Respiratory syncytial virus: Difference between revisions
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(Created page with "== Management == * In high-risk patients, can treat with Is treated by::ribavirin ± Is treated by::IVIg Category:RNA viruses") |
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| + | == Background == |
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| + | === Microbiology === |
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| + | * Single-stranded, enveloped RNA virus in the Pneumoviridae subfamily of the Paramyxoviridae family |
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| + | * Two antigenic groups, A and B |
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| + | |||
| + | === Epidemiology === |
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| + | * Worldwide distribution |
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| + | * In Canada and US, more common in late fall to early spring, but can occur at any time |
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| + | * Most common cause of bronchiolitis in children |
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| + | * Spread via droplets, either person-to-person or via fomites |
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| + | ** Typically inoculated into respiratory or ocular mucosa rather than inhaled |
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| + | * Infection does not generate persistent immunity |
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| + | |||
| + | == Clinical Presentation == |
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| + | * Incubation period of 3 to 5 days (up to 8) |
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| + | |||
| + | === Children === |
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| + | * Generally starts with an upper respiratory tract infection ± fevers and [[otitis media]] |
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| + | * Then can progress to [[bronchiolitis]], [[pneumonia]], [[tracheobronchitis]], and, rarely, [[croup]] |
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| + | ** Highest risk for lower respiratory infections are with the first infection, age less than 6 months, and underlying cardiac or lung disease |
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| + | ** Highest risk for requiring hospitalization is premature infants and those with chronic lung disease, congenital heart disease, immunosuppression, and neuromuscular disease |
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| + | * Wheezing and increased work of breathing are common and cough becomes prominent |
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| + | * Bronchiolitis may involve inspiratory and expiratory obstruction |
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| + | * Hypoxia necessitates hospitalization, and may fluctuate, and can also have apnea |
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| + | |||
| + | ==== Outcomes and sequelae === |
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| + | * Cough may last for 4 or more weeks, despite resolution of the infection |
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| + | * Recurrent infections are common |
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| + | * May have persistent wheezing into adolescence |
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| + | |||
| + | === Adults === |
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| + | * More common in people who work with children and military recruits living in barracks |
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| + | * Highest risk for severe disease includes the elderly, patients with COPD, and immunocompromised patients |
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| + | * Immunocompromised patients include solid-organ and hematologic transplant patients and those on chemotherapy |
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| + | ** Much higher mortality |
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| + | 88 '''[[Bronchiolitis obliterans syndrome]]''' can be a complication in lung transplant patients with RSV pneumonia |
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| + | |||
| + | == Diagnosis == |
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| + | * Most often with PCR |
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| + | * Serology not generally helpful |
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| + | |||
== Management == |
== Management == |
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| + | * Supportive care |
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| − | * In high-risk patients, can treat with [[Is treated by::ribavirin]] ± [[Is treated by::IVIg]] |
||
| + | ** Can use puffers and steroids for bronchiolitis with wheezing, but not clear that they are helpful in children |
||
| + | ** Monitor for development of bacterial superinfection |
||
| + | * Hospitalized children may benefit from inhaled [[Is treated by::ribavirin]], though the benefit is unclear |
||
| + | * In high-risk patients with hematologic malignancies, hematologic transplants, or solid-organ transplants, treat with [[Is treated by::ribavirin]] |
||
| + | * In the highest-risk group of patients, those with allogeneic stem cell transplantation who present with pneumonia, add [[Is treated by::IVIg]] |
||
| + | |||
| + | === Prevention === |
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| + | * [[Palivizumab]] is indicated for some high risk groups of infants in order to prevent severe disease[[CiteRef::robinson2015pr]] |
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| + | ** Children with hemodynamically significant CHD or CLD if they are <12 months of age at the start of RSV season |
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| + | ** Preterm infants born before 30+0 weeks’ GA who are <6 months of age at the start of RSV season, it is reasonable (but not essential) to offer palivizumab |
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| + | ** Infants in remote communities who would require air transportation for hospitalization born before 36+0 weeks’ GA and <6 months of age at the start of RSV season should be offered palivizumab |
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[[Category:RNA viruses]] |
[[Category:RNA viruses]] |
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Revision as of 07:31, 7 November 2019
Background
Microbiology
- Single-stranded, enveloped RNA virus in the Pneumoviridae subfamily of the Paramyxoviridae family
- Two antigenic groups, A and B
Epidemiology
- Worldwide distribution
- In Canada and US, more common in late fall to early spring, but can occur at any time
- Most common cause of bronchiolitis in children
- Spread via droplets, either person-to-person or via fomites
- Typically inoculated into respiratory or ocular mucosa rather than inhaled
- Infection does not generate persistent immunity
Clinical Presentation
- Incubation period of 3 to 5 days (up to 8)
Children
- Generally starts with an upper respiratory tract infection ± fevers and otitis media
- Then can progress to bronchiolitis, pneumonia, tracheobronchitis, and, rarely, croup
- Highest risk for lower respiratory infections are with the first infection, age less than 6 months, and underlying cardiac or lung disease
- Highest risk for requiring hospitalization is premature infants and those with chronic lung disease, congenital heart disease, immunosuppression, and neuromuscular disease
- Wheezing and increased work of breathing are common and cough becomes prominent
- Bronchiolitis may involve inspiratory and expiratory obstruction
- Hypoxia necessitates hospitalization, and may fluctuate, and can also have apnea
= Outcomes and sequelae
- Cough may last for 4 or more weeks, despite resolution of the infection
- Recurrent infections are common
- May have persistent wheezing into adolescence
Adults
- More common in people who work with children and military recruits living in barracks
- Highest risk for severe disease includes the elderly, patients with COPD, and immunocompromised patients
- Immunocompromised patients include solid-organ and hematologic transplant patients and those on chemotherapy
- Much higher mortality
88 Bronchiolitis obliterans syndrome can be a complication in lung transplant patients with RSV pneumonia
Diagnosis
- Most often with PCR
- Serology not generally helpful
Management
- Supportive care
- Can use puffers and steroids for bronchiolitis with wheezing, but not clear that they are helpful in children
- Monitor for development of bacterial superinfection
- Hospitalized children may benefit from inhaled ribavirin, though the benefit is unclear
- In high-risk patients with hematologic malignancies, hematologic transplants, or solid-organ transplants, treat with ribavirin
- In the highest-risk group of patients, those with allogeneic stem cell transplantation who present with pneumonia, add IVIg
Prevention
- Palivizumab is indicated for some high risk groups of infants in order to prevent severe disease1
- Children with hemodynamically significant CHD or CLD if they are <12 months of age at the start of RSV season
- Preterm infants born before 30+0 weeks’ GA who are <6 months of age at the start of RSV season, it is reasonable (but not essential) to offer palivizumab
- Infants in remote communities who would require air transportation for hospitalization born before 36+0 weeks’ GA and <6 months of age at the start of RSV season should be offered palivizumab
References
- ^ Joan L Robinson, Nicole Le Saux. Preventing hospitalizations for respiratory syncytial virus infection. Paediatrics & Child Health. 2015;20(6):321-326. doi:10.1093/pch/20.6.321.
