title: Robust Cytokine and Chemokine Response in Nasopharyngeal Secretions: Association With Decreased Severity in Children With Physician Diagnosed Bronchiolitis.
abstract: Bronchiolitis causes substantial disease in young children. Previous findings had indicated that a robust innate immune response was not associated with a poor clinical outcome in bronchiolitis. This study tested the hypothesis that increased concentrations of cytokines and chemokines in nasal wash specimens were associated with decreased severity in bronchiolitis.
  
  
  
  Children <24 months old who presented to the emergency department with signs and symptoms of bronchiolitis were eligible for enrollment. Nasal wash specimens were analyzed for viral pathogens and cytokine/chemokine concentrations. These results were evaluated with regard to disposition.
  
  
  
  One hundred eleven children with bronchiolitis were enrolled. A viral pathogen was identified in 91.9% of patients (respiratory syncytial virus in 51.4%, human rhinovirus in 11.7%). Higher levels of cytokines and chemokines (interferon [IFN] γ; interleukin [IL] 4, 15, and 17; CXCL10; and eotaxin) were significantly associated with a decreased risk of hospitalization. IL-17, IL-4, IFN-γ, and IFN-γ-inducible protein 10 (CXCL10 or IP-10) remained statistically significant in the multivariate analyses.
  
  
  
  The cytokines and chemokines significantly associated with decreased bronchiolitis severity are classified in a wide range of functional groups (T-helper 1 and 2, regulatory, and chemoattractant). The involvement of these functional groups suggest that a broadly overlapping cytokine/chemokine response is required for control of virus-mediated respiratory disease in young children.
authors.affiliation: Department of Pediatric.
authors.forename: Erin G
authors.initials: EG
authors.lastname: Nicholson
authors.affiliation: Department of Allergy & ENT Associates, The Woodlands.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Schlegel
authors.affiliation: Department of Pediatrics, University of Texas Medical Branch, Galveston.
authors.forename: Roberto P
authors.initials: RP
authors.lastname: Garofalo
authors.affiliation: Allergy & Asthma Specialists, Saddle River, New Jersey.
authors.forename: Reena
authors.initials: R
authors.lastname: Mehta
authors.affiliation: Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Margaret
authors.initials: M
authors.lastname: Scheffler
authors.affiliation: Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston.
authors.forename: Minghua
authors.initials: M
authors.lastname: Mei
authors.affiliation: Department of Pediatric Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Piedra
mesh_terms: D012634:Bodily Secretions / Q000737:chemistry* / Q000821:virology; D001988:Bronchiolitis / Q000276:immunology* / Q000473:pathology*; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000032:analysis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017817:Nasal Lavage Fluid; D009305:Nasopharynx / Q000276:immunology* / Q000473:pathology*; D011446:Prospective Studies; D014780:Viruses / Q000302:isolation & purification
chemical_list: D016207:Cytokines
keywords: bronchiolitis; chemokine; cytokine; infants and children; innate antiviral immune response