. 346 patients (mean age 4.1 ± 2.8 months, 55% males) were admitted in the study period; 43.3%, 49.4%, and 7.3% of patients had mild, moderate or severe bronchiolitis, respectively. The mean length of hospital stay was 6.7 ± 2.9 days; 90.5% of the patients underwent nasal swab and 200 patients tested positive for RSV (in mono or coinfection with other viruses). We found no difference in RSV prevalence and severity distribution between the two groups, while we observed a significant reduction in the use of both chest X‐rays (66.9% vs. 34.8%, p < 0.001), blood testing (93.4% vs. 58.2%, p < 0.001) and inhaled or systemic corticosteroids (93.1% vs. 47.8%, p < 0.001) in Group 2. No significant reduction in the use of antibiotics and of inhaled β2 agonists was found. Our data suggest that the publication of the Italian guidelines for bronchiolitis has contributed to improving the management of patients admitted for bronchiolitis in our Unit.

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Bronchiolitis

Cited by 25 publications

References 53 publications

Respiratory Viral Infections in Patients With Cancer or Undergoing Hematopoietic Cell Transplant

Respiratory Viral Infections in Patients With Cancer or Undergoing Hematopoietic Cell Transplant

Design and Synthesis of 2-(1-Alkylaminoalkyl)pyrazolo[1,5-a]pyrimidines as New Respiratory Syncytial Virus Fusion Protein Inhibitors

Impact of the publication of the Italian guidelines for bronchiolitis on the management of hospitalized children in Pisa, Italy

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