Abstract
Antecedentes
El rinovirus se considera un agente causal de cuadros catarrales banales, sin embargo se ha descrito como un agente inductor de exacerbaciones asmáticas en adultos y niños mayores. En nuestro medio no se ha descrito el papel del rinovirus en infecciones respiratorias de niños hospitalizados.
Objetivos
Describir las infecciones confirmadas por rinovirus en niños hospitalizados por infección respiratoria en un hospital de segundo nivel.
Pacientes y métodos
Estudio descriptivo prospectivo de las infecciones confirmadas por rinovirus en niños hospitalizados por fiebre o infección respiratoria en la temporada 2004-2005. Para el diagnóstico virológico se realizó inmunofluorescencia y reacción en cadena de la polimerasa (PCR) en aspirado nasofaríngeo. Se describen las características clínicas de los pacientes.
Resultados
Se describen un total de 76 niños hospitalizados con infección por rinovirus, lo que supuso el 25 % de los pacientes hospitalizados por procesos respiratorios o fiebre. El rinovirus fue el segundo agente viral identificado tras el virus respiratorio sincitial (29,9% de los hospitalizados). El 71,1 % de los pacientes fueron menores de 2 años. Los diagnósticos más frecuentes fueron sibilancias recurrentes en el 60,5 %, bronquiolitis en 23,7 %, neumonía en el 7,9 % e infección respiratoria de vías altas en el 5,3%. Presentaron fiebre de más de 38 °C el 57,9 % de los niños e infiltrado radiológico el 23,7%. Presentaron hipoxia el 43,4% de los niños. En niños mayores de 2 años el diagnóstico fue crisis asmática en 21 de los 22 casos.
Conclusiones
Los rinovirus se detectaron en un importante porcentaje de los niños hospitalizados a consecuencia de infección respiratoria, siendo precedidos en frecuencia sólo por el virus respiratorio sincitial. En nuestra serie es el agente viral más frecuentemente asociado con episodios de sibilancias recurrentes en niños mayores de 2 años, y el segundo en los más pequeños.
Palabras clave: Lactantes, Infección respiratoria, Rinovirus, Sibilancias recurrentes
Abstract
Background
Rhinovirus is a recognized cause of common cold and has been shown to cause asthma exacerbations in adults and children. The burden of rhinovirus infections in hospitalized children has not been described in Spain.
Objective
To describe confirmed rhinovirus infections in children hospitalized for respiratory tract infection in a secondary public hospital.
Patients and methods
We performed a prospective descriptive study in children admitted to hospital with fever or respiratory tract infection and with a positive isolation of rhinovirus in nasopharyngeal washings between September 2004 and July 2005. Virological diagnosis was made with direct immunofluorescent assay and/or reverse transcription-polymerase chain reaction in specimens obtained from nasopharyngeal washings. The clinical characteristics of the patients were analyzed.
Results
There were 76 children with rhinovirus infection, representing 25 % of admissions in 304 children with fever or respiratory tract infection. Rhinovirus was the second most frequent viral agent identified after respiratory syncytial virus (RSV) (29.9 % of admissions). Fifty-four children (71.1%) were under 2 years of age. The most frequent clinical diagnoses were recurrent wheezing in 60.5 %, bronchiolitis in 23.7%, pneumonia in 7.9%, and upper respiratory tract infection in 5.3 %. Fever > 38 °C was present in 57.9% of the patients and radiologic infiltrate was found in 23.7%. Oxygen saturation less than 95% was found in 43.4% of the patients. Of 22 children aged more than 2 years, a diagnosis of asthmatic crisis was made in 21.
Conclusions
Rhinoviruses were frequently identified in hospitalized children with respiratory tract disease and were the second most common viruses after RSV. In our series, it was the most frequent cause of recurrent wheezing in hospitalized children and the second most common cause in infants.
Key words: Infants, Respiratory tract infection, Rhinovirus, Recurrent wheezing
Bibliografía
- 1.Makela M.J., Puhakka T., Ruuskanen O., Leinonen M., Saikku P., Kimpimaki M. Viruses and bacteria in the etiology of the common cold. J Clin Microbiol. 1998;36:539–542. doi: 10.1128/jcm.36.2.539-542.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Arruda E., Pitkaranta A., Witek T.J., Jr., Doyle C.A., Hayden F.G. Frequency and nautral history of rhinovirus infections in adults during autum. J Clin Microbiol. 1997;35:2864–2868. doi: 10.1128/jcm.35.11.2864-2868.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Blomqvist S., Roivainen M., Puhakka T., Kleemola M., Hovi T. Virological and serological analysis of rhinovirus infections during the first two years of life in a cohort of children. J Med Virol. 2002;66:263–268. doi: 10.1002/jmv.2140. [DOI] [PubMed] [Google Scholar]
- 4.Andreoletti L., Lesay M., Deschildre A., Lambert V., Dewilde A., Wattre P. Differential detection of rhinoviruses and enteroviruses RNA sequences associated with classical immunofluorescence assay detection of respiratory virus antigens in nasopharyngeal swabs from infants with bronchiolitis. J Med Virol. 2000;61:341–346. doi: 10.1002/1096-9071(200007)61:3<341::AID-JMV10>3.0.CO;2-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Johnston S.L., Pattemore P.K., Sanderson G., Smith S., Lampe F., Josephs L. Community study of role of viral infections in exacerbations of asthma in 9-11 year old children. BMJ. 1995;310:1225–1229. doi: 10.1136/bmj.310.6989.1225. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Rawlinson W.D., Waliuzzaman Z., Carter I.W., Belessis Y.C., Gilbert K.M., Morton J.R. Asthma exacerbations in children associated with rhinovirus but not human metapneumovirus infection. J Infect Dis. 2003;187:1314–1318. doi: 10.1086/368411. [DOI] [PubMed] [Google Scholar]
