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Respiratory Syncytial Virus Infection

Respiratory Tract Syncytial Virus Infection

Respiratory syncytial virus infection is a common cause of morbidity and death in pediatric patients. The clinical presentation ranges from mildly symptomatic to life-threatening pneumonia presenting as apnea and respiratory distress. Early suspicion must be mounted whenever respiratory symptoms are seen in young children, and various microbiological methods, most importantly polymerase chain reaction (PCR) that quickly identify viral genetic material, are used to confirm the diagnosis.


Presentation

Responsible for more than 100,000 pediatric hospitalizations in the United States every year, respiratory syncytial virus (RSV) is considered to be the major cause of respiratory infections in infants and young children [1] [2]. In fact, it is estimated that virtually all children up to age 3 will become infected with RSV, almost universally in a symptomatic fashion [3]. However, several reports have emphasized its role as a respiratory pathogen across all age groups, including adults and the elderly, and approximately 11,000-17,000 deaths in the United States are attributed to RSV every year [4] [5]. In milder cases, the clinical presentation is comprised of a cough, wheezing, fever, croup, and nasal congestion, with bronchiolitis being the most common type of infection [2] [6]. In some patients, otitis media may be the initial manifestation of RSV infection [3]. More severe forms, however, such as pneumonia, have been encountered more commonly in patients who exhibit any of the following risk factors: immunosuppression (B or T-cell inherited immunodeficiencies, human immunodeficiency virus infection, immunosuppressive therapy after marrow transplantation), premature birth, cyanotic congenital heart disease, chronic obstructive pulmonary disease (COPD), and older age [1] [3] [6] [7]. Severe pneumonia can be life-threatening, both in infants and in adults, suggesting that an early diagnosis is pivotal.

