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Air pollution is associated with a substantial burden on human health; however, the most important pollutants may vary with location. Proper monitoring is necessary to determine the effect of these pollutants on respiratory health.This study was designed to evaluate the role of outdoor, indoor and personal exposure to combustion-related pollutants NO(2) and O(3) on respiratory health of children in a non-affluent urban area of São Paulo, Brazil.Levels of NO(2) and O(3) were continuously measured in outdoor and indoor air, as well as personal exposure, for 30 days using passive measurement monitors. Respiratory health was assessed with a Brazilian version of the ISAAC questionnaire.Complete data were available from 64 children, aged 6-10 years. Respiratory morbidity was high, with 43 (67.2%) reporting having had wheezing at any time, 27 (42.2%) wheezing in the last month, 17 (26.6%) asthma at any time and 21 (32.8%) pneumonia at any time. Correlations between levels of NO(2) and O(3) measured in the three locations evaluated were poor. Levels of NO(2) in indoor air and personal exposure to O(3) were independently associated with asthma (both cases P=.02), pneumonia (O(3), P=.02) and wheezing at any time (both cases P.01). No associations were seen between outdoor NO(2) and O(3) and respiratory health.Exposure to higher levels of NO(2) and O(3) was associated with increased risk for asthma and pneumonia in children. Nonetheless, the place where the pollutants are measured influences the results. The measurements taken in indoor and personal exposure were the most accurate.

To test the hypothesis that azithromycin reduces the length of hospitalization and oxygen requirement in infants with acute viral bronchiolitis (AB).We performed a randomized, double-blinded, placebo-controlled trial in southern Brazil, from 2009 to 2011. Infants (12 months of age) hospitalized with AB were recruited in 2 hospitals. Patients were randomized to receive either azithromycin or placebo, administered orally, for 7 days. At enrollment, clinical data were recorded and nasopharyngeal samples were collected for viral identification through immunofluorescence. Main outcomes were duration of oxygen requirement and length of hospitalization.One hundred eighty-four patients were included in the study (azithromycin 88 subjects, placebo 96 subjects). Baseline clinical characteristics and viral identification were not different between the groups studied. A virus was detected in 112 (63%) patients, and of those, 92% were positive for respiratory syncytial virus. The use of azithromycin did not reduce the median number of days of either hospitalization (P = .28) or oxygen requirement (P = .47).Azithromycin did not improve major clinical outcomes in a large sample of hospitalized infants with AB, even when restricting the findings to those with positive respiratory syncytial virus samples. Azithromycin therapy should not be given for AB because it provides no benefit and overuse increases overall antibiotic resistance.

Mechanisms of the Development of Allergy (MeDALL), a Seventh Framework Program European Union project, aims to generate novel knowledge on the mechanisms of initiation of allergy. Precise phenotypes of IgE-mediated allergic diseases will be defined in MeDALL. As part of MeDALL, a scientific seminar was held on January 24, 2011, to review current knowledge on the IgE-related phenotypes and to explore how a multidisciplinary effort could result in a new integrative translational approach. This article provides a summary of the meeting. It develops challenges in IgE-related phenotypes and new clinical and epidemiologic approaches to the investigation of allergic phenotypes, including cluster analysis, scale-free models, candidate biomarkers, and IgE microarrays; the particular case of severe asthma was reviewed. Then novel approaches to the IgE-associated phenotypes are reviewed from the individual mechanisms to the systems, including epigenetics, human in vitro immunology, systems biology, and animal models. The last chapter deals with the understanding of the population-based IgE-associated phenotypes in children and adolescents, including age effect in terms of maturation, observed effects of early-life exposures and shift of focus from early life to pregnancy, gene-environment interactions, cohort effects, and time trends in patients with allergic diseases. This review helps to define phenotypes of allergic diseases in MeDALL. (J Allergy Clin Immunol 2012;129:943-54.)

Bronchial responsiveness is an objectively measurable trait related to asthma. Its prevalence and association with asthma symptoms among children in many countries are unknown.To investigate international variations in bronchial responsiveness (BR) and their associations with asthma symptoms and atopic sensitization.Bronchial challenge tests were conducted in 6,826 schoolchildren (aged 8-12 years) in 16 countries using hypertonic (4.5%) saline. FEV(1) was measured at baseline and after inhalation for 0.5, 1, 2, 4, and 8 min. BR was analyzed both as a dichotomous (bronchial hyperreactivity, BHR, at least 15% decline in FEV(1)) and as a continuous variable (time-response slope, BR slope, individual decline in FEV(1) per log(min)).Prevalence of wheeze last year ranged from 4.4% in Tirana (Albania) to 21.9% in Hawkes Bay (New Zealand) and of BHR from 2.1% in Tirana to 48% in Mumbai (India). The geometric mean BR slope varied between 3.4%/log(min) in Tirana and 12.8%/log(min) in Mumbai and Rome (Italy). At the individual level, BHR was positively associated with wheeze during the past 12 months both in affluent countries (OR = 3.6; 95% CI: 2.7-5.0) and non-affluent countries (OR = 3.0; 1.6-5.5). This association was more pronounced in atopic children. There was a correlation (rho = 0.64, P = 0.002) between center-specific mean BR slope and wheeze prevalence in atopic, but not in non-atopic children.BR to saline in children varied considerably between countries. High rates of BR were not confined to affluent countries nor to centers with high prevalences of asthma symptoms. The association between wheeze and BHR at the individual level differed across centers and this heterogeneity can be largely explained by effect modification by atopy. Pediatr. Pulmonol. 2010; 45:796-806. (c) 2010 Wiley-Liss, Inc.

