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Seguimiento de lactantes hospitalizados por
bronquiolitis por virus respiratorio sincicial.
Evolución clínica, respuesta de atopia inflamatoria y
marcadores. Resultados preliminares
Guillermo Zepeda F.*, Patricia Díaz A.**, Ricardo Pinto M.*,
Aldo Gaggero B.*** y Paola Uasapud E.****
Follow-up of infants hospitalized for bronchiolitis by respiratory syncytial virus.
Clinical evolution, inflammatory response and markers of atopy. Preliminary results
Background:
Respiratory syncytial virus infection (RSV) alone or associated to rhinovirus (RV)
in the infant has been linked with more likelihood to develop asthma and atopy.
Aim:
Analyze clinical
and immunological markers of patients with RSV or RV bronchiolitis that determine their evolution.
Patients and Methods:
We studied previously healthy infants hospitalized for bronchiolitis during the
fall-winter period of 2009 and 2010. RSV and RV by qPCR, and proinflammatory interleukins (IL). IL-6,
IL-8, TNF-α, IL-1β and IL-12, were determined in nasopharyngeal aspirate (NPA). A follow-up clinical,
indoor pollution and immunological study was done at 4 or 5 years. Results are expressed in median
and range. Mann-Whitney’s test was used in the nonparametric statistical analysis.
Results:
Eight out
of 22 patients (36%) are currently with recurrent wheezing (RW) in treatment with budesonide 400 µg
per day as a mean dose. In the IL assessment significant changes were detected only in IL-1β that was
increased and in IL-12 that was decreased in the RW group versus the non RW (NRW) group. There
were not significant differences in both groups in age at hospitalization, infection severity, presence of
personal or family atopy, co-infection with RSV and RV, presence of older siblings or indoor air po-
llution.
Conclusions:
The determination of IL-1β and IL-12 in NPA for bronchiolitis could be an early
marker of subsequent inflammation of the airway. Co-infection of RSV and RV does not get worse the
clinical evolution. The group RW of preschool children had no further development of atopy than the
NRW group. There could be other factors that contribute to the manifestation of bronchial inflammation
in the RW group.
Key words:
bronchiolitis, respiratory syncytial virus, rhinovirus, interleukins, follow up, recurrent
wheezing, asthma.
Resumen
Introducción:
Se ha relacionado la infección por Virus Respiratorio Sincicial (VRS) solo o aso-
ciado a Rinovirus (RV) en el período de lactante con mayor probabilidad de desarrollar atopia y asma.
Objetivo:
Analizar marcadores clínicos e inmunológicos de pacientes con bronquiolitis por VRS y/o RV
que determinen su evolución.
Material y Método:
Lactantes previamente sanos hospitalizados por bron-
quiolitis, en el hospital Roberto del Río en el período de otoño-invierno de 2009 y 2010. Se determinó
en aspirado nasofaríngeo (ANF) VRS y RV por qPCR, e interleuquinas (IL) proinflamatorias (IL-6,
IL-8, TNF-α, IL-1β e IL-12). Seguimiento clínico y estudio inmunológico a los 4 o 5 años. Los resulta-
dos se expresan en medianas y rango. Análisis estadístico no paramétrico con test de Mann-Whitney.
* Departamento de Pediatría y Cirugía Infantil, Facultad de Medicina, Campus Norte, Universidad de Chile. Hospital
Roberto del Río.
** Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile.
*** Programa de Virología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile.
**** Médico-Cirujano. Centro de Salud Familiar Agustín Cruz Melo.
Rev Chil Enferm Respir 2016; 32: 18-24
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