Association of respiratory virus types with clinical features in bronchiolitis: Implications for virus testing strategies. A systematic review and meta-analysis

Paediatr Respir Rev. 2024 Mar:49:34-42. doi: 10.1016/j.prrv.2023.09.003. Epub 2023 Sep 17.


Background: Bronchiolitis is a leading cause of infant hospitalization, linked to respiratory syncytial virus (RSV) and rhinovirus (RV). Guidelines lack specific viral testing for bronchiolitis management. To establish effective management strategies, it is crucial to assess whether specific respiratory virus types are correlated with distinct examination features.

Methods: Through a systematic search of three databases, 21 studies were qualitatively analyzed, with 18 used for meta-analysis. Various outcomes like wheezing on auscultation, fever, atopic traits, and infection severity were evaluated.

Results: RSV-positive bronchiolitis was associated with a higher need for oxygen supplementation (OR 1.78, 95% CI 1.04-3.02) in 5 studies, while RV-positive bronchiolitis was more frequently linked to personal history of eczema (OR 0.60, 95% CI 0.41-0.88) in 6 studies. No significant differences were observed in the other outcomes examined.

Conclusions: Bronchiolitis caused by RSV or RV presents with similar clinical features. Despite the associations between RSV-positive bronchiolitis and need for oxygen supplementation, and RV-positive bronchiolitis and a history of eczema, our study shows that viral etiology of bronchiolitis cannot be determined solely based on clinical presentation. Tailored management strategies, informed by accurate viral testing, seem crucial in clinical practice for enhancing patient outcomes in severe bronchiolitis.

Keywords: Bronchiolitis; Infant; Respiratory syncytial virus; Rhinovirus; Systematic review; Wheeze.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Bronchiolitis* / diagnosis
  • Eczema* / complications
  • Hospitalization
  • Humans
  • Infant
  • Respiratory Sounds / etiology
  • Respiratory Syncytial Virus Infections* / complications
  • Respiratory Syncytial Virus Infections* / diagnosis
  • Respiratory Syncytial Virus, Human*
  • Rhinovirus