Viral aetiology of bronchiolitis in hospitalised children in Qatar

Abstract

BackgroundBronchiolitis is considered one of the earliest and most common causes of hospitalisation in young children. Development of molecular technologies allowed a better understanding of bronchiolitis aetiology. Results from cohort studies evaluating the association between single, multiple viral infections and clinical outcomes are conflicting. Data on viral bronchiolitis in children were found to be limited in Qatar. This study aimed to determine frequency and seasonal trends of viral pathogens causing acute bronchiolitis, and to explore association between viral pathogens, disease severity and length of stay (LOS).MethodsThis is a retrospective descriptive study, including children admitted in 2010 and 2011 with acute bronchiolitis. Presenting history, physical examination and respiratory viral co-infections as detected by molecular assays were analysed.ResultsAt least one virus was detected in 315/369 (85.4%) of included children with single and multiple viruses in 67 and 33% of cases respectively. Respiratory syncytial virus (RSV) was the most detected virus, accounting for 51.2% followed by rhinovirus (RV) in 25.5% of cases. Fall and summer admissions were associated with longer LOS. On multivariate logistic regression analysis, retraction (OR 3.96; 95% CI 1.64,9.59) and age group 1–3 months (OR 3.09; 95% CI 1.06,9.05) were associated with longer LOS. Crepitation (OR 9.15; 95% CI 1.58,53.13), retraction (OR 4.10; 95% CI 1.05,16.12) and respiratory rate (OR 1.46; 95% CI 1.28,1.66) were associated with moderate to severe bronchiolitis. Identifying the viral agent did not influence disease severity or LOS.ConclusionClinical presentation is of more relevance to LOS and disease severity than the detected viruses. Future studies should investigate the interplay between climate characteristics, population’s factors and the most detectable circulating viruses.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2225-z) contains supplementary material, which is available to authorized users.

Predictors of Prolonged Length of Hospital Stay for Infants with Bronchiolitis

“…A large, multicenter, multiyear prospective study of children hospitalized with bronchiolitis in 16 hospitals in the USA found that in comparison with children with RSV-only infections, those infected with RSV in combination with human rhinovirus (HRV) were more likely to have an LOS of 3 days or more and that those with HRV-only infections were less likely to present this outcome 39. An observational study that included 369 patients admitted to the pediatric ward for bronchiolitis detected RSV in 51.2% of the cases and in second place HRV in 25.5% of cases, but found that identifying the viral agent did not influence disease severity or LOS 28. In our study RSV isolation was associated with almost two times higher odds of prolonged LOS for bronchiolitis.…”

“…The presence of cyanosis was significantly associated with prolonged LOS in a population of 1046 children hospitalized for acute lower respiratory infections in a hospital located in Cairo, Egypt 32. Janahi et al 28 in a retrospective cohort study examined an inpatient population of 369 infants admitted with acute bronchiolitis in a hospital in Qatar, and found that retraction was an independent predictor of longer LOS. Finally, Mansbach et al 33 identified decreasing lowest oxygen saturation in the ED as a variable independently associated with ED LOS.…”

Respiratory Support during Bronchiolitis Due to One Virus versus More Than One Virus: An Observational Study

“…When looking at the primary outcome of duration of respiratory support via any mode, there was no difference between the two groups with a median duration of respiratory [1][2][3][4] in the more than one virus group (p ¼ 0.06). The median duration of hospital LOS was 4 days (IQR: 3-6) in the one virus group and 5 days (IQR: [4][5][6][7][8][9] in the more than one virus group (p ¼ 0.03).…”

“…3 Respiratory syncytial virus (RSV), followed by rhinovirus, seem to be the most prevalent pathogens. [3][4][5] Influenza, parainfluenza, metapneumovirus, adenovirus, and coronavirus are also frequently identified and might be responsible for greater illness severity. 3 The treatment for bronchiolitis, irrespective of the pathogen, is supportive and includes different levels of respiratory assistance that range from oxygen delivered via lowflow nasal cannula to invasive mechanical ventilation (IMV).…”

Influence of seasonal variation on severity and outcomes in acute bronchiolitis

“…Influence of seasonal activity of the most commonly detected respiratory viruses has been reported in the literature. 13,14 According to Heyman et al, respiratory syncytial virus is the dominant pathogen during the winter months whereas rhinovirus is more common during other months. 15 However, we did not identify the virus.…”