The authors are indebted to the collaborators in the participating centres and all parents, children, teachers and other school staff who participated in the surveys. There are many field workers and funding agencies who supported data collection and national, regional and international meetings, including the meetings of the ISAAC Steering Committee. Unfortunately, these are too numerous to mention (they are acknowledged elsewhere) but the authors particularly wish to thank the funders who supported the ISAAC International Data Centre including the Health Research Council of New Zealand, the Asthma and Respiratory Foundation of New Zealand, the National Child Health Research Foundation, the Hawke’s Bay Medical Research Foundation, the Waikato Medical Research Foundation, Glaxo Wellcome New Zealand and Astra New Zealand, as well as Glaxo Wellcome International Medical Affairs for finding the regional coordinating centres. The International Data Centre is now supported by a grant from the BUPA Foundation., The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here. In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution. Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence. The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit., peer-reviewed

Episodes of lower respiratory illnesses (LRIs) in the first years of life have been associated with recurrent wheeze in studies of high-risk and community-based cohorts. Respiratory syncytial virus (RSV) is an agent especially associated with severe cases of bronchiolitis affecting young infants in winter months and has a typical seasonal pattern. Data from the Children's Respiratory Study from Arizona and a hospital-based Swedish study have been interpreted as evidence that severe RSV bronchiolitis is associated with a 30-40% likelihood of subsequent asthma. Other respiratory viruses, especially Rhinovirus, have been identified to be importantly associated with recurrent wheeze in children at risk for asthma. A case-control study of palivizumab given in the first year of life to preterm infants has shown a 50% reduction in the occurrence of recurrent wheeze even after controlling for potential confounding variables. Prospective trials with anti-viral strategies, including potential new vaccines, should give us better understanding of the role of viral infections in early life in the causation of childhood asthma.

Background: Asthma phenotypes are well described among children. However, there are few studies comparing airway inflammation in different clinical presentations of pediatric asthma. We tested the hypothesis that nonatopic asthma is associated with a predominant noneosinophilic inflammation in the airways, as assessed by induced sputum. The objective of this study was to evaluate the cytological characteristics of induced sputum (IS) in atopic (AA), nonatopic asthmatics (NAA) and nonatopic nonasthmatic children (NANA). Methods: Of 90 selected children, 77 met eligibility criteria for performing IS and were classified as: AA, n = 28, NAA, n = 29 and NANA, n = 19. Subjects answered to a set of ISAAC-based questions and were skin-tested for common aeroallergens. A defined series of exclusion criteria was applied. Results: Induced sputum was obtained from 54 (70.1%) subjects (21 AA, 20 NAA and 13 NANA). Demographic data and mean FEV1 were similar in the three groups. The proportion of eosinophils [median, inter quartile range (IQR)] was significantly higher in the sputum of AA [(6.0.)12)] compared with NAAs [0 (2)] and NANAs [0 (1)], P 3%) was also significantly higher in AA (71.4%) when compared with NAA (28.6%); none of the NANA had sputum eosinophilia. Nonatopic asthmatic children had significantly higher proportions and absolute number of neutrophils than AA and controls. Conclusions: The results suggest that nonatopic children present IS with a cell pattern that is predominantly neutrophilic while eosinophilia is the hallmark of airway inflammation in the majority of atopic wheezing children not treated with inhaled steroids.

To present the most important and recent results of studies on asthma genetics. These data may help general physicians understand the impact of genetics on this complex disorder and how genes and polymorphisms influence asthma and atopy.Data were collected from MEDLINE. Genetic association studies were selected from the Genetic Association Database, which is an archive of human genetic association studies of complex diseases and disorders organized by the National Institutes of Health.Considering the data from several important twin studies on asthma genetics, heritability, which measures the contribution of genetic factors to the variance of asthma, may be estimated in 0.48-0.79. A huge number of genetic association studies have been trying to identify asthma susceptibility genes. The most replicated results in the genetic association studies involve the following five regions of the human genome: 5q31-32, 6p21, 11q12-13, 16p11-12, and 20p13. Only recently a new asthma susceptibility gene (ORMDL3) has been identified by a whole genome association study, considered to be a major determinant for childhood asthma.Genetic contribution to asthma may be estimated ranging from 48 to 79%. Several loci seem to influence asthma susceptibility. Genes located on chromosome 5q (ADRB2, IL13 and IL4) and the recently identified ORMDL3, on chromosome 17, seem to be determinants of childhood asthma. Diagnostics and pharmacogenetics may be the first clinical implication of extensive studies on asthma genetics.

Background and objective: Pulmonary aspiration (PA) is a significant respiratory disease in children. However, the diagnosis of aspiration is often difficult owing to the poor efficacy of currently available diagnostic tests. The aim of this study was to assess in a mouse model the specificity of starch granule detection in BAL as a new method for detecting PA in children. Methods: Twenty BALB/c mice were divided into the following groups according to the solution instilled into the airways: corn flour milk 7.5%—a source of starch (CM), Pseudomonas aeruginosa, normal saline and a control group. BAL was performed 2 days after instillation. Detection of starch granules and lipid-laden macrophages were compared in BAL. Results: Starch granules were detected in BAL fluids from all mice in the CM group (food aspiration model), whereas no starch granules were detected in the other three groups, demonstrating a sensitivity and specificity of 100%. On the other hand, lipid-laden macrophages were found in all mice from all the groups studied. Conclusions: The detection of starch granules in BAL is a simple and highly specific method for the diagnosis of PA in an experimental model. Clinical studies using the starch granule detection method in BAL should be tested in at risk patients to evaluate the utility of this method for investigating PA.

