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Parainfluenza Virus. Case Study # 2 Galarah D Golanbar Christopher Kwon Vanessa Munoz. Case study.

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parainfluenza virus

Parainfluenza Virus

Case Study # 2

Galarah D Golanbar

Christopher Kwon

Vanessa Munoz

case study
Case study
  • A 13 month old child has a runny nose, mild cough, and a low grade fever for several days. The cough got worse and sounded like “barking”. The child made a wheezing sound when agitated. The child appeared well except for the cough. A lateral X-ray examination of the neck showed a subglottic narrowing.
background information
Background information
  • Parainfluenza virus (PIV)
    • Negative sense, single-stranded RNA virus
    • Varies in size and shape
      • Averaging in diameters of 150-300 nm
    • Account for a large percentage of pediatric respiratory infections, second to respiratory syncitial virus.
    • Major cause of croup
    • Divided into 4 types
      • Type 1 is the most frequent in children, followed by type 3 and type 2.
      • Type 4 is less likely to cause a severe illness.
  • Self- limited infection
    • Can manifest repeatedly throughout life
described symptoms
Described Symptoms
  • Coryza
    • Symptoms of a common head cold
      • nasal congestion
      • runny nose
      • Sore throat
      • cough
    • Inflammation of nasal cavity mucous membrane, affecting upper respiratory tract
  • Viral croup
    • Inflammation of the larynx and upper airway
      • Results in narrowing of the airway
    • Characterized by a barking cough, inspiratory stridor, and a variable amount of respiratory distress that develops over a brief period.
  • Stridor
    • A high pitched, breathing sound caused by turbulent flow of air, usually caused by a blockage in breathing
    • Inspiratory stridor (a sound heard in inspiration through a spasmodically closed glottis)
described symptoms5
Described Symptoms
  • Retractions
    • Intercostal retractions: retractions of the chest cavity
      • The inward movement of the chest due to decreased pressure in the chest cavity.
      • Usually an indicator for difficulty in breathing
  • The virus will cause a diffused inflammationwith erythema and edema in the tracheal walls that will affect the mobility of the vocal cords.
    • The subglottic region of the child’s upper airway is narrow. So, a small amount of edema will significantly restrict airflow.
other causative agents
Other causative agents
  • Viruses from the Paramyxoviridae family
    • Mumps, measles, and respiratory syncitial virus (RSV)
      • Can also cause sporadic cases of croup
  • Adenovirus
    • Infection of the respiratory tract, as well as eyes, intestines, and urinary tract
  • Pneumonia
    • Inflammation of the lungs caused by bacteria, viruses, or other microorganisms
    • Leading cause of death in children worldwide
  • Influenza A and B
    • Both caused by viruses in the family Orthomyxoviridae
differential diagnosis
Differential Diagnosis
  • There are several differential diagnoses listed:
parainfluenza virus current diagnosis
Parainfluenza virus : Current Diagnosis
  • Pulse Oximetry
    • Monitors oxygen saturation in the blood.
      • Used to evaluate the severity of the illness.
  • Laryngoscopy
    • Direct: An examination used to look inside the throat with a small camera.
      • Used in severe cases of parainfluenza virus infection.
    • Indirect: done with a small handheld mirror to look at the back of the throat.
techniques and tests for diagnosis
Techniques and Tests for Diagnosis
  • Diagnostic Techniques:
    • Radiographic Studies
      • Posteroanterior (PA) radiography of the neck
    • Only confirms 50% of cases

