Abstract
The clinical impact of viral factors (types and viral loads) during respiratory syncytial virus (RSV) infection is still controversial, especially regarding newly described genotypes. In this study, infants with RSV bronchiolitis were recruited to describe the association of these viral factors with severity of infection. RSV antigenic types, genotypes, and viral loads were determined from hospitalized patients at Hospital Roberto del Río, Santiago, Chile. Cases were characterized by demographic and clinical information, including days of lower respiratory symptoms and severity. A total of 86 patients were included: 49 moderate and 37 severe cases. During 2013, RSV-A was dominant (86%). RSV-B predominated in 2014 (92%). Phylogenetic analyses revealed circulation of GA2, Buenos Aires (BA), and Ontario (ON) genotypes. No association was observed between severity of infection and RSV group (p = 0.69) or genotype (p = 0.87). After a clinical categorization of duration of illness, higher RSV genomic loads were detected in infants evaluated earlier in their disease (p < 0.001) and also in infants evaluated later, but coursing a more severe infection (p = 0.04). Although types and genotypes did not associate with severity in our children, higher RSV genomic loads and delayed viral clearance in severe patients define a group that might benefit from new antiviral therapies.
Highlights
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection (LRTI) in children [1] and an important agent in the elderly and immunocompromised patients [2], generating a global public health problem [3]
RSV has been classified into groups A and B based on antigenic differences of the G, F, and N proteins [8]
Further genetic analysis of the nucleotide sequence of the second hypervariable region on the G gene allowed for the classification into genotypes within antigenic groups RSV-A and B [9,10]
Summary
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection (LRTI) in children [1] and an important agent in the elderly and immunocompromised patients [2], generating a global public health problem [3]. In Chile, RSV is the cause of important outbreaks each winter, accounting for a high number of outpatient visits and hospitalizations [4]. The pathogenesis of RSV remains the topic of intense basic and clinical research with emphasis on the host (genetic and immunologic), viral, and environmental factors in relation to severity of infection. Further genetic analysis of the nucleotide sequence of the second hypervariable region on the G gene allowed for the classification into genotypes within antigenic groups RSV-A and B [9,10]. None of the variants or genotypes has been consistently associated with greater virulence or pathogenicity [13,18,22,23], some recent reports describing clinical aspects of contemporary genotypes (NA1 and ON1) have shown higher frequencies of LRTI and hospitalizations rates [24,25,26]
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