OBJETIVO: Verificar a prevalência de sintomas de distúrbios respiratórios do sono em crianças de baixo nível socioeconômico no Sul do Brasil. MÉTODOS: Foi realizado um estudo transversal em Uruguaiana (RS), utilizando questionário específico sobre sintomas de distúrbios respiratórios do sono, respondido pelos pais, em uma amostra de escolares de 9 a 14 anos participantes do International Study of Asthma and Allergies in Childhood (ISAAC). RESULTADOS: Foram respondidos 998 questionários de um total de 1.011 escolares elegíveis. Relato de ronco habitual ocorreu em 27,6% das crianças, apnéia em 0,8%, respiração oral diurna em 15,5% e sonolência diurna excessiva em 7,8%. Crianças com sonolência diurna excessiva apresentaram maior risco de ronco habitual (OR = 2,7; IC95% 1,4-5,4), apnéia (OR = 9,9; IC95% 1,2-51), respiração oral (OR = 13,1; IC95% 6,2-27,4) e problemas de aprendizado (OR = 9,9; IC95% 1,9-51,0). Rinite, fumo materno e testes cutâneos alérgicos estiveram significativamente associados a ronco habitual e respiração oral diurna. CONCLUSÕES: A prevalência de sintomas de distúrbios respiratórios do sono é elevada em crianças de 9 a 14 anos na cidade de Uruguaiana. A prevalência de ronco habitual foi quase duas vezes maior que a descrita nessa faixa etária em outras populações. Crianças com sonolência diurna excessiva parecem ter quase 10 vezes mais risco de problemas de aprendizado. OBJECTIVE: To identify the prevalence of symptoms of sleep-disordered breathing among children of low socioeconomic status in the South of Brazil. METHODS: This was a cross-sectional study, carried out in the city of Uruguaiana, RS, in which specific questionnaire about the symptoms of sleep-disordered breathing was completed by the parents of a sample of schoolchildren aged 9 to 14 years, enrolled on the International Study of Asthma and Allergies in Childhood (ISAAC). RESULTS: From the total of 1,011 eligible schoolchildren, 998 questionnaires were completed. The parents of 27.6% of the children reported habitual snoring, while 0.8% reported apnea, 15.5% described daytime mouth breathing and 7.8% complained of excessive daytime sleepiness. Children with excessive daytime sleepiness were at greater risk of habitual snoring (OR = 2.7; 95%CI 1.4-5.4), apnea (OR = 9.9; 95%CI 1.2-51), mouth breathing (OR = 13.1; 95%CI 6.2-27.4) and learning difficulties (OR = 9.9; 95%CI 1.9-51.0). Rhinitis, maternal smoking and positive allergy skin test results were significantly associated with habitual snoring and daytime mouth breathing. CONCLUSIONS: There is an elevated prevalence of symptoms of sleep-disordered breathing among children from 9 to 14 in the city of Uruguaiana. The prevalence of habitual snoring was almost twice that described in this age group in other populations. Children with excessive daytime sleepiness appear to have almost 10 times the risk of learning difficulties.

To identify the prevalence of symptoms of sleep-disordered breathing among children of low socioeconomic status in the South of Brazil.This was a cross-sectional study, carried out in the city of Uruguaiana, RS, in which specific questionnaire about the symptoms of sleep-disordered breathing was completed by the parents of a sample of schoolchildren aged 9 to 14 years, enrolled on the International Study of Asthma and Allergies in Childhood (ISAAC).From the total of 1,011 eligible schoolchildren, 998 questionnaires were completed. The parents of 27.6% of the children reported habitual snoring, while 0.8% reported apnea, 15.5% described daytime mouth breathing and 7.8% complained of excessive daytime sleepiness. Children with excessive daytime sleepiness were at greater risk of habitual snoring (OR = 2.7; 95%CI 1.4-5.4), apnea (OR = 9.9; 95%CI 1.2-51), mouth breathing (OR = 13.1; 95%CI 6.2-27.4) and learning difficulties (OR = 9.9; 95%CI 1.9-51.0). Rhinitis, maternal smoking and positive allergy skin test results were significantly associated with habitual snoring and daytime mouth breathing.There is an elevated prevalence of symptoms of sleep-disordered breathing among children from 9 to 14 in the city of Uruguaiana. The prevalence of habitual snoring was almost twice that described in this age group in other populations. Children with excessive daytime sleepiness appear to have almost 10 times the risk of learning difficulties.

In an attempt to study the association between Pseudomonas aeruginosa colonization and clinical factors present before colonization, we studied 502 patients who attended our cystic fibrosis (CF) clinic between 1975 and 1988 and who were not colonized with P. aeruginosa before the study period. Twelve percent of the patients became colonized with P. aeruginosa before the age of 1 year and 44% by the age of 7 years. In a birth cohort followed from diagnosis during the study period, 23% were colonized with P. aeruginosa before age 1 year and 67% before age 7 years. Early P. aeruginosa colonization was associated with early diagnosis of CF. Presence of meconium ileus, gastrointestinal symptoms and pancreatic insufficiency at the time of diagnosis was also associated with early colonization. There was no association between the presence of respiratory symptoms at the time of diagnosis and age at first P. aeruginosa colonization. In families in which more than one sibling had CF, the age of P. aeruginosa acquisition was similar in the first colonized and the subsequently colonized siblings. In the year before the colonization patients with P. aeruginosa who were older than 1 year had higher rates of hospitalization and spent more days in hospital compared with patients without P. aeruginosa. In conclusion most P. aeruginosa colonization occurs at a younger age than previously reported. Early age at diagnosis and presence of CF-associated gastrointestinal abnormalities increase the likelihood of earlier colonization of P. aeruginosa.

O aumento na prevalência da asma e atopia, observado em diversas populações nos anos recentes, contribui para torná-las importantes problemas de saúde pública. A possível influência de fatores relacionados à nutrição humana tem sido demonstrada em crescente número de estudos. O entendimento do papel do aleitamento materno, da dieta, e do estado nutricional, particularmente da obesidade, assim como as respostas imunológicas desencadeadas, ajuda a melhorar a compreensão sobre a relação entre estresse oxidativo, inflamação brônquica, e o desenvolvimento de sintomas asmáticos e atópicos. Este artigo apresenta uma revisão da literatura publicada sobre os aspectos da relação entre nutrição, asma, e atopia, nas duas últimas décadas. In many populations, the prevalence of asthma and atopy has increased in recent years. As a result, both conditions have become major public health problems. The possible influence of nutrition-related factors has been demonstrated in an increasing number of studies. Information regarding the role of breastfeeding, diet, nutritional status (obesity in particular), as well as regarding the immunologic responses triggered, helps to improve our understanding of the correlation between oxidative stress, bronchial inflammation, and the development of atopic and asthma symptoms. The article presents a review of the published literature on the relationships established between and among nutrition, asthma, and atopy over the last two decades.

In the beginning of this 21st century, community-acquired pneumonias (CAP) are still responsible for a significant number of deaths among young children in many developing countries. Public health initiatives such as those proposed by the World Health Organization (WHO) for the management of CAP by means of identifying highly predictable signs and symptoms have had great positive impact in some communities. Still, this approach induces an overdiagnosis and overtreatment of CAP in children below the age of 5 years due to the misclassification of pneumonia in children with fast breathing associated with viral bronchiolitis. Even among children of developed countries, CAP is an important public health problem and many aspects of current diagnostic and management measures are discussed here. In this article, we review the epidemiology and basic concepts of CAP and update current information on clinical evaluation and management of the disease.

