Search

Bronchiolitis is one of the leading causes of hospitalisation in infancy, with highly variable clinical presentations ranging from mild disease safely managed at home to severe disease requiring invasive respiratory support. Identifying immune biomarkers that can predict and stratify this variable disease severity has important implications for clinical prognostication/disposition. A systematic literature search of the databases Embase, PubMed, ScienceDirect, Web of Science, and Wiley Online Library was performed. English language studies that assessed the association between an immune biomarker and bronchiolitis disease severity among children aged less than 24 months were included. 252 distinct biomarkers were identified across 90 studies. A substantial degree of heterogeneity was observed in the bronchiolitis definitions, measures of disease severity, and study designs. 99 biomarkers showed some significant association with disease severity, but only 18 were significant in multiple studies. However, all of these candidate biomarkers had comparable studies that reported conflicting results. Conclusion: The heterogeneity among included studies and the lack of a consistently significant biomarker highlight the need for consensus on bronchiolitis definitions and severity measures, as well as further studies assessing their clinical utility both in isolation and in combination., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Hospitalization with bronchiolitis is linked to the development of early childhood chronic wheeze and asthma. Viral etiology and severity of inflammation are potential contributing factors. Previously we observed reduced airway neutrophil infiltration in breastfed bronchiolitic infants, with a corresponding reduction in disease severity. This study aimed to examine whether respiratory viral etiology and co-infection alters the pattern of neutrophil influx, and the inflammatory mediator profile, resulting in epithelial damage in bronchiolitis., Methods: Nasopharyngeal aspirates (NPAs) collected from hospitalized infants were assessed for viruses, soluble protein, cellular infiltrate, interleukin (IL)-6, -8, and myeloperoxidase (MPO)., Results: NPAs were collected from 228 bronchiolitic and 14 non-bronchiolitic infants. In the bronchiolitic cohort, human rhinovirus was most prevalent (38%), followed by respiratory syncytial virus (36%), adenovirus (10%), and human metapneumovirus (6%), with 25% positive for viral co-infections and 25% negative for all screened viruses. Viral-induced bronchiolitis was associated with increased cellular infiltrate and protein, above control, and virus-negative infants (P < 0.05). Cellular infiltrate correlated to IL-6, -8, and MPO (r = 0.331, 0.669, and 0.661; P < 0.01). Protein, IL-6, -8, and MPO differed significantly between viral groups; however, the majority of marker values for all groups fall within an overlapping, indistinguishable range, precluding their use as biomarkers of viral etiology. No significant difference was found between single and viral co-infections for any parameter., Conclusion: Bronchiolitic infants presenting with a detectable respiratory virus during hospitalization demonstrated elevated markers of airway tissue inflammation and injury. In this cohort, viral etiology did not discernibly modulate chemokine-mediated neutrophil infiltration and activation. Pediatr Pulmonol. 2017;52:238-246. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

We evaluated the ability of UNICEF-designed pot-chlorinators to achieve recommended free residual chlorine (FRC) levels in well water in Bissau, Guinea-Bissau, during a cholera outbreak. Thirty wells were randomly selected from six neighbourhoods. Pot-chlorinators--perforated plastic bottles filled with gravel, sand and calcium hypochlorite granules--were placed in each well. FRC was measured before and 24, 48 and 72 h after placement and compared with World Health Organization (WHO)-recommended levels of 21 mg L(-1) for well water during cholera outbreaks and 0.2-5 mg L 1 in non-outbreak settings. Presence of well covers, distance from wells to latrines, and rainfall were noted. Complete post-chlorination data were collected from 26 wells. At baseline, no wells had FRC>0.09 mg L(-1). At 24, 48 and 72 h post-chlorination, 4 (15%), 1 (4%) and 0 wells had FRC>or=1 mg L(-1) and 16 (62%), 4 (15%) and 1 (4%) wells had FRC between 0.2 and 5 mg L(-1), respectively. Several families reported discontinuing household water chlorination after wells were treated with pot-chlorinators. Pot-chlorinators failed to achieve WHO-recommended FRC levels in well water during a cholera outbreak, and conveyed a false sense of security to local residents. Pot-chlorination should be discouraged and alternative approaches to well-water disinfection promoted.