PURPOSE: Bronchiolitis, due to Respiratory Syncytial Virus (RSV) is a disease of young infants in developed countries but there is a suggestion of a later age of involvement in the developing world. Bronchiolitis is frequently incorrectly managed with antibiotic therapy because diagnostic testing is misused. The aims of this study were: 1.To describe the microbiological profile of children with bronchiolitis in Pretoria, South Africa. 2.To assess the rate of bacterial co-infection in bronchiolitis. 3.To seek laboratory (biochemical; immunological) parameters that predict mixed (both viral and bacterial) infection.
METHODS: This was a prospective longitudinal study of all children (under 2 years of age) admitted to Steve Biko (Pretoria) Academic Hospital with bronchiolitis during a two year period (January 2006 - December 2007). Virological, bacteriological, biochemical and immunological parameters were assessed.
RESULTS: HIV was clinically suspected in 41 patients (38.7%) and then proven in 14 patients (13.2%). The mean age of bronchiolitis in these children was 8 months, as opposed to the HIV-uninfected children where the mean age was 5.8 months. The HIV-infected bronchiolitics isolated the same viral organisms as the HIV-uninfected children, but the percentage composition was different. A positive bacterial blood culture was found in 18 patients (28.1%). However most organisms were deemed to be contaminants. No correlation was found between CRP, white cell count, neutrophil count and positive blood cultures in the group.
CONCLUSION: RSV Bronchiolitis in children in Pretoria has a different age distribution to developed countries. There are no readily done laboratory tests which predict bacterial co-infection in bronchiolitis.
CLINICAL IMPLICATIONS: HIV co-infection changes the expression of common Paediatric conditions. Antibiotic therapy should be carefully considered in bronchiolitis in children.
DISCLOSURE: Robin Green, Grant monies (from industry related sources) Unrestricted educational grant from Abbott Laboratories; No Product/Research Disclosure Information