Objetivo: Avaliar, atraves de uma revisao de literatura, a influencia da prematuridade e do baixo peso ao nascimento sobre a funcao pulmonar na idade escolar. Materiais e Metodos: Trata-se de uma revisao integrativa. Foram utilizadas as bases de dados Lilacs, Pubmed, Scopus e Scielo, selecionando estudos observacionais ou ensaios clinicos, publicados em ingles ou portugues, que objetivassem avaliar a funcao pulmonar (espirometria) na idade escolar de prematuros com baixo peso ao nascimento em comparacao com criancas nascidas a termos com peso adequado. As palavras-chave e os operadores boleanos utilizados foram: Infant, Extremely Premature AND Respiratory Function Tests OR Forced Expiratory Volume in 1 second OR FVC OR Forced Vital Capacity OR 25 75 percent, FeF OR Forced mid-expiratory flow OR FEV1 OR Forced Expiratory volume AND Very low birth weight. Resultados: De um total de 1032 artigos encontrados, 15 foram selecionados para inclusao final no presente estudo. Grande parte dos estudos (33,3%) foi realizada na Australia, sendo que nenhum foi localizado na populacao brasileira. O tamanho amostral dos artigos variou de 27 ate 2150 individuos entre cada grupo estudado. A idade gestacional e o baixo peso ao nascimento do grupo de prematuros foram classificados como abaixo de 37 semanas e 53,3% avaliaram recem-nascidos de muito baixo peso. A idade dos escolares, no momento da avaliacao da funcao pulmonar, variou entre 5 e 14 anos, sendo que a maioria, 12 (80,0%), apresentou reducao da funcao pulmonar no grupo de criancas prematuras e com baixo peso, enquanto 3 (20%) dos trabalhos apontaram valores espirometricos normais. Conclusao: Os resultados demonstram que a prematuridade e o baixo peso ao nascimento parecem influenciar de maneira negativa sobre a funcao pulmonar das criancas na idade escolar.

Acute viral bronchiolitis by Respiratory Syncytial Virus (RSV) is the most common respiratory illness in children in the first year of life. RSV bronchiolitis generates large numbers of hospitalizations and an important burden to health systems. Neutrophils and their products are present in the airways of RSV-infected patients who developed increased lung disease. Neutrophil Extracellular Traps (NETs) are formed by the release of granular and nuclear contents of neutrophils in the extracellular space in response to different stimuli and recent studies have proposed a role for NETs in viral infections. In this study, we show that RSV particles and RSV Fusion protein were both capable of inducing NET formation by human neutrophils. Moreover, we analyzed the mechanisms involved in RSV Fusion protein-induced NET formation. RSV F protein was able to induce NET release in a concentration-dependent fashion with both neutrophil elastase and myeloperoxidase expressed on DNA fibers and F protein-induced NETs was dismantled by DNase treatment, confirming that their backbone is chromatin. This viral protein caused the release of extracellular DNA dependent on TLR-4 activation, NADPH Oxidase-derived ROS production and ERK and p38 MAPK phosphorylation. Together, these results demonstrate a coordinated signaling pathway activated by F protein that led to NET production. The massive production of NETs in RSV infection could aggravate the inflammatory symptoms of the infection in young children and babies. We propose that targeting the binding of TLR-4 by F protein could potentially lead to novel therapeutic approaches to help control RSV-induced inflammatory consequences and pathology of viral bronchiolitis.

p.1-9 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2013-07-12T12:44:00Z No. of bitstreams: 1 1471-2466-6-24.pdf: 278319 bytes, checksum: 3c6eccbcc64cc0fa2a46555c9f28ef01 (MD5) Made available in DSpace on 2013-07-12T12:44:00Z (GMT). No. of bitstreams: 1 1471-2466-6-24.pdf: 278319 bytes, checksum: 3c6eccbcc64cc0fa2a46555c9f28ef01 (MD5) Previous issue date: 2006 Background Asthma and allergic diseases are becoming increasingly frequent in children in urban centres of Latin America although the prevalence of allergic disease is still low in rural areas. Understanding better why the prevalence of asthma is greater in urban migrant populations and the role of risk factors such as life style and environmental exposures, may be key to understand what is behind this trend. Methods/design The Esmeraldas-SCAALA (Social Changes, Asthma and Allergy in Latin America) study consists of cross-sectional and nested case-control studies of school children in rural and urban areas of Esmeraldas Province in Ecuador. The cross-sectional study will investigate risk factors for atopy and allergic disease in rural and migrant urban Afro-Ecuadorian school children and the nested case-control study will examine environmental, biologic and social risk factors for asthma among asthma cases and non-asthmatic controls from the cross-sectional study. Data will be collected through standardised questionnaires, skin prick testing to relevant aeroallergen extracts, stool examinations for parasites, blood sampling (for measurement of IgE, interleukins and other immunological parameters), anthropometric measurements for assessment of nutritional status, exercise testing for assessment of exercise-induced bronchospasm and dust sampling for measurement of household endotoxin and allergen levels. Discussion The information will be used to identify the factors associated with an increased risk of asthma and allergies in migrant and urbanizing populations, to improve the understanding of the causes of the increase in asthma prevalence and to identify potentially modifiable factors to inform the design of prevention programmes to reduce the risk of allergy in urban populations in Latin America.

10 p. Submitted by Ana Valéria de Jesus Moura (anavaleria_131@hotmail.com) on 2012-01-23T16:54:39Z No. of bitstreams: 1 1471-2466-6-15.pdf: 276139 bytes, checksum: 3e0e88f4db73985a7ce550293f20e399 (MD5) Made available in DSpace on 2012-01-23T16:54:39Z (GMT). No. of bitstreams: 1 1471-2466-6-15.pdf: 276139 bytes, checksum: 3e0e88f4db73985a7ce550293f20e399 (MD5) Previous issue date: 2006 Background: The prevalence of asthma and allergic diseases has increased in industrialised countries, and it is known that rates vary according whether the area is urban or rural and to socio-economic status. Surveys conducted in some urban settings in Latin America found high prevalence rates, only exceeded by the rates observed in industrialised English-speaking countries. It is likely that the marked changes in the environment, life style and living conditions in Latin America are responsible for these observations. The understanding of the epidemiological and immunological changes that underlie the increase in asthma and allergic diseases in Latin America aimed by SCAALA studies in Brazil and Ecuador will be crucial for the identification of novel preventive interventions. Methods/Design: The Salvador-SCAALA project described here is a longitudinal study involving children aged 4–11 years living in the city of Salvador, Northeastern Brazil. Data on asthma and allergic diseases (rhinitis and eczema) and potential risk factors will be collected in successive surveys using standardised questionnaire. This will be completed with data on dust collection (to dust mite and endotoxin), skin test to most common allergens, stool examinations to helminth and parasites, blood samples (to infection, total and specific IgE, and immunological makers), formaldehyde, physical inspection to diagnoses of eczema, and anthropometric measures. Data on earlier exposures when these children were 0–3 years old are available from a different project. Discussion: It is expected that knowledge generated may help identify public health interventions that may enable countries in LA to enjoy the benefits of a "modern" lifestyle while avoiding – or minimising – increases in morbidity caused by asthma and allergies.

