Risk factors for admission and the role of respiratory syncytial virus-specific cytotoxic T-lymphocyte responses in children with acute bronchiolitis.

Background: Risk factors for admission of children with acute bronchiolitis have remained controversial. Technological advances in the measurements of cytotoxic T-lymphocyte (CTL) activity, enable respiratory syncytial virus (RSV)-specific CTL activity to be studied in infants with bronchiolitis for the first time. We evaluated risk factors for admission of children with acute bronchiolitis and determined the role of CTL responses in those infected with RSV.

Method: Children between 3 and 24 months of age presenting with bronchiolitis to the paediatric outpatient department at King Edward VIII Hospital, Durban, over a 1-year period were enrolled. Management included clinical evaluation, nasopharyngeal aspiration, standard treatment and hospitalisation if indicated. Secretions were tested with monoclonal antibodies for RSV and pooled respiratory viruses; shell vial cultures were also established. Permission was requested from parents of RSV-infected subjects for blood draws for specific cytotoxic T-cell assays and CD4/CD8 cells on admission and repeat CTL on day 7.

Results: Viruses were identified in 55 of the 114 subjects studied (48.2%). RSV was seen in 41 cases (74.5%). Twenty-three infants (20.2%) required admission. Risk factors associated with inpatient admissions on univariate analysis included younger mean age (7.6 months v. 10.1 months), overcrowding (p < 0.01) and indoor exposure to products of combustion of cooking fuels (p = 0.05). Only the former two were significant on multivariate analysis. RSV-specific CTL responses were obtained in 21 children (51.2%). Responses were either very weak (N = 7) or negative (N = 14) on day 0 and did not alter significantly on day 7. The mean CD4/CD8 ratios in this group were 2.27:1. The highest frequency of CTL was directed against the proteins M4/5/6', with counts ranging from 100 to 400 spot forming cells (sfc)/million.

Conclusion: Measures to address risk factors identified in this study may decrease the need for hospitalisation from bronchiolitis. The lack of RSV-specific CTL responses in peripheral blood of immunocompetent RSV-infected children suggest an alternative method of induction of immunity or compartmentalisation of immune cells.