Abstract • In a prospective hospital-based study of 328 children under 5 years of age with acute lower respiratory infections, 114 (35%) were diagnosed to have acute bronchiolitis. Of them, 87 (76%) were less than 1 year and 107 (94%) were less than 2 years of age. Signs of severe lower respiratory infections, namely tachypnea (respiratory rate greater than 50/min) and subcostal retraction, were present in 95% and 93%, respectively. Of 88 children of whom roentgenographs were taken, 30 (34%) had evidence of pneumonia. No clinical signs discriminated between those with and without pneumonia. By culture or immunofluorescence antigen detection, viruses were found in 81 (71%) children with bronchiolitis; respiratory syncytial virus was the most common agent, found in 65 (57%). Parainfluenza viruses were the next most common, found in 12 (11%). Most cases of bronchiolitis occurred in outbreaks during the rainy months of August through November, coinciding with respiratory syncytial virus outbreaks. Although bacterial culture of blood was done in 56 children, no respiratory pathogen was isolated. In one child with bronchiolitis and consolidation, postmortem lung aspirate yielded Staphylococcus aureus. Thus, bronchiolitis is primarily a viral syndrome in this tropical region, just as it is in temperate regions. Eight (7%) children died (all were infants); 5 had roentgenographic pneumonia and the remaining had other abnormalities contributing to death; all had been treated with antibiotics. Since one third of lower respiratory infections are bronchiolitis, and among infants under 1 year of age bronchiolitis comprises 47% of all lower respiratory infection cases, criteria for antibiotic management must take into account the availability of roentgenographic investigation. (AJDC. 1990;144:1026-1030) References 1. Wohl MEB. Bronchiolitis . In: Kendig EL, Chernick V, eds. Disorders of the Respiratory Tract in Children . Philadelphia, Pa: WB Saunders Co; 1983:283-294. 2. Bronchiolitis in infancy and childhood . Br Med J . 1980;280:428-429.Crossref 3. Wohl MEB, Chernick V. Bronchiolitis . Am Rev Respir Dis . 1978;118:759-781. 4. Henderson FW, Clyde WA, Collier AM, Denny FW. The etiologic and epidemiologic spectrum of bronchiolitis in pediatric practice . J Pediatr . 1979;95:183-190.Crossref 5. Denny FW, Collier AM, Henderson FW, Clyde WA. The epidemiology of bronchiolitis . Pediatr Res . 1977;11:234-236. 6. Khatua SP. Acute bronchiolitis: a study of 205 cases . Indian Pediatr . 1977;14:285-294. 7. Agarwal SC, Bardoloi JNS, Mehta S. Respiratory syncytial virus infection in infancy and childhood in a community in Chandigarh . Indian J Med Res . 1971;59:19-25. 8. Subramaniam S, Krishnan Prakash S, Sukumar S, Lakshminarayana CS. Respiratory syncytial virus infection in Madras . Indian J Med Res . 1980;72:317-326. 9. Vellayappan K, Teo J, Doraisingham S. Respiratory syncytial virus infections in children . J Singapore Paediatr Soc . 1982;24:69-77. 10. Sung RY, Murray HG, Chan RC, Davies DP, French GL. Seasonal patterns of respiratory syncytial virus infection in Hong Kong: a preliminary report . J Infect Dis . 1987;156:527-528.Crossref 11. Spence L, Barratt N. Respiratory syncytial virus associated with acute respiratory infections in Trinidadian patients . Am J Epidemiol . 1968;88: 257-266. 12. Berman S, Duenas A, Bedoya A, et al. Acute lower respiratory tract illness in Cali, Colombia: a two-year ambulatory study . Pediatrics . 1983;71: 210-218. 13. Hayes EB, Hurwitz ES, Schonberger LB, Anderson LJ. Respiratory syncytial virus outbreak on American Samoa . AJDC . 1989;143:316-321. 14. World Health Organization. A programme for controlling acute respiratory infections in children: memorandum from a WHO meeting . Bull WHO . 1984;62:47-58. 15. Loda FA, Clyde WA, Glezen WP, Senior RJ, Sheaffer CI, Denny FW. Studies on the role of viruses, bacteria and M pneumoniae as causes of lower respiratory infections in children . J Pediatr . 1968;72:161-176.Crossref 16. Gardner PS, McQuillin J. Rapid Virus Diagnosis: Application of Immunofluorescence . 2nd ed. Stoneham, Mass: Butterworths; 1980:110-123. 17. Koshy G, Alex W, Menon T. An improved technique for blood culture . Indian J Med Res . 1981;70:733-738. 18. Pio A, Leowski J, TenDam HG. The magnitude of the problem of acute respiratory infections . In: Douglas RM, Kerby-Eaton E, eds. Acute Respiratory Infections in Childhood (Proceedings of an International Workshop, Sydney, August 1984) . Adelaide, Australia: University of Adelaide; 1985:3-16. 19. Campbell H, Byass P, Lamont AC, et al. Assessment of clinical criteria of severe acute lower respiratory tract infection in children . Lancet . 1989;1:297-299.Crossref 20. Shann F, Hart K, Thomas D. Acute lower respiratory tract infections in children: possible criteria for selection of patients for antibiotic therapy and hospital admission . Bull WHO . 1984;62:749-753. 21. Cherian T, John TJ, Simoes E, Steinhoff MC, John M. Evaluation of simple clinical signs for the diagnosis of acute lower respiratory infection . Lancet . 1988;2:125-128.Crossref 22. Monto AS, Johnson KM. A community study of respiratory infection in the tropics, I: description of the community and observations on the activity of certain respiratory agents . Am J Epidemiol . 1967;86:78-91. 23. Venkitaraman AR, John TJ. The epidemiology of varicella in staff and students of a hospital in the tropics . Int J Epidemiol . 1984;13:502-505.Crossref 24. Hillis WD, Cooper MR, Bang FB, Dey AK, Shah KV. Respiratory syncytial virus infection in children in West Bengal . Indian J Med Res . 1971;59:1354-1364. 25. Hansmann D, Devitt L, Miles H, Riley I. Pneumococci relatively insensitive to penicillin in Australia and New Guinea . Med J Aust . 1974;2:353-356. 26. Jesudason MV, Lalitha MK, Koshi G. Changes in incidence of shigella subgroups and their antibiotic susceptibility pattern in Vellore, South India . J Trop Med Hyg . 1985;88:355-358. 27. Shann F, Gratten M, Montgomery J, Lupiwa T, Polume H. Haemophilus influenzae resistant to penicillin in Goroka . P N G Med J . 1982;25:23-25. 28. Respiratory Infections in Children: Management in Small Hospitals . Geneva, Switzerland: World Health Organization; 1988.
American Journal of Diseases of Children – American Medical Association
Published: Sep 1, 1990