Objective: Plastic bronchitis is an unusual condition in children, associated with formation of mucofibrinous casts and mucous plugging of the tracheobronchial tree. Given that this illness is part of the differential diagnosis of acute respiratory failure, early treatment is important for improved prognosis. The aim of this report is to describe a case of plastic bronchitis in a child with alpha-thalassemia that was treated successfully with endoscopy. Description: A 3 year old, black, male child, previously healthy, presented with acute respiratory failure and a chest x-ray showing pulmonary atelectasis. There was no evidence of respiratory symptoms or previous allergy state. The diagnosis of plastic bronchitis was made using flexible and rigid bronchoscopy, and confirmed by histopathologic findings. The child progressed well, treatment was based on supportive care and antibiotics were not used. Ten days after discharge, radiographic appearance was normal. Alpha thalassemia was diagnosed through hemoglobin electrophoresis. Comments: Plastic bronchitis is clinically important because has similar presentation to other prevalent diseases, such as foreign body aspiration and asthma. When plastic bronchitis is suspected, endoscopy is indicated in order to confirm diagnosis and define treatment. Plastic bronchitis has been previously described in patients with cystic fibrosis, cardiac surgery and sickle cell disease. In this case, an association with alpha-thalassemia was observed.

Epidemiological and experimental studies have demonstrated an association between parasitic infections and the allergic diseases. A protective effect in asthma was shown in animals infected with helminths. The aim of this study was to determine the effect of Angiostrongylus costaricensis extract on inflammatory lung response to ovalbumin (OVA) in mice. Four BALB/c mice received A. costaricensis extract by intraperitoneal (i.p.) injection on the first day. Mice were immunised against OVA by i.p. injection on day (D) 5 and D12 and received a daily intranasal OVA challenge (40 microl) between the D19 and D21. On D23, we performed a bronchoalveolar lavage (BAL) on the mice. Four BALB/c mice (control group) were immunised against OVA using the same protocol, but did not receive parasite extract. Total cell counts (TCC) and differential cell counts were performed in BAL fluid samples. Eosinophil cell counts in BAL fluid were lower in the group that received A. costaricensis extract when compared with the control group (0.04 x 10(6) cells/ml and 0.01 x 10(6) cells/ml, respectively; p=0.04). TCC were not different between the groups studied. A. costaricensis extract in mice decreases eosinophilic response to OVA in BAL fluid.

In the present report, we describe an unusual presentation of post-infectious bronchiolitis obliterans accompanied by pulmonary hemosiderosis in a nine-year-old boy with persistent respiratory symptoms subsequent to an episode of acute bronchiolitis occurring at the age of seven months. After the episode, the persistent respiratory symptoms worsened significantly, and, by the age of seven, the patient began to have difficulty breathing after minimal exertion. Computed tomography of the chest presented findings consistent with bronchiolitis obliterans. Open lung biopsy revealed numerous hemosiderin-laden macrophages, as well as other findings consistent with bronchiolitis obliterans. Pulmonary hemosiderosis can occasionally be accompanied by bronchiolitis obliterans in children with severe sequelae after an episode of viral infection.

Wheezing associated with respiratory viral infections in infancy is very common and results in high morbidity worldwide. The Th1/Th2 pattern of immune response in these patients remains unclear and previous studies have shown controversial results. The aim of the present study was to compare the type of Th1/Th2 cytokine response between infants with acute bronchiolitis, recurrent wheezing and upper respiratory infections from a developing country. Infants younger than 2 years of age admitted to Hospital São Lucas, Porto Alegre, RS, Brazil, between May and November 2001, with an acute episode of wheezing associated with viral respiratory infection were selected. Subjects with upper respiratory infections from the emergency department were selected for the control group. Interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) levels from nasal aspirates were determined by ELISA from peripheral mononuclear cell cultures. Twenty-nine subjects with acute bronchiolitis, 18 with recurrent wheezing and 15 with upper respiratory infections were enrolled. There were no differences in family history of atopy or parental smoking between groups. Oxygen requirement was similar for the acute bronchiolitis and recurrent wheezing groups. The percentage of positive tests for the cytokines studied and the IFN-gamma/IL-4 ratio was similar for all groups. Comparison of the polarized Th1/Th2 cytokine results for the various groups showed no specific pattern of cytokine production. Infants with wheezing from a developing country do not show any specific predominant pattern of Th1/Th2 cytokine production, suggesting that multiple factors may be involved in the pathogenesis of this illness.

Background Many studies have measured cytokine production derived from peripheral blood mononuclear cells (PBMCs) to evaluate the immune response in acute bronchiolitis (AB), but no previous reports have examined the association between PBMC release of cytokines and concomitant airway immune response. Objective To determine whether interferon-γ (IFN-γ), interleukin 4 (IL-4), and IL-10 levels from PBMCs are associated with concurrent cytokine release in the airways of infants with AB. Methods Infants with acute viral-associated first episode of wheezing who required hospitalization between May and September 2002 were recruited. Nasopharyngeal aspirates (NPAs) and PBMC samples were collected simultaneously. The concentrations of IFN-γ, IL-4, and IL-10 in NPA and PBMC supernatants were determined by enzyme-linked immunosorbent assay. Results Twenty infants with AB were enrolled in the study of whom 17 (85%) had positive NPA immunofluorescence results for viral detection and respiratory syncytial virus. Median total cell count and viability from NPA samples were 2.2 × 10 6 cells/mL (SD, 1.7 cells/mL) and 92% (SD, 6.0%), respectively. There was a significant correlation between IL-4 levels from NPA and PBMC samples ( r = 0.5, P = .02); however, we did not find an association between IFN-γ and IL-10 levels. Conclusions Cytokines produced by in vitro PBMCs may not necessarily reflect the concurrent cytokine pattern production at the mucosal surface in the respiratory tract of infants with AB. Further studies are required to determine whether peripheral blood is a reliable sample for airway inflammation evaluation and to explain the discrepancies of cytokine productions found in this study.

