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

Dominika Ambrożej; Izabela Orzołek; Heidi Makrinioti; Jose A Castro-Rodriguez; Carlos A Camargo Jr; Kohei Hasegawa; Nikolaos G Papadopoulos; James E Gern; Gustavo Nino; Luiz Vicente Ribeiro Ferreira da Silva Filho; Aya Takeyama; Özlem Üzüm; Aleksander Adamiec; Marek Ruszczyński; Tuomas Jartti; Wojciech Feleszko

doi:10.1016/j.prrv.2023.09.003

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

Paediatr Respir Rev. 2024 Mar:49:34-42. doi: 10.1016/j.prrv.2023.09.003. Epub 2023 Sep 17.

Authors

Dominika Ambrożej¹, Izabela Orzołek², Heidi Makrinioti³, Jose A Castro-Rodriguez⁴, Carlos A Camargo Jr⁵, Kohei Hasegawa³, Nikolaos G Papadopoulos⁶, James E Gern⁷, Gustavo Nino⁸, Luiz Vicente Ribeiro Ferreira da Silva Filho⁹, Aya Takeyama¹⁰, Özlem Üzüm¹¹, Aleksander Adamiec¹, Marek Ruszczyński¹², Tuomas Jartti¹³, Wojciech Feleszko¹⁴

Affiliations

¹ Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland; Doctoral School, Medical University of Warsaw, Warsaw, Poland.
² Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland.
³ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁵ 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.
⁶ 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.
⁷ Department of Paediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, WI, USA.
⁸ 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.
⁹ Instituto da Criança e do Adolescente, Hospital das Clínicas, University of São Paulo Medical School (USP), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
¹⁰ Department of Pediatrics, Soma General Hospital, Fukushima, Japan.
¹¹ Department of Pediatric Diseases, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey.
¹² Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.
¹³ Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland; Department of Pediatrics, University of Oulu, Oulu, Finland.
¹⁴ Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland. Electronic address: wojciech.feleszko@wum.edu.pl.

PMID: 37743159
DOI: 10.1016/j.prrv.2023.09.003

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.

Keywords: Bronchiolitis; Infant; Respiratory syncytial virus; Rhinovirus; Systematic review; Wheeze.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Bronchiolitis* / diagnosis
Eczema* / complications
Hospitalization
Humans
Infant
Respiratory Sounds / etiology
Respiratory Syncytial Virus Infections* / complications
Respiratory Syncytial Virus Infections* / diagnosis
Respiratory Syncytial Virus, Human*
Rhinovirus