Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Infect Dis. 2021 Feb 3;223(2):268-277. doi: 10.1093/infdis/jiaa348.
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.
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.
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).
Among infants with severe bronchiolitis, those with RV at hospitalization followed by a new RV infection had the highest risk of recurrent wheezing.
在严重细支气管炎中，尚不清楚呼吸道合胞病毒（RSV）或鼻病毒（RV）的清除延迟或连续感染是否与反复喘息有关。
在一个 17 中心的严重细支气管炎队列中，我们使用 PCR 检测住院时和 3 周后（清除拭子）鼻咽抽吸物（NPA）中的呼吸道病毒。NPA 和清除拭子中相同的 RSV 亚型或 RV 基因型定义为清除延迟（DC）；在清除时出现新的 RSV 亚型或 RV 基因型定义为连续感染（SI）。根据国家哮喘指南定义 3 岁时反复喘息。
在 673 名婴儿中，RSV DC 和 RV DC 与反复喘息无关，且 RSV SI 很少见。128 名具有 RV SI（19%）的婴儿与无 RV SI 的婴儿相比，反复喘息的风险略有升高（危险比 [HR]，1.31；95%置信区间 [CI]，0.95-1.80；P =.10）。在住院时患有 RV 的婴儿中，与没有 RV SI 的儿童相比，患有 RV SI 的儿童反复喘息的风险更高（HR，2.49；95% CI，1.22-5.06；P =.01）。
在患有严重细支气管炎的婴儿中，那些在住院后感染 RV 且随后发生新的 RV 感染的婴儿，反复喘息的风险最高。