- 7.Nicholson K.G., Kent J., Ireland D.C. Respiratory virases and exacerbations of asthma in adults. BMJ. 1993;307:982–986. doi: 10.1136/bmj.307.6910.982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Teichtahl H., Buckmaster N., Petrinkovs E. The incidente of respiratory tract infection in adults requiring hospitalization for asthma. Chest. 1997;112:591–596. doi: 10.1378/chest.112.3.591. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Seemungal T., Harper-Owen R., Bhowmik A., Moric I., Sanderson G., Message S. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary desease. Am J Respir Crit Care Med. 2001;164:1618–1623. doi: 10.1164/ajrccm.164.9.2105011. [DOI] [PubMed] [Google Scholar]
- 10.McConnochie K., Bronchiolitis. What’s in the name? Am J Dis Child. 1983;137:11–13. [PubMed] [Google Scholar]
- 11.Coiras M.T., Pérez-Brena P., García M.L., Casas I. Simultaneous detection of influenza A, B, and C viruses, respiratory syncytial virus, and adenoviruses in clinical samples by multiplex reverse transcription nested-PCR assay. J Med Virol. 2003;69:132–144. doi: 10.1002/jmv.10255. [DOI] [PubMed] [Google Scholar]
- 12.García García M.L., Calvo Rey C., Martín del Valle F., López Huertas M.R., Casas Flecha I., Díaz-Delgado R. Infecciones respiratorias por metapneumovirus en lactantes hospitalizados. An Pediatr (Barc) 2004;61:213–218. doi: 10.1016/S1695-4033(04)78799-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Corias M.T., Aguilar J.C., García M.L., Casas I., Pérez-Brena P. Simultaneous detection of fourteen respiratory virases in clinical specimens by two multiplex reverse transcription nested- PCR assays. J Med Virol. 2004;72:484–495. doi: 10.1002/jmv.20008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Gruteke P., Glas A.S., Dierdorp M., Vrede W.B., Pilon J.W., Bruisten S.M. Practical implementation of a multiplex PCR for acute respiratory tract infections in children. J Clin Microbiol. 2004;42:5596–5603. doi: 10.1128/JCM.42.12.5596-5603.2004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Billaud G., Peny S., Legay V., Lina B., Valette M. Detection of rhinovirus and enterovirus in upper respiratory tract samples using a multiplex nested PCR. J Virol Meth. 2003;108:223–228. doi: 10.1016/s0166-0934(03)00038-7. [DOI] [PubMed] [Google Scholar]
- 16.Papadopoulus N.G., Moustki M., Tsolia M., Bossios A., Astra E., Prezerakou A. Association of rhinovirus infection with increased disease severity in acute bronchiolitis. Am J Respir Crit Care Med. 2002;165:1285–1289. doi: 10.1164/rccm.200112-118BC. [DOI] [PubMed] [Google Scholar]
- 17.Kotaniemi-Syrjänen A., Vainionpää R., Reijonen T.M., Waris M., Korhonen K., Korppi M. Rhinovirus-induced wheezing in infancy- the first sign of childhood asthma? J Allergy Clin Immunol. 2003;111:66–71. doi: 10.1067/mai.2003.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Turner R.B. New considerations in the treatment and prevention of rhinovirus infections. Pediatr Annals. 2005;34:53–57. doi: 10.3928/0090-4481-20050101-12. [DOI] [PubMed] [Google Scholar]
- 19.Rakes G.P., Arruda E., Ingram J.M., Hoover G.E., Zambrano J.C., Hayden F.G. Rhinovirus and respiratory syncitial virus in wheezing children requiring emergency care. IgE and eosinophil analyses. An J Respir Crit Care Med. 1999;159:785–790. doi: 10.1164/ajrccm.159.3.9801052. [DOI] [PubMed] [Google Scholar]
- 20.Heymann P.W., Harper H.T., Murphy D.D., Platts-Mills T.A.E., Patrie J., McLaughlin A.P. Viral infection in resolution to age, atopy, and season of admission among children hospitalized for wheezing. J Allergy Clin Immunol. 2004;114:239–247. doi: 10.1016/j.jaci.2004.04.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Jartti T., Lehtinen P., Vuorinen T., Österback R., Van den Hoogen B., Osterhaus A. Respiratory picornaviruses and respiratory syncitial virus as causative agents of acute expiratory wheezing in children. Emerg Infect Dis. 2004;10:1095–1101. doi: 10.3201/eid1006.030629. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Andréoletti L., Lesay M., Deschildre A., Lambert V., Dewilde A., Wattré P. Differential detection of rhinoviruses and enteroviruses RNA sequences associated with classical immunofluorescence assay detection of respiratory virus antigens in nasopharyngeal swabs from infants with bronchiolitis. J Med Virol. 2000;61:341–346. doi: 10.1002/1096-9071(200007)61:3<341::AID-JMV10>3.0.CO;2-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Nokso-Koivisto J., Kinnari T.J., Lindahl P., Hovi T., Pitkäranta A. Human picornavirus and coronavirus RNA in nasopharynx of children without concurrent respiratory symptoms. J Med Virol. 2002;66:417–420. doi: 10.1002/jmv.2161. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Van Benten I., Koopman L., Niesters B., Hop W., Van Middelkoop B., De Waal L. Predominante of rhinovirus in the nose of symptomatic and asymptomatic infants. Pediatr Allergy Immunol. 2003;14:363–370. doi: 10.1034/j.1399-3038.2003.00064.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Juven T., Metsola J., Waris M., Leinonen M., Meurman O., Roivainen M. Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J. 2000;19:293–298. doi: 10.1097/00006454-200004000-00006. [DOI] [PubMed] [Google Scholar]