Study of 8-year-old children with a history of respiratory syncytial virus bronchiolitis in infancy.

Abstract

11 the severity of the clinical symptoms could not be adequately explained by valvular regurgitation, of which there was little evidence on examination of the heart. Blood cultures usually remained sterile, presumably because of inappropriate antibiotic treatment or the limited infectiveness of the organisms present, or both.A striking feature in three patients (cases 1, 2, and 4) was the acute, severe, and rapidly resolving but recurrent episodes of pulmonary oedema. Possibly these were caused by sudden blocking of the orifice by -vegetation-this was indeed shown echocardiographically in one patient (case 4). Other patients (cases 3 and 5 and those reported by Reeve et all and Matula et al2) had more progressive pulmonary oedema, suggesting increasing mitral stenosis. In our experience both types of pulmonary oedema are uncommon in patients with isolated mitral valve regurgitation during bacterial endocarditis.Those of our patients who did not have mitral valve replacement (cases 2, 4, and 5) and the patient of Reeve and his colleagues' had a sudden cardiac arrest. Mitral valve vegetations cause obstruction just as catastrophic as an atrial tumour or a ball thrombus, and hence once the doctor suspects mitral valve obstruction he should confirm the diagnosis promptly and ensure that the patient is rapidly operated on.Accurate diagnosis is vital. Right heart catheterisation showed a raised pulmonary wedge pressure without a striking V wave, but was nevertheless of little value in assessing the severity of the haemodynamic disturbance: pressures may be very high because of rheumatic valve disease (case 4) Journal, 1978, 1, 11-14 Summary and conclusions Thirty-five children known to have had respiratory syncytial virus bronchiolitis in infancy were examined at the age of 8 and their respiratory function tested. The results were compared with those in 35 controls matched for age, sex, and social class. Although 18 of the children who had had bronchiolitis in infancy had experienced subsequent episodes of wheezing, these were neither severe nor frequent in most cases and had apparently ceased by the age of 8. Nevertheless, the mean exercise bronchial lability of the children who had had bronchiolitis was significantly higher than that of the control children and the mean peak expiratory flow rate at rest significantly lower.

Epidemiology and aetiology of acute bronchiolitis in Hong Kong infants

“…This observation is in agreement with the general consensus that recurrent wheezing after acute bronchiolitis in infancy is common [15][16][17][18]. Thirteen of the 119 patients had four or more admissions under the same diagnosis, 'acute bronchiolitis'.…”

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

“…However, studies to determine whether RSV infections enhance allergy in humans have arrived at different conclusions [2,3,45,[48][49][50][51][52][53]. Since long-term prospective studies have failed to demonstrate a correlation between atopy and RSV-associated wheezing [3,51,52], the hypothesis is regarded as controversial [38].…”

“…Several long-term follow-up studies of bronchial reactivity, after hospitalization with proven RSV bronchiolitis, have reported bronchial hyperresponsiveness to exercise and histamine several years later, even at school age [48,49,53,71]. However, in mild cases there seemed to be no hyperresponsiveness present at 8-12 yrs follow-up [72,73].…”

Hospitalização por bronquiolite aguda como fator de risco para sibilância recorrente

“…Panitch et al (1993) apontaram história familiar de asma e de atopia como fatores de risco para sibilância recorrente pós-bronquiolite. Entretanto, neste estudo, predisposição hereditária para atopia ou asma brônquica não se mostrou como explicação provável para o desfecho, pois tanto os casos quanto os controles apresentaram fatores hereditários similares, e este achado é semelhante ao de outros estudos (Sims et al, 1978(Sims et al, , 1981Murray et al, 1992;Sigurs et al, 1995).…”

“…Martinez et al (1988Martinez et al ( , 1995Martinez et al ( , 1996 sugerem, em vários estudos, que existiriam alterações iniciais da via aérea, tornando algumas crianças predispostas a apresentarem sibilância em associação com infecções respiratórias virais, além de postular que, na maioria dos casos, essa seria situação transitória. Entretanto, estudos como os de Kattan et al (1977) e Sims (1978) reportaram reatividade brônquica em indiví-duos avaliados dez e oito anos, respectivamente, após o episódio agudo de bronquiolite.…”