In Very Young Infants Severity of Acute Bronchiolitis Depends On Carried Viruses

Background: RI amplification reaction has revealed that various single viruses or viral co-infections caused acute bronchiolitis in infants, and RV appeared to have a growing involvement in early respiratory diseases. Because remaining controversial, the objective was to determine prospectively the respective role of RSV, RV, hMPV and co-infections on the severity of acute bronchiolitis in very young infants. Methods and Principal Findings: 209 infants (median age: 2.4 months) were enrolled in a prospective study of infants <1 year old, hospitalized for a first episode of bronchiolitis during the winter epidemic season and with no high risk for severe disease. The severity was assessed by recording SaO(2)% at admission, a daily clinical score (scale 0-18), the duration of oxygen supplementation and the length of hospitalization. Viruses were identified in 94.7% by RT amplification reaction: RSV only (45.8%), RV only (7.2%), hMPV only (3.8%), dual RSV/RV (14.3%), and other virus only (2%) or coinfections (9%). RV compared respectively with RSV and dual RSV/RV infection caused a significant less severe disease with a lower clinical score (5[3.2-6] vs. 6[4-8], p=0.01 and 5.5[5-7], p=0.04), a shorter time in oxygen supplementation (0[0-1] days vs. 2[0-3] days, p=0.02 and 2[0-3] days, p=0.03) and a shorter hospital stay (3[3-4.7] days vs.6 [5-8] days, p=0.001 and 5[4-6] days, p=0.04). Conversely, RSV infants had also longer duration of hospitalization in comparison with RSV/RV (p=0.01) and hMPV (p=0.04). The multivariate analyses showed that the type of virus carried was independently associated with the duration of hospitalization. Conclusion: This study underlined the role of RV in early respiratory diseases, as frequently carried by young infants with a first acute bronchiolitis. RSV caused the more severe disease and conversely RV the lesser severity. No additional effect of dual RSV/RV infection was observed on the severity.