Fever
  • KEYWORDS: fever; fever duration; fever responses; pediatrics; respiratory syncytial virus [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • Respiratory syncytial virus disease must be considered in the differential diagnosis of fever and pulmonary infiltrates in immunocompromised adults.[ncbi.nlm.nih.gov]
  • Respiratory syncytial virus (RSV) infection, an important and sometimes lethal disease of infants and children, generally causes a milder and self-limited syndrome of cough, nasal congestion and fever in adults.[ncbi.nlm.nih.gov]
  • Fever (P CONCLUSIONS: Most immunocompromised children with RSV detected while outpatients did not require hospitalization or receive antiviral treatment.[ncbi.nlm.nih.gov]
  • Cardiopulmonary arrest occurred within 3 days after the onset of symptoms, which included cough and high fever. Complete brain edema was prominent, and encephalopathy was developing.[ncbi.nlm.nih.gov]
Malaise
  • Common symptoms of RSV infection for both adults and children include: fever congestion cough Less common symptoms include: wheezing difficult, short, or fast breathing bluish skin irritability, malaise, or trouble breathing in infants Usually, these[healthline.com]
  • Signs and Symptoms of RSV The first symptoms of RSV infection typically include runny nose and decreased appetite—followed by fever, cough, wheezing and other cold symptoms (headache, sneezing, sore throat, fatigue, malaise).[healthcommunities.com]
Fatigue
  • Signs and Symptoms of RSV The first symptoms of RSV infection typically include runny nose and decreased appetite—followed by fever, cough, wheezing and other cold symptoms (headache, sneezing, sore throat, fatigue, malaise).[healthcommunities.com]
Cough
  • Among individual signs and symptoms, cough alone had the highest sensitivity to detect laboratory-confirmed RSV [96 %, 95 % CI (95-98)].[ncbi.nlm.nih.gov]
  • Respiratory syncytial virus (RSV) infection, an important and sometimes lethal disease of infants and children, generally causes a milder and self-limited syndrome of cough, nasal congestion and fever in adults.[ncbi.nlm.nih.gov]
  • Clinical symptoms included low-grade fever, nonproductive cough, rhinorrhea or nasal congestion, and radiographic evidence of interstitial infiltrates and sinusitis.[ncbi.nlm.nih.gov]
  • Cardiopulmonary arrest occurred within 3 days after the onset of symptoms, which included cough and high fever. Complete brain edema was prominent, and encephalopathy was developing.[ncbi.nlm.nih.gov]
  • Characterised by cough, wheeze, respiratory distress, and hypoxia. Most episodes are mild and self-limiting. Treatment is mostly supportive: supplemental oxygen, nasal and pulmonary toilet, respiratory support, nutritional support.[bestpractice.bmj.com]
Common Cold
  • Most children’s RSV appears as a common cold, but a few infant’s RSV can cause serious problems such as an infection in the small airway of the lungs (Bronchiolitis) or pneumonia.[breathepa.org]
  • Some facts about common colds are as follows: Although colds have been with humans likely for eons, the first common cold virus was identified in 1956 in England, so the history of the cause of colds is relatively recent.[emedicinehealth.com]
  • Protective measures are similar to those that help stop the spread of other respiratory infections like the common cold—such as frequent hand washing.[healthcommunities.com]
  • Typical symptoms resemble the common cold. However, RSV infection can also result in pneumonia, especially in the very young, the very old or those with weakened immune systems. However, mild or unnoticeable illness may occur.[health.ny.gov]
  • cold that the true cause is undiagnosed.[healthofchildren.com]
Rhinorrhea
  • Clinical symptoms included low-grade fever, nonproductive cough, rhinorrhea or nasal congestion, and radiographic evidence of interstitial infiltrates and sinusitis.[ncbi.nlm.nih.gov]
  • When to Get Medical Help While most cases of RSV infection are not life threatening, it is a good idea to get the infant to a doctor when rhinorrhea (runny nose) and pharyngitis (sore throat) are combined with constant fever after three days.[news-medical.net]
  • […] to Day 1 New onset of at least 1 of the following respiratory symptoms for 7 days prior to Day 1: nasal congestion, runny nose, cough, or sore throat, or worsening of one of these chronic (associated with a previously existing diagnosis, eg, chronic rhinorrhea[clinicaltrials.gov]
  • Definitions RSV-associated URI was defined as rhinorrhea, nasal or sinus congestion, or cough without hypoxemia or infiltrates on chest radiography or chest computed tomography in a patient with RSV isolated in a specimen from the upper respiratory tract[haematologica.org]
Nasal Flaring
  • Hypoxia, wheezing, stridor, nasal flaring and chest wall in-drawing had sensitivities ranging from 8 to 31 %, but had specificities 75 %.[ncbi.nlm.nih.gov]
  • Infants under age 1 may have more severe symptoms and often have the most trouble breathing: Bluish skin color due to a lack of oxygen ( cyanosis ) in more severe cases Breathing difficulty or labored breathing Nasal flaring Rapid breathing (tachypnea[medlineplus.gov]
Dry Cough
  • These include: Congested or runny nose Dry cough Low-grade fever Sore throat Mild headache In severe cases Respiratory syncytial virus infection can spread to the lower respiratory tract, causing pneumonia or bronchiolitis — inflammation of the small[mayoclinic.org]
Headache
  • If needed, you can also give a pain reliever (not aspirin) for fever and headache. RSV easily spreads from person to person.[medlineplus.gov]
  • Patients develop fever and other symptoms such as runny nose, cough, headache, decreased appetite, body ache or weakness, and occasionally otitis media.[chp.gov.hk]
  • Signs and Symptoms of RSV The first symptoms of RSV infection typically include runny nose and decreased appetite—followed by fever, cough, wheezing and other cold symptoms (headache, sneezing, sore throat, fatigue, malaise).[healthcommunities.com]
  • Kids with RSV might have cold symptoms, such as: a stuffy or runny nose sore throat mild headache cough fever a general ill feeling RSV infections in premature babies, infants, and kids with diseases that affect the lungs, heart, or immune system, can[kidshealth.org]
  • These include: Congested or runny nose Dry cough Low-grade fever Sore throat Mild headache In severe cases Respiratory syncytial virus infection can spread to the lower respiratory tract, causing pneumonia or bronchiolitis — inflammation of the small[mayoclinic.org]

Workup

Having in mind the rather common occurrence of RSV infection in clinical practice, particularly in young children, the physician must include this viral pathogen in the differential diagnosis of respiratory infections. The first step during workup is a thorough patient (or parent) interview that will assess the presence and course of symptoms, as well as the existence of any of the mentioned risk factors that could predispose to a more severe form of infection. The physical examination, particularly lung auscultation, is equally important, after which laboratory studies should be conducted. Microbiological testing is the cornerstone for the diagnosis of RSV infection, as the clinical presentation is nonspecific [7], and several methods have been described in the literature. Initially, viral cell cultivation was considered as the optimal procedure for isolation of RSV but the introduction of more rapid and also more reliable tests has removed it from regular use [5] [6] [8]. Direct antigen detection through immunofluorescent or enzyme immunoassays (IFA and EIA) has shown to be an efficient test to recognize RSV, but even better results are obtained through molecular studies that evaluate the presence of viral genetic material, such as polymerase chain reaction (PCR) and reverse-transcriptase PCR (RT-PCR) [4] [6] [8]. Unfortunately, their cost still is a major limiting factor [5].

