title: Analysis of the local and systemic inflammatory response in hospitalized infants with respiratory syncitial virus bronchiolitis.
abstract: BACKGROUND
  Respiratory syncytial virus acute bronchiolitis (RSV-AB) is a major cause of hospital admission among our infants. The immune and inflammatory mechanisms involved in the RSV-AB and factors influencing severity have not been clearly established, although an imbalanced Th1 and Th2 response seems to be crucial.
  
  
  OBJECTIVE
  To assess the local and systemic inflammatory response in RSV-AB. To find a possible marker of clinical severity and/or oxygen requirements.
  
  
  METHODS
  Levels of nine cytokines were measured in nasopharyngeal aspirate (NPA) and peripheral blood (PB) of 45 infants with RSV-AB and 27 peer controls, including IFNγ, TNFα, VEGF, interleukins 4, 6 and 10, and chemokines (IL-8 and macrophage inflammatory proteins 1-α and 1-β).
  
  
  RESULTS
  The levels of the analyzed cytokines and chemokines were significantly higher in the NPA of RSV-AB group, with a decrease in IL-4/IFNγ ratio. IL-6 and MIP-1β levels in NPA were directly correlated to oxygen therapy. PB showed an increase in IL-8 and a decrease in MIP-1α and MIP-1β in the RSV-AB group (only MIP-1β associated to the need for oxygen therapy). No correlation was found between cytokines and chemokines levels in NPA and PB.
  
  
  CONCLUSIONS
  This study shows that RSV triggers an inflammatory response fundamentally at the respiratory level, with scant systemic repercussion. This local response is characterized by an increase in Th1 and Th2 cytokines, although with a relative predominance of Th1. The determination upon patient admission of IL-6 and MIP-1β levels in NPA, and of MIP-1β in PB could help predict severe forms and the need for oxygenotherapy.
authors.affiliation: Pediatric Pneumology and Allergy Unit, Pediatrics Clinical Management Unit, Reina Sofía Children's University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Moreno-Solís
authors.affiliation: Pediatric Pneumology and Allergy Unit, Pediatrics Clinical Management Unit, Reina Sofía Children's University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain. Electronic address: jtorbo@yahoo.es.
authors.forename: J
authors.initials: J
authors.lastname: Torres-Borrego
authors.affiliation: Pediatric Pneumology and Allergy Unit, Pediatrics Clinical Management Unit, Reina Sofía Children's University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: de la Torre-Aguilar
authors.affiliation: Pediatric Pneumology and Allergy Unit, Pediatrics Clinical Management Unit, Reina Sofía Children's University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Fernández-Gutiérrez
authors.affiliation: Pediatric Pneumology and Allergy Unit, Pediatrics Clinical Management Unit, Reina Sofía Children's University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Llorente-Cantarero
authors.affiliation: Pediatric Pneumology and Allergy Unit, Pediatrics Clinical Management Unit, Reina Sofía Children's University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Pérez-Navero
mesh_terms: D001988:Bronchiolitis / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D016207:Cytokines / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D006931:Hyperbaric Oxygenation; D007223:Infant; D018836:Inflammation Mediators / Q000378:metabolism; D008297:Male; D011379:Prognosis; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D012136:Respiratory Syncytial Viruses / Q000276:immunology*; D018417:Th1 Cells / Q000276:immunology*; D058408:Th1-Th2 Balance
chemical_list: D016207:Cytokines; D018836:Inflammation Mediators
keywords: Acute bronchiolitis; Chemokines; Cytokines; Hospitalization; Infants; Interleukins; Macrophage inflammatory proteins 1-α and 1-β RSV; Nasopharyngeal secretions; Oxygen therapy; Severity; Th1; Th2