Asthma is a heterogenous disease with variable signs and symptoms among patients. It also presents significant individual variability over time. Recently, some important population-based studies that followed children from birth or from early childhood into adulthood have shed new light on how we understand this syndrome. Three phenotypes have been identified in children with asthma: transient wheezing, non-atopic wheezing of the toddler and pre-school-aged child and IgE-mediated wheezing. Transient wheezing is associated with symptoms that are limited to the first 3-5 years of life, decreased lung function, maternal smoking during pregnancy and exposure to other siblings or children at daycare centres. There is no association between transient wheezing and family history of asthma or allergic sensitisation. Children wheezing with respiratory syncytial virus in the first years of life are more likely to be wheezing up to 13 years of age; this is independent of atopy (non-atopic wheezers) and is not related to atopic sensitisation. Wheezing associated with evidence of allergic sensitisation has been identified as the 'classic' asthma phenotype. Early allergic sensitisation is a major risk factor for persistent asthma.

Over the last two decades since its emergence human immunodeficiency virus (HIV) infection has been a major epidemiological problem. There are 42 million people living with HIV/AIDS worldwide and 3.2 million are children under the age of 15. The epidemic continues to expand rapidly in many countries. Most of the HIV/AIDS patients are from developing countries and Africa has the highest prevalence of this illness in the world. Mother-to-child transmission is estimated to happen in 85% of children with HIV infection. Pulmonary involvement is common and responsible for almost 80% of the symptoms in children under 12 months of age. Bacterial pneumonia~ can be recurrent in AIDS patients and are the main cause of hospital admissions. The same bacteria associated to pneumonia in immune competent children are also observed in AIDS patients. HIV positive children are at higher risk for pneumonia associated to opportunistic agents like protozoa viruses fungi and mycobacteria. Most children with AIDS develop some type of lung disease throughout life. Pneumocystis carinii pneumonia (PCP) and lymphocytic interstitial pneumonitis (LIP) used to be even more prevalent until very recently. With earlier diagnosis and new treatments the prevalence of these illnesses has been changing over the last years. Since the mid- to late 1990s a dramatic decrease in the frequency of most opportunistic infections and other severe manifestations of HIV infection in children has been observed in pediatric AIDS due primarily to the development and implementation of guidelines for PCP prophylaxis and availability of highly active antiretroviral therapy. (excerpt)

AIMS: To present a case of dermatitis herpetiformis, a papulovesicular rash due to deposits of immunoglobulin A in the papillary dermis. This is a common extraintestinal manifestation of celiac disease, although rare in childhood. CASE DESCRIPTION: A 10-year-old girl was diagnosed with celiac disease, suspected only due to the occurrence of typical lesions of dermatitis herpetiformis. Intestinal biopsy demonstrated total atrophy of duodenal villi in spite of the lack of clinical digestive manifestations. Under a gluten-free diet the patient presented favorable evolution, with regression of cutaneous lesions. CONCLUSIONS: Dermatitis herpetiformis is a common manifestation of celiac disease, but is not frequent in infants. Therefore, is very important to investigate any child that presents a chronic papulovesicular cutaneous eruption non-responsive to usual treatments in order to perform a precocious diagnosis of celiac disease, avoiding its serious repercussions.

During the past two decades, a large number of studies have addressed the association of viral respiratory events in early life and the subsequent development of recurrent wheezing and asthma later in life.1–4 Investigations performed both in animal models and in humans have provided new insights into potential pathogenetic mechanisms discernible during acute and convalescent stages of viral events and their potential association with the long-term consequences of these events.5 6 Retrospective analysis of clinical trials has suggested that the use of anti-respiratory syncytial virus (RSV) antibodies may decrease the incidence of subsequent asthma-like symptoms,7 but prospective data are lacking. The strongest data for the association between early RSV events and asthma comes from longitudinal studies. The Tucson Children's Respiratory Study was based on a healthy and representative population, and its results, if not automatically applicable to all communities given the peculiarities of the Arizona desert, have been replicated in other population-based studies. The main findings from the Tucson study indicated that RSV, independent of other known risk factors for asthma, was significantly associated with recurrent wheeze in the first decade of life.1 The results of a larger birth cohort, also population based, the ALSPAC study from Bristol points in the same direction as the Tucson study: children with a RSV bronchiolitis admission in the first year of life were more likely to have asthma at age 7 years, compared with controls and there was no relation with RSV infection and the development of atopy at this age.8 The issue of a possible relation between early life RSV bronchiolitis and the later development of atopy has been entertained by a series of studies, and the disparities of findings seem to be …

The prevalence of respiratory symptoms indicative of asthma in children from Latin America has been largely ignored. As part of the International Study of Asthma and Allergies in Childhood (ISAAC), 17 centers in 9 different Latin American countries participated in the study, and data from 52,549 written questionnaires (WQ) in children aged 13-14 years and from 36,264 WQ in 6-7 year olds are described here. In children aged 13-14 years, the prevalence of asthma ever ranged from 5.5-28%, and the prevalence of wheezing in the last 12 months from 6.6-27%. In children aged 6-7 years, the prevalence of asthma ever ranged from 4.1-26.9%, and the prevalence of wheezing in the last 12 months ranged from 8.6-32.1%. The lower prevalence in centers with higher levels of atmospheric pollution suggests that chronic inhalation of polluted air in children does not contribute to asthma. Furthermore, the high figures for asthma in a region with a high level of gastrointestinal parasite infestation, and a high burden of acute respiratory infections occurring early in life, suggest that these factors, considered as protective in other regions, do not have the same effect in this region. The present study indicates that the prevalence of asthma and related symptoms in Latin America is as high and variable as described in industrialized or developed regions of the world. Revisión por pares

