Methods: We retrospectively reviewed the medical records of hospitalized children younger than 2 years old with acute bronchiolitis, which caused by respiratory virus between April 1, 2012 and April 1, 2015 in Severance children’s hospital. Specific viral etiologies were detected in nasopharyngeal aspirates by multiplex reverse transcription polymerase chain reaction at the time of admission. Clinical severity score, based on the age, respiratory rate, wheezing, chest wall retraction, and percutaneous oxygen saturation at admission; duration of fever, use of oxygen therapy and inhaled corticosteroid within 24 hours after admission were investigated. According to the scores, all patients were divided into a mild to moderate and severe bronchiolitis group. Host factors and type of respiratory viruses, were compared among the severity groups. Multivariate logistic regression analyses were performed to verify the risk factors for severe bronchiolitis.
Results: A total of 780 children were studied. A single virus was identified in 530(68%) and multiple viruses in 250(32%). Respiratory syncytial virus (RSV), rhinovirus (RV), RSV+RV, influenza viruses (Flu), human metapneumovirus (hMPV) and parainfluenza virus were detected in 34, 27, 14, 12, 7 and 6 % of samples respectively. RSV and rhinovirus were the viruses most frequently identified in mixed infections. There were no differences in age and severity scores between patients with prevalent viruses (RSV and RV) and those with less common infections. Patients with coinfections were 2.25 times (95% confidence interval, 1.02 to 8.02) more at risk for severe bronchiolitis than those with a single viral infection. Host factors associated with severe bronchiolitis included younger age, prematurity and chronic cardiopulmonary diseases. Type of viruses, personal and family history of allergic diseases was not significantly associated with bronchiolitis severity.
Conclusions: We compared the clinical characteristics of respiratory viral infections in wheezy bronchiolitis patients younger than 2 years old. Viral coinfections and host factors, including younger age, prematurity, and chronic cardiopulmonary diseases are risk factors for severe bronchiolitis.