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RSV, rhinovirus coinfection increased bronchiolitis relapse risk
Children with respiratory syncytial virus and human rhinovirus coinfection who are hospitalized for bronchiolitis are more likely to have relapse, according to recent study findings published in The Pediatric Infectious Disease Journal.
Korey Hasegawa, MD, MPH, of the department of emergency medicine at Massachusetts General Hospital, and colleagues evaluated 1,836 children younger than 2 years (median age, 4 months) hospitalized for bronchiolitis after a 2-week follow-up to determine whether rhinovirus alone or combined with RSV increased the risk for bronchiolitis relapse during the 2 weeks after hospital discharge.
Sixty-four percent of patients had a single virus infection, followed by 30% with two or more viruses and 6% with no pathogen. RSV only was found in 48%; followed by neither RSV nor rhinovirus (16%); RSV and rhinovirus (13%); RSV with non-rhinovirus pathogens (10%); rhinovirus only (8%); and rhinovirus with non-RSV pathogens (5%).
Eight percent of patients had a bronchiolitis relapse. Fifty-five percent of the relapses occurred within 3 days of discharge from the hospital.
There was an increased risk for bronchiolitis relapse if the patient had a family history of asthma, gestational age younger than 37 weeks, special care facility use at birth, and comorbid medical disorders.
There was no significant change of relapse in patients with rhinovirus alone (adjusted OR=0.99; 95% CI, 0.52-1.9); however, patients were more likely to have a relapse if they had an RSV/rhinovirus coinfection (adjusted OR=1.54; 95% CI, 1.03-2.3).
“For researchers, a major implication is that randomized trials that combine all children with bronchiolitis into one group or that categorize children by RSV status alone (yes/no) may obscure true associations,” the researchers wrote. “Therefore, bronchiolitis research should include viral testing for both RSV and [rhinovirus], which may in turn yield important insights for the management of bronchiolitis.”
Disclosure: The researchers report no relevant financial disclosures. The study was funded in part by the NIH.
Perspective
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Bronchiolitis is a common and important illness for infants and young children and is a leading cause of hospitalization in this age range. Although the clinical illness was recognized over 100 years ago it was not until the late 1950's that a specific etiologic agent, respiratory syncytial virus (RSV), was associated with this illness. Over the subsequent decades cases of bronchiolitis cases in association with a number of other respiratory viruses have been described. Most recently application of molecular technology has led to the ability to detect viral co-infection in respiratory diseases. As data on co-infection become available the clincial significance of these findings needs to be further elucidated.
Hasegawa and colleagues, in a multi-center study over 2007 to 2010, evaluated infants hospitalized with bronchiolitis and assessed short term outcome to viral etiology. They defined a relapse as an urgent visit related to bronchiolitis symptoms or additional medications for bronchiolitis given at a visit for another health problem within 2 weeks of the bronchiolitis hopsitalization. They noted that children co-infected with RSV and rhinovirus (RV) were more likely to have a relapse event over this period of time compared to those case from whom RSV or RV alone were detected. There were no differences in the duration of their initial hospital stay or need for readmission. This may suggest that bronchiolitis with co-infection of RSV and RV leads to more prolonged if not more severe illness. This was not seen in children co-infected with RSV and another non-RV pathogen.Those who relapsed also were more likely to be premature, have a family history of asthma, and a co-morbid medical disorder. Further studies examining the short term and long term effects of viral co-infection in babies with bronchiolitis may provide evidence for the role of these agents in relationship to development reactive airway disease.
