Continuing Medical Education

Acute viral bronchiolitis in South Africa: Viral aetiology and clinical epidemiology

Debbie A White, Shabir A Madhi, Prakash A Jeena, Heather J Zar, Brenda M Morrow, Refiloe Masekela, Samuel Risenga, Robin J Green

Abstract


Bronchiolitis is a viral-induced lower respiratory tract infection that occurs predominantly in children <2 years of age, particularly infants.
Many viruses have been proven or attributed to cause bronchiolitis, including and most commonly the respiratory syncytial virus (RSV)
and rhinovirus. RSV is responsible for more severe disease and complications (including hospitalisation) in bronchiolitis patients. Whereas
bronchiolitis is exclusively due to respiratory viral infections, with little evidence of bacterial co-infection, the former could nevertheless
predispose to superimposed bacterial infections. Although data support an interaction between RSV and pneumococcal superimposed
infections, it should be noted that this specifically refers to children who are hospitalised with RSV-associated pneumonia, and not to
children with bronchiolitis or milder outpatient RSV-associated illness. As such, empiric antibiotic treatment against pneumococcus in
children with RSV-associated pneumonia is only warranted in cases of hospitalisation and when the clinical syndrome is more in keeping
with pneumonia than uncomplicated bronchiolitis. In South Africa, the peak in the RSV season varies only slightly by province, with onset
in February, and lasting until June. The important implication of these new seasonality findings is that where prophylaxis is possible, as in
the case of RSV, it should be commenced in January of each year.


Authors' affiliations

Debbie A White, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Shabir A Madhi, Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa

Prakash A Jeena, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Heather J Zar, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and MRC Unit on Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa

Brenda M Morrow, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa

Refiloe Masekela, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Samuel Risenga, Department of Pulmonology, Faculty of Health Sciences, University of Limpopo, Polokwane, and Pietersburg Hospital, South Africa

Robin J Green, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa

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Keywords

Acute viral bronchiolitis; Viral aetiology; Clinical epidemiology

Cite this article

South African Medical Journal 2016;106(5):443-445. DOI:10.7196/SAMJ.2016.v106i5.10444

Article History

Date submitted: 2015-12-08
Date published: 2016-03-30

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