RSV RT 265

Respiratory Syncytial Virus Manifests primarily as: Bronchiolitis Bronchiolitis Viral pneumonia Viral pneumonia Leading cause of lower respiratory tract infection in infants

Syncytium: Multinucleate mass of protoplasm produced by the merging of neighboring cells

Incidence Peak ages 2-8months Peak ages 2-8months Usually >4years old Usually >4years old Mid-winter and spring months Mid-winter and spring months Virtually all children have been exposed by 3 rd birthday Virtually all children have been exposed by 3 rd birthday Disease is mild in older children and adults (upper respiratory tract) Disease is mild in older children and adults (upper respiratory tract) WHY THE LITTLE ONES? WHY THE LITTLE ONES? Smaller airways Smaller airways Reduced immune system Reduced immune system High-risk groups for severe RSV infection include the following: High-risk groups for severe RSV infection include the following: premature infants in their first year of life (the younger the child is [gestational and chronological age] at the start of RSV season, the greater the risk) premature infants in their first year of life (the younger the child is [gestational and chronological age] at the start of RSV season, the greater the risk) Infants with chronic lung disease (eg, bronchopulmonary dysplasia,cystic fibrosis) during their first 2 years of life Infants with chronic lung disease (eg, bronchopulmonary dysplasia,cystic fibrosis) during their first 2 years of life Children with hemodynamically significant congenital heart disease, especially with increased pulmonary blood flow Children with hemodynamically significant congenital heart disease, especially with increased pulmonary blood flow Immunodeficient states Immunodeficient states Children with metabolic and neuromuscular disorders Children with metabolic and neuromuscular disorders Children of multiple births (triplets or greater) Children of multiple births (triplets or greater)

Diagnosis Correlate symptoms with the time of year, presence of a regional outbreak, patient age, and history of the illness Correlate symptoms with the time of year, presence of a regional outbreak, patient age, and history of the illness Specific diagnostics testing: Specific diagnostics testing: Nasal swabs Nasal swabs Nasal lavage Nasal lavage Nasopharyngeal aspiration Nasopharyngeal aspiration CXR hyperinflation diffuse increase in interstitial markings CXR hyperinflation diffuse increase in interstitial markings

Presentation Fever Fever Cough Cough Tachypnea Tachypnea Retractions Retractions Wheezing Wheezing Crackles Crackles Sepsis like symptoms Sepsis like symptoms Apneic episodes in the very young Apneic episodes in the very young Diffuse small airway disease Diffuse small airway disease

Management Supportive care Can be managed at home unless requiring: Supplemental oxygen Supplemental oxygen Fluid replacement – normal feeding or IV if unable Fluid replacement – normal feeding or IV if unable Bronchial hygiene - suctioning Bronchial hygiene - suctioning Bronchodilators? (alpha and beta agonists) Bronchodilators? (alpha and beta agonists) Ribavirin (Virazole) Ribavirin (Virazole) Mechanical ventilation/CPAP Mechanical ventilation/CPAPPrevention WASH YOUR HANDS WASH YOUR HANDS Avoid mucus membrane exposure Avoid mucus membrane exposure Palivizumab (Synagis) antiviral immunoglobulins /motavizumab (investigational – not FDA approved) Palivizumab (Synagis) antiviral immunoglobulins /motavizumab (investigational – not FDA approved)

The “best” part: No lifelong immunity develops! Reinfection is common 