Respiratory syncytial virus infection
A subgroup of the myxoviruses resembling paramyxovirus causes respiratory syncytial virus (RSV) infection. RSV is the leading cause of lower respiratory tract infections in infants and young children; it’s the major cause of pneumonia, tracheobronchitis, and bronchiolitis in this age-group and a suspected cause of the fatal respiratory diseases of infancy.
Each year, 125,000 infants are hospitalized with severe RSV; between 1% and 2% die. RSV also causes repeated infections throughout life, usually associated with moderate-to-severe coldlike symptoms, and may predispose a child to asthma. Severe lower respiratory tract disease can occur, especially among elderly people and those with compromised cardiac, pulmonary, or immune systems.
Causes
Antibody titers seem to indicate that few children younger than age 4 escape contracting some form of RSV, even if it’s mild. In fact, RSV is the only viral disease that has its maximum impact during the first few months of life (incidence of RSV bronchiolitis peaks at age 2 months).
This virus creates annual epidemics that occur during late winter and early spring in temperate climates and during the rainy season in the tropics. The organism is transmitted from person to person by respiratory secretions and has an incubation period of 4 to 5 days. Those at higher risk include infants who are exposed to tobacco smoke, attend day-care centers, live in crowded conditions, or have school-age siblings.
Reinfection is common, producing milder symptoms than the primary infection. School-age children, adolescents, and young adults with mild re-infections are probably the source of infection for infants and young children.
Signs and symptoms
Signs and symptoms of RSV infection vary in severity, ranging from mild coldlike symptoms to bronchiolitis or bronchopneumonia and, in a few patients, severe, life-threatening lower respiratory tract infections. Generally, signs and symptoms include coughing, wheezing, malaise, pharyngitis, dyspnea, and inflamed mucous membranes in the nose and throat.
Otitis media is a common complication of RSV in infants. RSV has also been identified in patients with various central nervous system disorders, such as meningitis and myelitis.
Diagnosis
The following clinical findings and epidemiologic information aid in the diagnosis:
❑ Cultures of nasal and pharyngeal secretions may show RSV.
❑ Serum antibody titers may be elevated, but before age 6 months, maternal antibodies may impair test results.
❑ Serology for RSV is positive.
❑ Chest X-rays help detect pneumonia or bronchiolitis.
Treatment
Among the goals of treatment are support of respiratory function, maintenance of fluid balance, and relief of symptoms. Mild cases resolve without treatment. Severe infections require hospitalization to provide supplemental oxygen, humidified air, and hydration by I.V. fluids. Respiratory support using mechanical ventilation may be needed. Ribavirin aerosol may be used in those who have severe RSV or are immunocompromised.
Special considerations
❑ Monitor respiratory status. Observe the rate and pattern; watch for nasal flaring or retraction, cyanosis, pallor, and dyspnea; and auscultate for wheezing, rhonchi, or other signs of respiratory distress. Monitor arterial blood gas values.
❑ Maintain a patent airway, and be especially watchful when the patient has periods of acute dyspnea. Perform percussion and provide drainage and suction when necessary. Provide a high-humidity atmosphere. Semi-Fowler’s position may help prevent aspiration of secretions.
CLINICAL TIP: The head of the bed or crib may be elevated to help prevent aspiration of secretions.
❑ Monitor intake and output carefully. Observe the patient for signs of dehydration, such as decreased skin turgor. Encourage the patient to drink plenty of high-calorie fluids, and administer I.V. fluids as needed.
❑ Promote bed rest, allowing for as much uninterrupted rest as possible.
❑ Hold and cuddle infants; talk to and play with toddlers. Offer diversionary activities suitable to the child’s condition and age. Foster parental visits and cuddling. Restrain a child only as necessary.
❑ Impose contact isolation. Enforce strict hand washing, because RSV may be transmitted from fomites.
❑ Staff members with respiratory illnesses shouldn’t care for infants.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
Other Book Chapters Related to Infection
Read excerpts from these other book chapters related to Infection:
Copyright Details: Handbook of Diseases, Copyright © 2008 Williams & Wilkins.
More About Causes of Infection
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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