Pulmonary Infiltrate
  • RSV infection is probably less severe in the late post-BMT period, but needs to be considered early in the differential diagnosis of pulmonary infiltrates in this patient population.[ncbi.nlm.nih.gov]
  • Cytologic examination of a bronchoalveolar lavage specimen from a 6-year-old bone marrow transplant recipient revealed pulmonary infiltrates and occasional cells containing discrete pink cytoplasmic inclusions on a May-Grunwald-Giemsa stain.[ncbi.nlm.nih.gov]
  • Respiratory syncytial virus disease must be considered in the differential diagnosis of fever and pulmonary infiltrates in immunocompromised adults.[ncbi.nlm.nih.gov]
  • Respiratory syncytial virus disease must be considered in the differential diagnosis of fever and pulmonary infiltrates in immunocompromised adults. FULL TEXT[annals.org]
Thrombocytosis
  • This is the case study of concurrent cytomegalovirus and respiratory syncytial virus infection in an infant who showed thrombocytosis, liver dysfunction and bronchiolitis.[ncbi.nlm.nih.gov]
Staphylococcus Aureus
  • MEASUREMENTS AND MAIN RESULTS: We identified five nasopharyngeal microbiota clusters characterized by enrichment of either Haemophilus influenzae, Streptococcus, Corynebacterium, Moraxella, or Staphylococcus aureus.[ncbi.nlm.nih.gov]
  • aureus, in addition to conventional cultures.[ncbi.nlm.nih.gov]
White Matter Lesions
  • In five of the six patients, diffusion-weighted magnetic resonance imaging showed subcortical white matter lesions.[ncbi.nlm.nih.gov]

Treatment

  • We also assessed changes in cell proliferation and measured changes in ·OH and NO in A549 cells from the different treatment groups.[ncbi.nlm.nih.gov]
  • Treatment options for severe RSV disease remain limited and the development of therapeutic treatment strategies remains a priority.[ncbi.nlm.nih.gov]
  • The present study also evaluated the differences in hydroxyl free radical (·OH), nitric oxide (NO) and total SOD activity in the different treatment groups.[ncbi.nlm.nih.gov]
  • Current treatment for RSV infection remains largely supportive and RSV-specific options for prophylaxis are limited to palivizumab.[ncbi.nlm.nih.gov]
  • Human respiratory syncytial virus (RSV), for which neither a vaccine nor an effective therapeutic treatment is currently available, is the leading cause of severe lower respiratory tract infections in children.[ncbi.nlm.nih.gov]

Prognosis

  • The presence of lower respiratory tract infection and infection in the pre-engraftment phase of BMT is believed to confer a poor prognosis.[ncbi.nlm.nih.gov]
  • What Is the Prognosis of Respiratory Syncytial Virus (RSV)? The prognosis for respiratory syncytial virus (RSV) is good.[emedicinehealth.com]
  • Prognosis RSV infection usually runs its course in seven to 14 days. The cough may linger for weeks. There are no medications that can speed the body's production of antibodies against the virus.[healthofchildren.com]
  • Prognosis RSV infection usually runs its course in seven to 14 days. The cough may linger weeks longer. There are no medications that can speed the body's production of antibodies against the virus.[medical-dictionary.thefreedictionary.com]
  • The aim of this case is to reaffirm the importance of this virus as a cause of severe disease and to emphasize the importance of adequate diagnosis and management to improve prognosis.[ncbi.nlm.nih.gov]

Etiology

  • The type of sequelae, however, depend on the etiology, including infection due to viral agents such as the influenza virus. Respiratory syncytial virus (RSV) infection in childhood may also contribute to this.[ncbi.nlm.nih.gov]
  • Respiratory syncytial virus (RSV) is an important etiological agent of respiratory infections, particularly in children. Much information regarding the immune response to RSV comes from animal models and in vitro studies.[ncbi.nlm.nih.gov]
  • In addition, defining the etiologic agent for bronchiolitis may have therapeutic implications.[jped.elsevier.es]
  • Complication (LRTC) was defined as one of the below as determined by the adjudication committee: Primary RSV lower respiratory tract infection (LRTI) Secondary bacterial LRTI LRTI due to unusual pathogens Lower respiratory tract complication of unknown etiology[clinicaltrials.gov]
  • Infants were followed prospectively during a year, to assess the impact of palivizumab on the viral etiology of acute infections in the respiratory tract and rates of hospitalization and death.[ncbi.nlm.nih.gov]

