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Vol. 54. Núm. 6.
Páginas 559-566 (Junio 2001)
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Vol. 54. Núm. 6.
Páginas 559-566 (Junio 2001)
Acceso a texto completo
Relación entre el subtipo del virus respiratorio sincitial y la gravedad clínica en la bronquiolitis
Relationship between respiratory syncytial virus subtype and clinical severity in bronchiolitis
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5992
J.L. Neves Barreiraa,
Autor para correspondencia
joaobarreira@mail.telepac.pt

Correspondencia: Departamento de Pediatría. Hospital de San João. Alameda Prof. Hernani Monteiro.4202-451 Oporto. Portugal.
, C. Fonsecaa, M.J. Cardosob, A. Azevedoc, A. Bonito Vítora
a Departamento de Pediatría
b Servicio de Microbiología y Serología. Hospital de San João
c Servicio de Higiene y Epidemiología. Facultad de Medicina de Oporto. Portugal
Este artículo ha recibido
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Antecedentes

El virus respiratorio sincitial (VRS) es el principal agente de la bronquiolitis y presenta dos subtipos distintos (A y B). Los trabajos acerca de la relación entre el subtipo de virus y la gravedad de la enfermedad obtienen resultados discordantes.

Propósito

Analizar si el subtipo de este virus constituye una variable independiente en la gravedad clínica de la enfermedad.

Pacientes y métodos

Estudio prospectivo que incluye niños previamente sanos menores de 2 años de edad, hospitalizados por infección respiratoria por VRS durante un brote epidémico anual. Se comparan la presentación y evolución clínica, las exploraciones complementarias y la radiografía pulmonar en los pacientes infectados por los subtipos A y B de VRS. Los indicadores clínicos de gravedad incluyen el grado y duración del distrés respiratorio, la necesidad de oxígeno suplementario, la admisión en cuidados intensivos, la ventilación mecánica y la duración del ingreso hospitalario.

Resultados

De los 85 enfermos incluidos (35 mujeres, 50 varones; edad media, 4,8 6 4,3 meses), 59 casos pertenecían al subtipo A. Ambos grupos no se diferenciaban en cuanto a sexo, edad y antecedentes, excepto en la lactancia materna que fue menos frecuente en el subtipo B. La presentación clínica, analítica y radiológica fue semejante en los dos grupos. Los indicadores clínicos de gravedad no difirieron de forma significativa en los dos grupos. La edad por debajo de los 3 meses se asoció a mayor duración del distrés respiratorio y de la estancia hospitalaria.

Conclusión

Los resultados no apoyan la hipótesis de que la infección por el subtipo A del VRS se asocie a mayor gravedad clínica.

Palabras clave:
Bronquiolitis
Virus respiratorio sincitial (VRS)
Subtipos del VRS
Indicadores de gravedad clínica
Background

Respiratory syncytial virus (RSV) is the most frequently implicated agent in bronchiolitis. The virus presents two antigenic subtypes (A and B). The results of studies on the relationship between viral subtype and clinical severity are conflicting.

Purpose

To evaluate whether the subtype of this virus constitutes an independent variable in the severity of clinical expression of RSV infection.

Patients and methods

We prospectively studied previously healthy children aged less than 2 years admitted for RSV infection during an epidemic season. Clinical presentation and evolution, laboratory and radiological aspects were compared in subsets of children infected with RSV subtype A or B. Clinical severity parameters included score and duration of respiratory distress, oxygen requirements, admission to the intensive care unit, mechanical ventilation and length of hospital stay.

Results

Eighty-five patients were enrolled in the study (50 boys and 35 girls; mean age 4.8 6 4.3 months). Fifty-nine children were infected with RSV subtype A. No differences were found in age, sex or antecedents but children with subtype B were less likely to have been breast-fed. Clinical presentation and laboratory and radiological findings were similar in both groups. No statistically significant differences in clinical severity parameters were found between subsets A and B. Age less than 3 months was associated with greater duration of respiratory distress and longer hospital stay.

Conclusion

The results do not support the hypothesis that subtype A infection is associated with more severe respiratory syncytial virus disease.

Key words:
Bronchiolitis
Respiratory syncytial virus
Respiratory syncytial virus subtypes
Clinical severity index
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