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An In vitro Model to Study Immune Responses of Human Peripheral Blood Mononuclear Cells to Human Respiratory Syncytial Virus Infection
Published on: December 10, 2013
Multicenter study of viral etiology and relapse in hospitalized children with bronchiolitis
Kohei Hasegawa1, Jonathan M Mansbach, Stephen J Teach
1From the *Department of Emergency Medicine, Massachusetts General Hospital; †Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA; ‡Division of Emergency Medicine, Children's National Health System, Washington, DC; §Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego; ¶Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, CA; ‖Department of Emergency Medicine, Weill Cornell Medical College, New York, NY; and **Departments of Molecular Virology and Microbiology, and Pediatrics, Baylor College of Medicine, Houston, TX.
Insights
Children hospitalized with bronchiolitis due to respiratory syncytial virus (RSV) and rhinovirus (RV) coinfection had a higher risk of relapse. This finding highlights how the specific virus causing severe bronchiolitis impacts short-term outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- The impact of specific viral etiologies on severe bronchiolitis outcomes, like post-hospitalization relapse, remains unclear.
- This study investigated whether rhinovirus (RV) infection, alone or with respiratory syncytial virus (RSV), increases relapse risk in hospitalized children.
Purpose of the Study:
- To determine the association between viral etiology and short-term outcomes in hospitalized infants with bronchiolitis.
- To test the hypothesis that RV infection, as a sole pathogen or in coinfection with RSV, elevates the risk of bronchiolitis relapse.
Main Methods:
- A prospective, 16-center cohort study involving hospitalized children under 2 years with bronchiolitis.
- Nasopharyngeal aspirates were collected and tested for viruses using real-time polymerase chain reaction (PCR).
- The primary outcome was bronchiolitis relapse, defined as an urgent visit or medication change within 2 weeks post-discharge.
Main Results:
- Among 1836 children, 48% had sole RSV, 8% sole RV, and 13% RSV/RV coinfection.
- Children with sole RV infection showed no increased relapse risk compared to sole RSV (OR: 0.99, P=0.98).
- RSV/RV coinfection was independently associated with a higher likelihood of relapse (OR: 1.54, P=0.03).
Conclusions:
- RSV/RV coinfection is an independent risk factor for bronchiolitis relapse in hospitalized children.
- The findings support the concept that the specific infectious agent in severe bronchiolitis influences short-term clinical outcomes.
- Understanding viral etiology is crucial for predicting and managing bronchiolitis relapse.
Background:
It is unclear whether the infectious etiology of severe bronchiolitis affects short-term outcomes, such as posthospitalization relapse. We tested the hypothesis that children hospitalized with rhinovirus (RV) bronchiolitis, either as a sole pathogen or in combination with respiratory syncytial virus (RSV), are at increased risk of relapse.
Methods:
We performed a 16-center, prospective cohort study of hospitalized children age <2 years with bronchiolitis. During the winters of 2007-2010, researchers collected clinical data and nasopharyngeal aspirates from study participants; the aspirates were tested using real-time polymerase chain reaction. The primary outcome was bronchiolitis relapse (urgent bronchiolitis visit or scheduled visit at which additions to the bronchiolitis medications were made) during the 2 weeks after hospital discharge.
Results:
Among 1836 enrolled children with 2-week, follow-up data, the median age was 4 months and 60% were male. Overall, 48% had sole RSV infection, 8% had sole RV infection, and 13% had RSV/RV coinfection. Compared with children with sole RSV infection, and adjusting for 10 demographic and clinical characteristics and clustering of patients within hospitals, children with sole RV infection did not differ in their likelihood of relapse (odds ratio: 0.99; 95% confidence interval: 0.52-1.90; P = 0.98), whereas those with RSV/RV coinfection were more likely to have relapse (odds ratio: 1.54; 95% confidence interval: 1.03-2.30; P = 0.03).
Conclusions:
In this prospective, multicenter, multiyear study of children hospitalized with bronchiolitis, we found that RSV/RV coinfection was independently associated with a higher likelihood of bronchiolitis relapse. Present data support the concept that the infectious etiology of severe bronchiolitis affects short-term outcomes.
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