Association of respiratory virus types with clinical features in bronchiolitis: Implications for virus testing strategies. A systematic review and meta-analysis

Dominika Ambrożej, Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland; Doctoral School, Medical University of Warsaw, Warsaw, Poland.
Izabela Orzołek, Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland.
Heidi Makrinioti, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Jose A. Castro-Rodriguez, Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Carlos A. Camargo, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Kohei Hasegawa, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Nikolaos G. Papadopoulos, Allergy and Clinical Immunology Unit, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece; Division of Evolution and Genomic Sciences, University of Manchester, Manchester, United Kingdom.
James E. Gern, Department of Paediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, WI, USA.
Gustavo Nino, Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, District of Columbia, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Luiz Vicente Ribeiro Ferreira da Silva Filho, Instituto da Criança e do Adolescente, Hospital das Clínicas, University of São Paulo Medical School (USP), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Aya Takeyama, Department of Pediatrics, Soma General Hospital, Fukushima, Japan.
Özlem Üzüm, Department of Pediatric Diseases, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey.
Aleksander Adamiec, Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland; Doctoral School, Medical University of Warsaw, Warsaw, Poland.
Marek Ruszczyński, Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.
Tuomas Jartti, Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland; Department of Pediatrics, University of Oulu, Oulu, Finland.
Wojciech Feleszko, Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland. Electronic address: wojciech.feleszko@wum.edu.pl.

Document Type

Journal Article

Publication Date

9-17-2023

Journal

Paediatric respiratory reviews

DOI

10.1016/j.prrv.2023.09.003

Keywords

Bronchiolitis; Infant; Respiratory syncytial virus; Rhinovirus; Systematic review; Wheeze

Abstract

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.

Department

Pediatrics

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