Rhinovirus and Respiratory Syncytial Virus in Wheezing Children Requiring Emergency Care

Abstract

This cross-sectional emergency department study of 70 wheezing children and 59 control subjects (2 mo to 16 yr of age) examined the prevalence of respiratory viruses and their relationship to age, atopic status, and eosinophil markers. Nasal washes were cultured for respiratory viruses, assayed for respiratory syncytial virus (RSV) antigen, and tested for coronavirus and rhinovirus RNA using reverse transcription-PCR (RT-PCR). Also evaluated were eosinophil numbers and eosinophil cationic protein (ECP) in both nasal washes and serum, along with total IgE and specific IgE antibody in serum. Respiratory viruses were detected in 82% (18 of 22) of wheezing infants younger than 2 yr of age and in 83% (40 of 48) of older wheezing children. The predominant pathogens were RSV in infants (detected in 68% of wheezing subjects) and rhinovirus in older wheezing children (71%), and both were strongly associated with wheezing (p < 0.005). RSV was largely limited to wheezing children younger than 24 mo of age, but rhinovirus was detected by RT-PCR in 41% of all infants and in 35% of nonwheezing control subjects older than 2 yr of age. After 2 yr of age the strongest odds for wheezing were observed among those who had a positive RT-PCR test for rhinovirus together with a positive serum radioallergosorbent testing (RAST), nasal eosinophilia, or elevated nasal ECP (odds ratios = 17, 21, and 25, respectively). Results from this study demonstrate that a large majority of emergent wheezing illnesses during childhood (2 to 16 yr of age) can be linked to infection with rhinovirus, and that these wheezing attacks are most likely in those who have rhinovirus together with evidence of atopy or eosinophilic airway inflammation.

Asthma Hospitalization Trends in Charleston, South Carolina, 1956 to 1997: Twenty-fold Increase Among Black Children During a 30-Year Period

“…Tree pollen levels in the Charleston area are highest in April, weed pollen levels are highest in October, and peak rhinovirus activity is highest in the fall and spring in nearby areas. [23][24][25] These seasonal associations would not, however, account for the long-term trend found in this study.…”

Respiratory virus transmission dynamics determine timing of asthma exacerbation peaks: Evidence from a population-level model

“…Exacerbations, the worsening of asthma symptoms, are a growing public health concern, resulting in millions of missed work and school days and $50 billion in direct healthcare costs in the United States each year (3)(4)(5). Prior studies have examined environmental correlates of asthma exacerbations, including air quality measures (6)(7)(8), whereas others have considered the role of respiratory virus infections in triggering asthma exacerbation (9)(10)(11)(12)(13). However, none have simultaneously considered both infectious and noninfectious factors that potentially influence the large-scale spatiotemporal dynamics of asthma exacerbations.…”

Bronquiolite aguda por rinovírus em lactentes jovens

“…12,16 The limited number of patients in the present study was probably the result of the rigorous criteria used to define the acute episode as the first in the childs life and of the use of a single center, but we believe that it is representative of the population of infants who visit the emergency care rooms and hospital infirmaries in the city of Porto Alegre.…”

“…[9][10] Furthermore, upper airway infections by this virus have been associated with episodes of asthma exacerbation in older children and adults. [11][12] Nevertheless, Papadopoulos et al 13 demonstrated that RV may also cause lower airway infections. Previous studies have demonstrated an association between RV infection and wheezing in infants.…”