Nasopharyngeal and Blood Cytokine Profile in Respiratory Syncytial Virus Bronchiolitis and Its Correlation with Disease Severity and Risk for Recurrent Wheeze

Abstract

Bronchiolitis is a disease of the lower respiratory tract that usually affects infants during the first year of life, predominantly during the winter months. American Academy of Pediatrics (AAP) defines Bronchiolitis as an acute onset of inflammation associated with edema and necrosis of epithelial cells lining the bronchioles, excess mucus production and bronchospasm . Bronchiolitis can be defined clinically as the first episode of wheeze in an infant lt 2 years of age with physical findings suggestive of viral lower respiratory infection characterized by coryza, cough, fever, noisy breathing, wheeze and breathlessness with no other explanation for the wheeze. OBJECTIVES: 1. To study the clinical profile of infants admitted for Respiratory Syncytial Virus (RSV) bronchiolitis. 2. To identify the risk factors of disease severity in RSV bronchiolitis. 3. To study the peripheral blood and nasopharyngeal aspirate cytokine profile of infants admitted with RSV bronchiolitis and to compare the cytokine responses between the hypoxic and the non hypoxic group. 4. To identify the clinical predictors of wheeze on follow up of infants with RSV bronchiolitis. METHODS: Study Design: This prospective study was carried out among infants admitted for RSV bronchiolitis at Kanchi Kamakoti CHILDS Trust hospital, Chennai. Study Setting: Department of Pediatrics and Paediatric Pulmonology, KKCTH, Chennai. This is a private paediatric tertiary care hospital with 220 beds. Study Period: The study was conducted from January 2011 till May 2014. CONCLUSION: The key problems associated with RSV bronchiolitis are hypoxemia at admission and recurrent wheeze on follow up. Infants who suffered bad child rearing practices in the form of nose blowing, oil instillation in nose, when infected with RSV are at risk of developing severe RSV disease. Similarly male infants, who presented with rhinorrhea and hypoxemia at admission and those who, required antibiotic usage during the hospitalization were at risk of developing recurrent wheeze following RSV bronchiolitis.