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RSV. RT 265. Respiratory Syncytial Virus. Manifests primarily as: Bronchiolitis 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

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RSV

RT 265


Respiratory syncytial virus
Respiratory Syncytial Virus

Manifests primarily as:

  • Bronchiolitis

  • Viral pneumonia

    Leading cause of lower respiratory tract infection in infants


Syncytium

Syncytium:

Multinucleate mass of protoplasm produced by the merging of neighboring cells


Incidence
Incidence

  • Peak ages 2-8months

  • Usually >4years old

  • Mid-winter and spring months

  • Virtually all children have been exposed by 3rd birthday

  • Disease is mild in older children and adults (upper respiratory tract)

  • WHY THE LITTLE ONES?

    • Smaller airways

    • Reduced immune system

  • 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)

    • 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

    • Immunodeficient states

    • Children with metabolic and neuromuscular disorders

    • Children of multiple births (triplets or greater)


Diagnosis
Diagnosis

  • Correlate symptoms with the time of year, presence of a regional outbreak, patient age, and history of the illness

  • Specific diagnostics testing:

    • Nasal swabs

    • Nasal lavage

    • Nasopharyngeal aspiration

  • CXR hyperinflation diffuse increase in interstitial markings


Presentation
Presentation

  • Fever

  • Cough

  • Tachypnea

  • Retractions

  • Wheezing

  • Crackles

  • Sepsis like symptoms

  • Apneic episodes in the very young

  • Diffuse small airway disease


Management
Management

Supportive care

Can be managed at home unless requiring:

  • Supplemental oxygen

  • Fluid replacement – normal feeding or IV if unable

  • Bronchial hygiene - suctioning

  • Bronchodilators? (alpha and beta agonists)

  • Ribavirin (Virazole)

  • Mechanical ventilation/CPAP

Prevention

  • WASH YOUR HANDS

  • Avoid mucus membrane exposure

  • Palivizumab (Synagis) antiviral immunoglobulins /motavizumab (investigational – not FDA approved)


The best part
The “best” part:

No lifelong immunity develops!

Reinfection is common 


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