Acute Viral Bronchiolitis: Aetiology and Treatment Implications in a Population that may be HIV Co-Infected

Abstract

Bronchiolitis is a disease where infection results in inflammation of the small airways and it occurs most commonly in children under 2 years of age. Most authors and experts agree that the condition has a viral aetiology. The commonest aetiology is respiratory syncitial virus (RSV) but parainfluenza virus (PIV) (especially type 3), influenza virus, adenovirus and some newer viruses have been identified. Despite the viral nature of this condition, and overwhelming evidence that bacterial co-infection is an extremely rare event, most general practitioners and even paediatricians in South Africa treat infants with bronchiolitis with an antibiotic. What is even more worrying is that the routine use of broad spectrum penicillins has made way for cephalosporins, macrolides and carbapenems. Recent guidelines have documented no additional benefit from routine antibiotic use in this condition. There are, however, some studies pointing to bacterial super-infection in children with severe bronchiolitis. One such study investigated 165 patients, with a median age of 1.6 months, and found that 70 (42.2%) had a bronchoalveolar lavage culture positive for bacteria. In 36 (21.8%), these were deemed to be co-infected, while 34 (20.6%) had low bacterial growth and were deemed ‘possibly’ co-infected. All children were, however, ventilated for severe bronchiolitis and those co-infected required longer intensive care stay. White cell count (WCC) and C-reactive protein (CRP) did not differentiate between the groups and did not help to identify bacterial co-infection.