Results
There were analyzed 450 files of pediatric patients diagnosed with RSV infection existing in the INER database, from May 2014 to June 2017, of which 167 were within the age limit set in the study.
In the prospective period, a total of 70 infected patients were identified, from August 2018 to September 2019, of whom 41 were within the delimited age limit in this study. Only 30 samples of nasopharyngeal exudate were available.
The total sum of patients included in this study was 197, of which clinical, laboratory, radiographic, and outcome variables (mechanical ventilation requirements, mortality, and hospitalization days) were analyzed. There were determined the levels of specific IgA against RSV from the 30 samples of nasopharyngeal exudate, by direct ELISA test, which was performed in triplicate (Table 5), a procedure already detailed in the methodology, obtaining the following results:
A male predominance of 59.9%. The patients who received exclusive breastfeeding for 6 months were 90, which corresponds to 45.7%. (Table 1)
Only 4.1% of infants received a complete vaccination schedule corroborated with a vaccination card.
The main symptoms found in this population were: rhinorrhea runny nose, fever, cough and irritability in order of frequency, 72.8%, 71.6%, 59.9% and 59.3% respectively. Solely 30 patients (15.2%) presented some kind of gastrointestinal symptom, such as nausea and vomiting, one of whom had febrile seizures. (Table 1)
Regarding the personal pathological history of the patients included in this research, it was found that up to 46.7% presented clinical symptoms of previous wheezing or bronchiolitis, as well as repeated respiratory tract infections (more than 3 episodes per year) in 34%. In 42.6% corresponding to 84 patients, it was identified that at least one of the 2 parents had a regular smoking habit, and it was also found that up to 41.6% of pediatric patients showed a previous medical history with a diagnosis of gastroesophageal reflux disease and a 12.2% of asthma.
Twenty patients, which corresponds to 10.2% of the total, were premature at birth (<34 weeks gestation). Only 3 patients presented some risk factor for immunosuppression and 11 (5.6%) reported bronchopulmonary dysplasia or some cardiac malformation, with patent ductus arteriosus and Ebstein’s anomaly being the reported ones.
Regarding respiratory distress data, during the physical examination, it was found that up to 75.1% of the patients presented intercostal retractions and 50.3% thoracoabdominal dissociation. The oxygenation index at admission was determined as moderate in a 43.1%. The severity of bronchiolitis was classified as moderate to severe in 19.8% of cases.
As outcomes, it was obtained that up to 22.8% were coinfected with some virus upon admission, being the Rhinovirus the main causative agent of said coinfection, up to 10.7%, followed by Seasonal influenza and Parainfluenza1 virus in 4.6% of cases. . In 1 patient, the 2009 H1N1 pandemic influenza virus was isolated and considered as clothing. (Table 1).
Likewise, it was identified that 23.4% of the children were coinfected with some bacterium, of which, in 11.7% it was Pneumococcus, followed by H. infuenzae by 5.1%. and C. pneumoniae in 1%.
About bacterial nosocomial coinfections, 2% of the patients presented them, being E. coli, Pseudomonas A. and S. aureus the isolated organisms, in 1%, 0.5% and 0.5% of cases respectively. Fungal coinfections were also found in 1 of the patients, in which Aspergillus spp was isolated as the responsible fungus.
The median age, weight and height were 12 months, 10Kg, and 77cm respectively. Physical examination revealed a median O2 saturation of 86%. The median hospitalization days was 7 days, 18 patients were transferred to the intensive care unit requiring invasive mechanical ventilation, which lasted up to 10 days in 1 patient. (Table 2)
Regarding laboratorials, the medians for the hematic biometry were as follows: 12 gr / dl for in hemoglobin, 37% hematocrit and 306 thousand platelets per microliter. Regarding the white series, a median of 8.7 thousand per microliter of leukocytes was found, with neutrophils being predominant in 57% on average, followed by lymphocytes in 31%. The mean of the creatinine levels was 0.3 mg / dl, likewise the CPK levels were 84 mg / dl and the lactic dehydrogenase 288 Ul / L as average.
The C-reactive protein was found in concentrations of 0.76 mg / L as average and the measured levels of procalcitonin were 0.15 ng / ml as average.