Epidemiology

  • We used two laboratory surveillance systems to examine the total number and number of positive RSV tests in children aged KEYWORDS: Children; England; epidemiology; laboratory-confirmed; respiratory syncytial virus[ncbi.nlm.nih.gov]
  • […] an epidemiological study from 2004 to 2012; recurrent wheezing rates associated to RSV infection from SPRING study were adjusted by the evidence on the palivizumab effect from clinical trials.[ncbi.nlm.nih.gov]
  • Respiratory syncytial virus (RSV) infection is most common in the first two years of life with the highest burden in children aged KEYWORDS: epidemiology; healthcare costs; outcomes; palivizumab; premature infant; prevention; respiratory syncytial virus[ncbi.nlm.nih.gov]
  • BACKGROUND: This study was designed to explore the epidemiological and clinical profiles of respiratory syncytial virus (RSV) infection in neonates from the Suzhou area of China, taking into consideration how climate factors influence disease.[ncbi.nlm.nih.gov]
  • Epidemiological studies have established that the age at initial infection plays a central role in the severity of the disease. Thus, neonatal susceptibility is intrinsically linked to the immunological characteristics of the young pulmonary mucosa.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Abstract Cytotoxic and neuroinflammatory effects of TiO 2 nanoparticles (TiO 2 -NP) in human airways are mediated by nerve growth factor (NGF), which is also implicated in the pathophysiology of respiratory syncytial virus (RSV) infection.[ncbi.nlm.nih.gov]

Prevention

  • This analysis of the preventive effect of vaccines on RSV infection has direct applications for the prevention of RSV infections. KEYWORDS: meta-analysis; respiratory syncytial virus (RSV); vaccine prophylaxis[ncbi.nlm.nih.gov]
  • For the global mortality cohort, the model predicted that maternal vaccination could have prevented 29-48% of RSV-related in-hospital deaths.[ncbi.nlm.nih.gov]
  • It is unclear if palivizumab can prevent respiratory syncytial virus hospitalisations and intensive care unit admissions in children with cystic fibrosis. This is an update of a previously published review.[ncbi.nlm.nih.gov]
  • CONCLUSION: Palivizumab was generally safe and effective for the prevention of LRI caused by RSV in newborns, infants, and children with immunocompromised conditions or Down syndrome up to the age of 24 months.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The prophylaxis with palivizumab is efficient for preventing from RSV infections in preterm infants 32 day 1 -35 day 0 wGA in Spain.[ncbi.nlm.nih.gov]

References

Article

  1. Walsh EE. Respiratory syncytial virus infection in adults. Semin Respir Crit Care Med. 2011;32(4):423-432.
  2. Lanari M, Giovannini M, Giuffré L, et al. Prevalence of respiratory syncytial virus infection in Italian infants hospitalized for acute lower respiratory tract infections, and association between respiratory syncytial virus infection risk factors and disease severity. Pediatr Pulmonol. 2002;33(6):458-465.
  3. Ogra PL. Respiratory syncytial virus: the virus, the disease and the immune response. Paediatr Respir Rev. 2004;5 Suppl A: S119-126.
  4. Walsh EE, Falsey AR. Respiratory syncytial virus infection in adult populations. Infect Disord Drug Targets. 2012;12(2):98-102.
  5. Popow-Kraupp T, Aberle JH. Diagnosis of Respiratory Syncytial Virus Infection. Open Microbiol J. 2011;5:128-134.
  6. Falsey AR, Walsh EE. Respiratory Syncytial Virus Infection in Adults. Clin Microbiol Rev. 2000;13(3):371-384.
  7. Falsey AR. Respiratory syncytial virus infection in adults. Semin Respir Crit Care Med. 2007;28(2):171-181.
  8. Falsey AR, Formica MA, Walsh EE. Diagnosis of Respiratory Syncytial Virus Infection: Comparison of Reverse Transcription-PCR to Viral Culture and Serology in Adults with Respiratory Illness. J Clin Microbiol. 2002;40(3):817-820.

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Last updated: 2019-06-28 09:24