The relation between lower respiratory tract illnesses in early life caused by the respiratory syncytial virus (RSV) and the subsequent development of wheezing and atopy in childhood is not well understood. We studied this relation in children who had lower respiratory tract illnesses that occurred before 3 years of age.Children were enrolled at birth and cases of lower respiratory tract illness were ascertained by a physician. Viral tests were done for specimens collected at the time of the illness. Children were classified into five groups according to type and cause of lower respiratory tract illness. Children were then followed prospectively up to age 13, and we measured frequency of wheezing, pulmonary function, and atopic status (allergy skin-prick tests, serum IgE concentrations).RSV lower respiratory tract illnesses were associated with an increased risk of infrequent wheeze (odds ratio 3.2 [95% CI 2.0-5.0], p0.001), and an increased risk of frequent wheeze (4.3 [2.2-8.7], por = 0.001) by age 6. Risk decreased markedly with age and was not significant by age 13. There was no association between RSV lower respiratory tract illnesses and subsequent atopic status. RSV lower respiratory tract illnesses were associated with significantly lower measurements of forced expiratory volume (2.11 [2.05-2.15], por = 0.001) when compared with those of children with no lower respiratory tract illnesses, but there was no difference in forced expiratory volume after inhalation of salbutamol.RSV lower respiratory tract illnesses in early childhood are an independent risk factor for the subsequent development of wheezing up to age 11 years but not at age 13. This association is not caused by an increased risk of allergic sensitisation.

Background: Asthma and wheezing during childhood are associated with elevated total serum IgE and with allergic sensitization to local aeroallergens. However, little is known about the longitudinal relationship between total serum IgE and the development of wheezing and allergic sensitization during childhood. Objective: The purpose of our investigation was to determine the relationship between total serum IgE and the development of wheezing and allergic sensitization in childhood. Methods: Our study subjects were participants in the Tucson Children's Respiratory Study who underwent an IgE measurement in at least 1 of 3 surveys (at years 1, 6, and 11) and complete allergy skin tests during the latter 2 surveys. The children's phenotypes were categorized on the basis of skin test response (never, early, and late) and wheezing status (never, early, late, and persistent). Repeated-measures analyses were used, allowing subjects to be included who had unequal numbers of IgE observations (a total of 263 boys and 277 girls). Results: We found that total serum IgE levels track with age: subjects with high serum IgE levels less than 1 year old continued to have high IgE levels at ages 6 and 11 years. Both persistent wheezing and early sensitization were associated with high serum IgE levels at all ages. Boys who had late or persistent wheezing or who were sensitized early or late had high serum IgE levels as early as age 9 months, whereas only girls with persistent wheezing and early sensitization had elevated IgE levels at that age. Children who wheezed only in the first years of life and not after (ie, those with early wheezing) had serum IgE levels that were not different from those of nonwheezing children. Conclusion: On the basis of these findings we conclude that although total serum IgE tracks with age, children who are predisposed to persistent wheezing and early sensitization to local aeroallergens already have high levels of IgE at age 9 months. This suggests that the predisposition to respond to environmental stimuli through high levels of IgE precede early allergic sensitization, indicating that there may be a common defect in the development of the immune system involving IgE production and early allergic sensitization. (J Allergy Clin Immunol 1999;104:28-36.)

Compelling evidence suggests a causal relation between exposure to parental cigarette smoking and respiratory symptoms during childhood. Still, the roles of prenatal versus postnatal parental smoking need clarification. In this study, the authors assessed the effects of passive smoking on respiratory symptoms in a cohort of over 1,000 children born during 1980-1984. The children were enrolled in the Tucson Children's Respiratory Study in Tucson, Arizona, and were followed from birth to age 11 years. The population was generally middle class and consisted of two main ethnic groups, non-Hispanic Whites (75%) and Hispanics (20%), reflecting Tucson's population. Information on parental smoking and on wheeze and cough in their children was elicited from parents by using questionnaires at five different surveys. Data were analyzed both cross-sectionally and by using the generalized estimation equation approach, a longitudinal mixed-effects model. The best-fitting model indicated that maternal prenatal but not postnatal smoking was associated with current wheeze (odds ratio = 2.3, 95% confidence interval 1.4-3.8) independently of a family history of asthma, socioeconomic factors, and birth weight. This effect was time dependent and significant only below age 3 years; although independent of gender, the association was stronger for girls (odds ratio = 3.6, 95% confidence interval 1.6-8.0). Cough was not associated with parental smoking during the first decade of life. This transitory effect of maternal prenatal smoking on wheezing could be due to changes that affect the early stages of lung development.

These figures arenot so different from those found in developedcountries, where asthma is seen as a significant publichealth problem.According to the Departamento de Informacaoe Informatica do Sistema Unico de Saude (DATASUS,Unified Health Care System Department ofInformation and Information Science), nearly200,000 children under 14 years of age anddiagnosed with asthma were hospitalized under theBrazilian Sistema Unico de Saude (SUS, Unified HealthCare System) in 2004, even considering that therewas probably significantly under-reporting of thedisease in various regions of the country. If weconsider that a reduction in the number of hospitaladmissions is one of the objectives to be achievedthrough the adequate control of the disease, wecan conclude, even through the use of an isolatedfinding, that the asthma management programs inBrazil are far from being adequate, which has asignificant impact on the health of children.Even more significant is the fact that asthma isresponsible for one in every 250 deaths worldwide.Many of these deaths are avoidable, since they arerelated to inappropriate medical care, lack ofadequate information, and delays in obtainingtreatment during more severe attacks. In Brazil, therewere 3000 asthma-related deaths in 2004 amongSUS patients alone.A recent study

