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Bronchiolitis in tropical south India.

T Cherian1, E A Simoes, M C Steinhoff

  • 1Department of Virology, Christian Medical College and Hospital, Vellore, Tamilnadu, India.

American Journal of Diseases of Children (1960)
|September 1, 1990
PubMed
Summary

Acute bronchiolitis in children under five is a viral illness, primarily caused by respiratory syncytial virus. Antibiotic use should be guided by radiographic evidence, especially in infants with severe lower respiratory infections.

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Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Respiratory Medicine

Background:

  • Acute lower respiratory infections (ALRI) are a major cause of morbidity and mortality in children under five.
  • Bronchiolitis is a common cause of ALRI, particularly in infants.
  • Understanding the etiology and clinical presentation of bronchiolitis is crucial for appropriate management.

Purpose of the Study:

  • To investigate the clinical characteristics, viral etiology, and outcomes of acute bronchiolitis in children under five.
  • To determine the role of bacterial infections and the need for antibiotic treatment in bronchiolitis.
  • To assess the association between bronchiolitis and pneumonia in this population.

Main Methods:

  • Prospective hospital-based study of 328 children under five with ALRI.

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  • Diagnosis of bronchiolitis based on clinical criteria.
  • Viral detection using culture or immunofluorescence antigen detection.
  • Radiographic assessment for pneumonia.
  • Bacterial blood cultures performed in a subset of patients.

    • Main Results:

    • 114 children (35%) were diagnosed with acute bronchiolitis, predominantly infants under one year.
    • Severe signs like tachypnea and subcostal retractions were highly prevalent (95% and 93%).
    • Viruses were identified in 71% of cases, with respiratory syncytial virus (RSV) being the most common (57%).
    • Pneumonia was present in 34% of children with available radiographs; no clinical signs differentiated pneumonia.
    • Bacterial pathogens were not isolated, except for Staphylococcus aureus in one fatal case.
    • Mortality rate was 7%, with all deaths occurring in infants, often with concurrent pneumonia.

    Conclusions:

    • Bronchiolitis is a predominantly viral syndrome in this tropical region, similar to temperate climates.
    • Antibiotic therapy is generally not indicated for bronchiolitis unless bacterial pneumonia is confirmed.
    • Radiographic investigation is important for diagnosing pneumonia in children with lower respiratory infections, guiding antibiotic management decisions.