Correlação entre mediadores inflamatórios na secreção nasofaríngea e no soro de crianças com infecção do trato respiratório inferior por vírus sincicial respiratório e a gravidade da doença / Correlation between inflammatory mediators in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection caused by respiratory syncytial virus and disease severity

OBJETIVO: Avaliar se as concentrações dos mediadores inflamatórios (CCL5, soluble intercellular adhesion molecule type 1 [sICAM-1], TNF-α, IL-6 e IL-10) na secreção nasofaríngea e no soro de crianças com infecção do trato respiratório inferior (ITRI) por vírus sincicial respiratório (VSR) apresentam correlação com os marcadores clínicos de gravidade da doença. MÉTODOS: Entre julho de 2004 e dezembro de 2005, 30 crianças com idade inferior a três meses, diagnosticadas com ITRI por VSR e admitidas em uma UTI neonatal foram incluídas neste estudo. RESULTADOS: Houve uma correlação positiva significante entre a gravidade da doença na admissão hospitalar, determinada por um sistema de escore clínico modificado, e as concentrações de sICAM-1 e de IL-10 na secreção nasofaríngea e de IL-6 no soro dos pacientes. Houve também uma correlação positiva significante entre a concentração de IL-6 no soro e o tempo de oxigenoterapia e a duração da internação. CONCLUSÕES: As concentrações de sICAM-1 e IL-10 na secreção nasofaríngea e de IL-6 no soro determinadas na admissão poderiam ser usadas como marcadores de gravidade da ITRI por VSR. Os níveis de IL-6 determinados no soro na admissão também poderiam ser usados para predizer o prolongamento da oxigenoterapia e da duração da internação.

OBJECTIVE: To determine whether the concentrations of inflammatory mediators (CCL5, soluble intercellular adhesion molecule type 1 [sICAM-1], TNF-α, IL-6 and IL-10) in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) correlate with the clinical markers of disease severity. METHODS: Between July of 2004 and December of 2005, 30 children less than three months of age, diagnosed with LRTI caused by RSV and admitted to a neonatal ICU, were included in this study. RESULTS: The severity of disease at hospital admission, as determined with a modified clinical scoring system, presented a significant positive correlation with sICAM-1 and IL-10 concentrations in the nasopharyngeal secretion, as well as with IL-6 concentrations in the serum, of the patients. In addition, serum IL-6 concentrations presented a significant positive correlation with the duration of oxygen therapy and with the length of hospital stay. CONCLUSIONS: At hospital admission, the concentrations of sICAM-1 and IL-10 in the nasopharyngeal secretion, as well as the concentration of IL-6 in the serum, could be used as markers of severity in patients with LRTI caused by RSV. The serum levels of IL-6 determined at admission could also be used to predict prolonged oxygen supplementation and hospital stay.

Respiratory syncytial virus infection and congenital heart disease

The association of congenital heart disease with severe respiratory syncytial virus (RSV) lower respiratory tract infection is examined in this review. Current perspectives on prophylaxis for RSV in this patient subgroup are also discussed

Estado nutricional y evolución clínica de lactantes chilenos hospitalizados con infección por virus respiratorio sincicial (VRS) / Nutritional status and clinical evolution of hospitalized Chilean infants with infection by respiratory syncytial virus (RSV)

Respiratory syncycial virus (RSV) is the first cause of acute lower respiratory tract infection in Chilean infants. A significant impact of nutrition on clinical course of these infections has been described. In order to analyze the association between nutritional status (NS) and clinical course of infants hospitalized with acute lower respiratory tract infection due to RSV, 130 infants (mean age 5.8 +/- 4.9 m) without chronic diseases, admitted to hospital with confirmed RSV infection, were studied. Clinical course of disease was assessed (hospitalization days and days with oxygen therapy) according to nutritional status on admission (weight/length (W/L), ratio, arm muscle area, lymphocyte count and albumin), antropometrics changes, and hospital dietary intake. On admission prevalence of malnutrition by W/L (z score) was 1, 14 overweight and 8 were obese. Median value of hospitalization days was 5 d (2-29 d) and days receiving oxygen was 3 d (0-19 d). Longer admission were observed in fasted patients than in those who were fed everyday (Wilcoxon and Log-rank test, 8 d vs 5 d; P < 0.01). Obese children (Wilcoxon and Log-rank test, 5 d vs. 3d in normal patients; P < 0.05), and patients not fed enterally (Wilcoxon and Log-rank test, 7 d vs. 3 d; P < 0.01) required oxygen for longer time. Fasting and severity of illness (Tal score) were correlated variables (X2 0.001). The multivariate analysis showed an association of Tal score and NS on admission, with days receiving oxygen therapy. We conclude that obesity is a risk factor for worse clinical course of acute lower respiratory tract infection in Chilean infants with RSV infection and without chronic disease.

Association of interleukin-1 and and respiratory syncytial virus infection: a possible role in the pathogenesis of bronchial asthma in children

Bronchial asthma is considered an ongoing inflammatory process. Respiratory syncytial virus infection early in life may be the cause of the airway hyperresponsiveness. Many factors take part in the pathogenesis. The proinflammatory Interleukin-[1] alpha [IL-[1]alpha] seems to have a critical initiating role. The aim of this study was to assess the IL-[1]alpha level and R. S. V. antigen in the nasopharyngeal secretion of respiratory tract infected [wheezing and non-wheezing] children and the possible associations among several factors leading to the development of bronchial asthma. The present work is a cross-sectional cohort study on one hundred children attending Allergy Outpatient Clinic of New Children Hospital, Cairo University. All children were subjected to full routine investigations as well as to some immunological parameters. They were divided into 3 groups. Group [I] was formed of 50 children who suffered from acute respiratory infections with wheezes [asthmatics], most probably due to respiratory syncytial virus, [R.S.V.]; group [II] comprised 30 children, they were chronic asthmatic who came for follow up and were apparently free from any infections or wheezes and finally group [III] was formed of 20 children, they were not asthmatic but were suffering from viral respiratory infection with no wheezes. The 3 groups were examined for antigen detection of R.S.V. and Interlukin-[1]alpha was assessed by solid phase enzyme immunoassay in nasopharyngeal secretions in a trial to find out any association [correlation] in order to evaluate the pathophysiological events occurring in the microenvironment of the infected airway epithelium. The results were as such: - In group [I]: R.S.V. was significantly positively correlated with Interleukin-[1]alpha level [[54.7 +/- 64.3] pg/ml], [r = 0.486]. Also it was significantly positively correlated with the presence of infection [clinically] [r = 0.611, P < 0.001]. The graded level of Interleukin-[1]alpha was positively correlated with clinically diagnosed infection and also with the presence of R.S.V. [r = 0.673, P < 0.001] In group [II]: There was no correlation between R.S.V. and the severity of asthma, IL-[1]alpha level [mean level of IL-[1]alpha = [3.9 +/- 4.4] pg/ml] or clinically diagnosed infection. There was no correlation between IL-[1]alpha and total leucocytic count [TLC], Ig[E] level, Ig[G] level and mean absolute eosinophilic count. In group [III]: There was no correlation between R. S. V. and the severity of asthma, Interleukin-[1]alpha level [[41.2 +/- 57.5]pg/ml], or clinically infection. Also there was no correlation between IL-[1]alpha level and mean T.L.C, mean absolute eosinophilic count, Ig[G] level and Ig[E] level