Atopic asthma is the most common chronic disease in childhood with high prevalence in many industrialized countries. Recent studies have shown that, in contrast, among non-affluent populations the association between asthma and markers of atopy are not as significant as those observed in most Western countries. However, overall asthma prevalence in Latin America has been shown to be higher than expected. This finding may be in line with the concept of the ‘hygiene hypothesis’, in which a lower risk of asthma and allergy development may be associated with early life exposures to a high burden of infections (bacteria, viruses and parasites). On the basis of this hypothesis, a strong Th1-immune stimulation by microbial exposition and its products in early childhood may inhibit skewing towards Th2 immunity in atopic predisposed children. Consequently, other asthma phenotypes may emerge in different environmental settings, especially among nonaffluent populations. A fact that has been noticed is that the impact of hygiene seems to be mostly associated with markers of atopy instead of asthma-like symptoms. There is no consensus on why there is a greater prevalence for non-atopic asthma in non-affluent countries, but one possible explanation is that the role of crowding in poor urban environments as well as the early introduction of nursery care for children in the first years of life may facilitate an early and aggressive milieu mediated by respiratory viruses and environmental pollutants. A series of prospective longitudinal studies suggest that there is a significant association between early life bronchiolitis and persistent respiratory symptoms/asthma. These studies and other recent data, mostly experimental, suggest that some viruses, especially RSV and RV, may affect the airways, initiating a cascade of events (inflammatory or not) that seem to facilitate the persistence of symptoms. The evaluation of post-viral or even premorbid/predisposing effects associated with airway hyper-responsiveness or with lung function development seem to in part explain the persistence of respiratory symptoms in a complex model aiming to detect mechanisms associated with asthma, independent of atopy. It is well known that atopy is a main driving force in this explanatory model that leads to asthma, and these children are at greater risk of developing childhood asthma than non-atopic subjects who wheeze. Yet the morbidity associated with non-atopic/non-eosinophilic asthma and the size of the population possibly affected by this phenotype is beginning to be recognized as very important for understanding mechanisms of disease. Possible future asthma preventing strategies for affluent or nonaffluent populations depend on a better understanding of these phenotypes, that are far from exclusive, since they express a balancing act of environmental impact on the airways, and how the response is affected by predisposing genetic factors.

Lung disease in patients with severe combined immune deficiency (SCID) undergoing bone marrow transplantation (BMT) is most commonly caused by infection. Noninfectious episodes of pulmonary disease following BMT are more frequently encountered in patients with hematologic disorders or malignancy and are probably related to ablation therapy or graft-versus-host disease (GVHD). In contrast, patients with SCID do not receive chemotherapy before an HLA-identical allogeneic BMT and they do not suffer significant GVHD. We report a patient who developed severe lung disease during the period of rapid engraftment following an HLA-identical allogeneic bone marrow transplantation. Lung biopsy showed dense lymphocytic infiltrates in the alveolar septae and no evidence of infection. Following the idea that the acute recruitment of engrafted lymphocytes may have contributed to or caused the pulmonary disease, we have attempted to suppress cellular immunity by administering high-dose methylprednisolone. The patient's lung disease rapidly improved and eventually completely resolved.

Objective To compare the prevalence of asthma (A), rhinoconjunctivitis (R) and atopic eczema (AE) obtained in two different occasions, among adolescents from five Brazilian cities. Methods ISAAC's written questionnaire was applied to 13-14-year-old adolescents from five Brazilian cities (Curitiba, Porto Alegre, Recife, Salvador and Sao Paulo) in 1994/5 (Phase I) and 2002/3 (Phase III). "Have had wheezing in the last year" identified adolescents with A. The concomitant report of "nasal and ocular symptoms in the last year" identified the presence of R and "eczema in the last year evidenced in flexural areas" defined AE. Results The comparison of data obtained, showed that on Phase III: there was a significant reduction in the prevalence of A in Porto Alegre (24.7% × 18.2%) and Sao Paulo (23.3% × 18.7%). No significant differences were observed in Recife (19.7% × 19.1%), Salvador (27.1% × 24.6%) and Curitiba (18.4% × 18.9%). The prevalence of R increased significantly in Curitiba (14.1% × 17.2%) and Recife (11.3% × 14.5%). Significant changes did not occur in Salvador (25.0% × 24.4%), Sao Paulo (12.6% × 12.2%) and Porto Alegre (17.6% × 15.9%). There was a significant reduction in the prevalence of AE in Salvador (9.2% × 6.5%). In Recife (4.6% × 5.0%), Sao Paulo (3.7% × 3.6%), Curitiba (3.9% × 3.7%) and Porto Alegre (4.8% × 5.0%) the changes observed were not significant. Conclusions In Brazil, there is no homogeneous pattern in the prevalence of allergic diseases, comparing the prevalence in five cities (states' capitals) between ISAAC's phases I and III (7-8 years interval).

Subject/observers were accurate in identifying emergent leadership hierarchies on four leadership dimensions when provided records of target groups' meetings containing only verbal communications, only nonverbal communications, or both types of behavior. With knowledge of participation rates controlled by covariance, the subject/observers' accuracy scores retained significance in three of the information conditions demonstrating the presence of verbal and nonverbal leadership cues independent of participation rates. The value of verbal and nonverbal communications to identifying leaders varied with the type of leadership hierarchy being identified. The findings are presumed to hold for leader selection as well. The author proposes that the question of why a group member has emerged to fulfill a leadership role in a group be studied from the point of view of group members' selecting leaders or permitting emergence rather than leaders emitting behaviors.

Background Lower respiratory tract infection (LRTI) is a major cause of pediatric morbidity and mortality, especially among non-affluent communities. In this study we determine the impact of respiratory viruses and how viral co-detections/infections can affect clinical LRTI severity in children in a hospital setting. Methods Patients younger than 3 years of age admitted to a tertiary hospital in Brazil during the months of high prevalence of respiratory viruses had samples collected from nasopharyngeal aspiration. These samples were tested for 13 different respiratory viruses through real-time PCR (rt-PCR). Patients were followed during hospitalization, and clinical data and population characteristics were collected during that period and at discharge to evaluate severity markers, especially length of hospital stay and oxygen use. Univariate regression analyses identified potential risk factors and multivariate logistic regressions were used to determine the impact of specific viral detections as well as viral co-detections in relation to clinical outcomes. Results We analyzed 260 episodes of LRTI with a viral detection rate of 85% (n = 222). Co-detection was observed in 65% of all virus-positive episodes. The most prevalent virus was Respiratory Syncytial Virus (RSV) (54%), followed by Human Metapneumovirus (hMPV) (32%) and Human Rhinovirus (HRV) (21%). In the multivariate models, infants with co-detection of HRV + RSV stayed 4.5 extra days (p = 0.004), when compared to infants without the co-detection. The same trends were observed for the outcome of days of supplemental oxygen use. Conclusions Although RSV remains as the main cause of LRTI in infants our study indicates an increase in the length of hospital stay and oxygen use in infants with HRV detected by RT-PCR compared to those without HRV. Moreover, one can speculate that when HRV is detected simultaneously with RSV there is an additive effect that may be reflected in more severe clinical outcome. Also, our study identified a significant number of children infected by recently identified viruses, such as hMPV and Human Bocavirus (HBov), and this is a novel finding for poor communities from developing countries.