Respiratory Syncytial Virus is the Most Common Causative Agent of Viral Bronchiolitis in Young Children: An Updated Review

Abstract

Background: Viral bronchiolitis is a common condition and a leading cause of hospitalization in young children. Objective: This article provides readers with an update on the evaluation, diagnosis, and treatment of viral bronchiolitis, primarily due to RSV Methods: A PubMed search was conducted in December 2021 in Clinical Queries using the key terms "acute bronchiolitis" OR “respiratory syncytial virus infection”. The search included clinical trials, randomized controlled trials, case control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to children and English literature. The information retrieved from the above search was used in the compilation of this article. Results: Respiratory syncytial virus (RSV) bronchiolitis is the most common viral bronchiolitis in young children. Other viruses such as human rhinovirus and coronavirus could be etiological agents. Diagnosis is based on clinical manifestation. Viral testing is useful only for cohort and quarantine purposes. Cochrane evidence-based reviews have been performed on most treatment modalities for RSV and various viral bronchiolitis. Treatment for viral bronchiolitis is mainly symptomatic support. Beta-agonists are frequently used despite the lack of evidence that they reduce hospital admissions or length of stay. Nebulized racemic epinephrine, hypertonic saline and corticosteroids are generally not effective. Passive immunoprophylaxis with a monoclonal antibody against RSV, when given intramuscularly and monthly during winter, is effective in preventing severe RSV bronchiolitis in high-risk children who are born prematurely and in children under 2 years with chronic lung disease or hemodynamically significant congenital heart disease. Vaccines for RSV bronchiolitis are being developed. Children with viral bronchiolitis in early life are at increased risk of developing asthma later in childhood Conclusions: Viral bronchiolitis is common. No current pharmacologic treatment or novel therapy has been proven to improve outcomes comparing to supportive treatment. Viral bronchiolitis in early life predisposes asthma development later in childhood

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

“…by the potential presence of some older children with wheezing more than with bronchiolitis in the first group. In agreement with data from the literature 1,23 RSV was the main cause of bronchiolitis in our study cohort, both as a mono or coinfection (63.9% of patients) followed by rhinovirus (18 patients). Regarding viruses of more recent discovery, we detected 9 cases of metapneumovirus and 3 cases of bocavirus infection.…”

Infections caused by respiratory syncytial viruses - epidemiology, clinical picture, diagnosis, prevention and treatment options

“…(3) RSV infekce však může mít i dlouhodobý vliv na zdraví pacienta. Již více než 20 let se diskutuje vliv následků RSV infekce, zejména bronchiolitidy, na rozvoj bronchiální hyperreaktivity a astmatu, (14)(15)(16) například zvýšením exprese CXCL10 a CD14 a naopak snížením miR-34b/c-5p nebo zvýšením exprese IL-17A. (14,17,18) Poslední dobou se ukazuje také vliv infekce na metylační změny v buňkách, které v rámci epigenetických změn jsou asociovány s rozvojem astmatu (19) a objevují se i změny v T buněčné odpovědi.…”

Pediatric human nose organoids demonstrate greater susceptibility, epithelial responses, and cytotoxicity than adults during RSV infection

“…Populations that are at higher risk of severe clinical RSV infection include premature infants, infants under 6 months of age, those with existing cardiopulmonary disease, the immunocompromised, and the elderly (13)(14)(15). In children, the largest group needing hospitalization are previously healthy, young infants (16).…”