Lactate dehydrogenase and caspase activity in nasopharyngeal secretions are predictors of bronchiolitis severity

Mehta, Reena; Scheffler, Margaret; Tapia, Lorena; Aideyan, Letisha; Patel, Kirtida D; Jewell, Alan M; Avadhanula, Vasanthi; Mei, Minghua; Garofalo, Roberto P; Piedra, Pedro A

Bronchiolitis is the commonest lower respiratory tract illness in young children and the leading cause of hospitalization in this age group in the United States, resulting in significant morbidity and mortality in children less than 2 years. 1, 2 Bronchiolitis is primarily a viral illness, with respiratory syncytial virus (RSV) followed by rhinovirus (RV) as the most common viral etiologies. [3] [4] [5] [6] [7] The clinical spectrum of disease varies from mild illness not requiring hospitalization to severe respiratory failure necessitating ventilatory support in the intensive care unit. In the first year of life, approximately 15-20% of children with RSV will seek medical attention. 8 The majority of these children (95%) are treated as outpatients, in primary care physician offices or the emergency department. 8 Young age and co-morbidities such as prematurity, congenital heart disease, neuromuscular disease, and immunodeficiency are important risk factors for hospitalization, 9, 10 but determining the severity of disease can be still difficult in young infants and methods often differ among institutions. 11 Bronchiolitis is a clinical diagnosis and currently no standardized methods exist to aid the physician in determining the disposition of a patient. Clinicians commonly rely on parental history, clinical findings and the presence or absence of hypoxemia. Molecular diagnostics have improved our understanding of the viral etiology of bronchiolitis and the common occurrence of viral coinfections, 12 but there remains a clinical need for predictive biomarkers that can aid clinicians in the management and disposition of their patients with bronchiolitis.