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Association of respiratory virus types with clinical features in bronchiolitis: Implications for virus testing
Dominika Ambrożej1, Izabela Orzołek2, Heidi Makrinioti3
1Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland; Doctoral School, Medical University of Warsaw, Warsaw, Poland.
Insights
Bronchiolitis caused by respiratory syncytial virus (RSV) or rhinovirus (RV) shows similar clinical signs. Accurate viral testing is essential for effective management and improved patient outcomes in severe cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Bronchiolitis is a major cause of infant hospitalization, frequently associated with respiratory syncytial virus (RSV) and rhinovirus (RV).
- Current clinical guidelines often lack specific viral testing recommendations for bronchiolitis management.
- Identifying correlations between specific viral types and clinical features is crucial for developing effective management strategies.
Approach:
- A systematic literature search was conducted across three databases.
- 21 studies underwent qualitative analysis, with 18 selected for meta-analysis.
- Key outcomes including wheezing, fever, atopic history, and infection severity were evaluated.
Key Points:
- RSV-positive bronchiolitis showed a higher likelihood of requiring oxygen supplementation (OR 1.78).
- RV-positive bronchiolitis was more frequently associated with a personal history of eczema (OR 0.60).
- No significant differences in other clinical outcomes were observed between RSV and RV infections.
Conclusions:
- Clinical presentation of bronchiolitis caused by RSV or RV is largely similar.
- While specific associations exist (RSV with oxygen need, RV with eczema history), clinical features alone cannot determine viral etiology.
- Accurate viral testing is vital for tailoring management strategies and improving outcomes in severe bronchiolitis.
Background:
Bronchiolitis is a leading cause of infant hospitalization, linked to respiratory syncytial virus (RSV) and rhinovirus (RV). Guidelines lack specific viral testing for bronchiolitis management. To establish effective management strategies, it is crucial to assess whether specific respiratory virus types are correlated with distinct examination features.
Methods:
Through a systematic search of three databases, 21 studies were qualitatively analyzed, with 18 used for meta-analysis. Various outcomes like wheezing on auscultation, fever, atopic traits, and infection severity were evaluated.
Results:
RSV-positive bronchiolitis was associated with a higher need for oxygen supplementation (OR 1.78, 95% CI 1.04-3.02) in 5 studies, while RV-positive bronchiolitis was more frequently linked to personal history of eczema (OR 0.60, 95% CI 0.41-0.88) in 6 studies. No significant differences were observed in the other outcomes examined.
Conclusions:
Bronchiolitis caused by RSV or RV presents with similar clinical features. Despite the associations between RSV-positive bronchiolitis and need for oxygen supplementation, and RV-positive bronchiolitis and a history of eczema, our study shows that viral etiology of bronchiolitis cannot be determined solely based on clinical presentation. Tailored management strategies, informed by accurate viral testing, seem crucial in clinical practice for enhancing patient outcomes in severe bronchiolitis.
