Jonathan M Mansbach1, Ruth J Geller2, Kohei Hasegawa2, Pedro A Piedra3,4, Vasanthi Avadhanula3, James E Gern5,6, Yury A Bochkov5, Janice A Espinola2, Ashley F Sullivan2, Carlos A Camargo2. 1. Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA. 2. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 3. Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA. 4. Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. 5. Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. 6. Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Abstract
BACKGROUND: In severe bronchiolitis, it is unclear if delayed clearance or sequential infection of respiratory syncytial virus (RSV) or rhinovirus (RV) is associated with recurrent wheezing. METHODS: In a 17-center severe bronchiolitis cohort, we tested nasopharyngeal aspirates (NPA) upon hospitalization and 3 weeks later (clearance swab) for respiratory viruses using PCR. The same RSV subtype or RV genotype in NPA and clearance swab defined delayed clearance (DC); a new RSV subtype or RV genotype at clearance defined sequential infection (SI). Recurrent wheezing by age 3 years was defined per national asthma guidelines. RESULTS: Among 673 infants, RSV DC and RV DC were not associated with recurrent wheezing, and RSV SI was rare. The 128 infants with RV SI (19%) had nonsignificantly higher risk of recurrent wheezing (hazard ratio [HR], 1.31; 95% confidence interval [CI], .95-1.80; P = .10) versus infants without RV SI. Among infants with RV at hospitalization, those with RV SI had a higher risk of recurrent wheezing compared to children without RV SI (HR, 2.49; 95% CI, 1.22-5.06; P = .01). CONCLUSIONS: Among infants with severe bronchiolitis, those with RV at hospitalization followed by a new RV infection had the highest risk of recurrent wheezing.
BACKGROUND: In severe bronchiolitis, it is unclear if delayed clearance or sequential infection of respiratory syncytial virus (RSV) or rhinovirus (RV) is associated with recurrent wheezing. METHODS: In a 17-center severe bronchiolitis cohort, we tested nasopharyngeal aspirates (NPA) upon hospitalization and 3 weeks later (clearance swab) for respiratory viruses using PCR. The same RSV subtype or RV genotype in NPA and clearance swab defined delayed clearance (DC); a new RSV subtype or RV genotype at clearance defined sequential infection (SI). Recurrent wheezing by age 3 years was defined per national asthma guidelines. RESULTS: Among 673 infants, RSV DC and RV DC were not associated with recurrent wheezing, and RSV SI was rare. The 128 infants with RV SI (19%) had nonsignificantly higher risk of recurrent wheezing (hazard ratio [HR], 1.31; 95% confidence interval [CI], .95-1.80; P = .10) versus infants without RV SI. Among infants with RV at hospitalization, those with RV SI had a higher risk of recurrent wheezing compared to children without RV SI (HR, 2.49; 95% CI, 1.22-5.06; P = .01). CONCLUSIONS: Among infants with severe bronchiolitis, those with RV at hospitalization followed by a new RVinfection had the highest risk of recurrent wheezing.
Authors: Heidi Makrinioti; Paraskevi Maggina; John Lakoumentas; Paraskevi Xepapadaki; Stella Taka; Spyridon Megremis; Maria Manioudaki; Sebastian L Johnston; Maria Tsolia; Vassiliki Papaevangelou; Nikolaos G Papadopoulos Journal: Front Allergy Date: 2021-11-02