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parainfluenza virus current diagnosis10
Parainfluenza virus : Current Diagnosis
  • Lab tests:
    • Viral cultures
      • Requires several days to see the results. More helpful epidemiologically than clinically.
    • Immunofluorescence and enzyme immunoassay methods
      • Done in vitro and tests the nasopharyngeal washings of infected patients.
    • CBC:
      • Complete Blood Count measures:
        • Red blood cell (RBC), white blood cell (WBC), total hemoglobin in blood, hematocrit (fraction of blood composed of RBCs), and mean corpusular volume (MCV, which measures size of RBCs)
    • RNA amplification
    • Hemadsorption
treatment
Treatment
  • No vaccine or direct treatment for the virus. Instead, treatment is focused on managing the symptoms.
  • Based on the severity of symptoms, mainly of croup:
    • Croup severity ranges from mild or moderate, to severe
    • Severity of the infection is based upon five factors:
      • Level of consciousness, Cyanosis, Stridor, Air Entry and Retractions
treatment13
Treatment
  • Analgesics
  • Ribavirin
  • Cool mist and oral intake of fluids
    • Common types of treatment, as can be done at home
    • Cool mist helps to soothe inflamed mucosa
  • Nebulized epinephrine
    • Used for moderate to severe croup patients to alleviate symptoms
  • Corticosteroids
    • Orally administered
    • To treat airway inflammation and edema
  • Heliox
    • Breathing gas composed of a mixture of helium and oxygen
  • Intubation
    • Rare, done only in severe cases
references
References
  • 1.Viral Croup: A Current Perspective. Leung, A.K.C., Kellner, J.D., Johnson, D.W. Journal of Pediatric Health Care November/December (2004): 297-301.
  • 2.Infections: Croup. Dowshen, S., Homeier, B.P. Nemours Foundation. May, 2005.
  • 3.Parainfluenza virus infections. Vega, R.M. eMedicine from WebMD. Sept. 24, 2007.
  • 4.Evaluation of Stridor and Wheezing. Holinger, L.D. Journal of Children’s Memorial Hospital, Chicago. Spring, 1998.
  • 5.Definition of Human Parainfluenza Virus. (http://www.medterms.com/script/main/art.asp?articlekey=31631)
  • 6.Viral Croup: A Current Perspective. Leung, A.K.C., Kellner, J.D., Johnson, D.W. Journal of Pediatric Health Care November/December (2004): 297-301.
  • 7.Human Parainfluenza Virus Type 4 Infections: A report of 20 cases from 1998 to 2002. Billaud et al. Journal of Clinical Virology 34 (2005) 48–51.
  • 8.Clinical courses of croup caused by influenza and parainfluenza virus. Peltola, V., Heikkinen, T., & Ruuskanen, O. The Pediatric Infectious Disease Journal 21 (2002)
  • 9.Acute Epiglottitis. Jaffe, J.E. eMedicine.com by WebMD. (http://www.emedicine.com/Radio/topic263.htm)
  • 10.Parainfluenza Virus. Parija, S.C., Marrie, T.J. eMedicine.com by WebMD. (http://www.emedicine.com/MED/topic1733.htm)
references15
References

1.      11.Concise Review for Primary-Care Physicians-Viral Croup: Current Diagnosis and Treatment by Julia Rosekranse, MD (http://www.mayoclinicproceedings.com/inside.asp?AID=3078&UID)

2.      12.Quest Diagnosis Laboratories test guide (2006).

3.     13. Fan J, Henrickson KJ: Rapid diagnosis of human parainfluenza virus type 1 infection by quantitative reverse transcription-pcr-enzyme hybridization assay. Journal of Clinical Microbiology 34:1914-1917, 1996.

4.     14. Gilbert LL, Dakhama A, Bone BM, et al: Diagnosis of viral respiratory tract infections in children by using a reverse transcription-pcr panel. Journal of Clinical Microbiology 34:140-143, 1996.

5.      15.Steele RW: Pneumonia in children: Current status of diagnosis and treatment. Journal of Respiratory Diseases 8:63-73, 1987.

6.      16.Sidwell RW, Huffman JH, Khare GP, et al: Broad-spectrum antiviral activity of virazole 1-b-d-ribofuranosyl-1,2,4-triazole-3-carcoxamide. Science 177:705-706, 1972.

7.      17.Steele RW: Antiviral agents for respiratory infections. Pediatric Infectious Diseases Journal 7:457-461, 1988.

8.     18. Cobian L, Houston S, Greene J, et al: Parainfluenza virus respiratory infection after heart transplantation: Successful treatment with ribavirin. CID 21:1040-1041, 1995.

9.      19.Gilbert B, Knight V: Biochemistry and clinical applications of ribavirin. Antimicrob Agents Chemother 30:201-205, 1986.

10.  20. Gelfand E: Ribavirin treatment of viral pneumonia in severe combined immunodeficiency. Lancet 1:732-733, 1983.

11.  21.Kairys SW, Olmstead EM, O'Connor GT: Steroid treatment of laryngotracheitis: A meta-analysis of the evidence from randomized trials. Pediatrics 83:683-693, 1989.

12.  22.Klassen TP, Feldman ME, Watters LK, et al: Nebulized budesonide for children with mild-to-moderate croup. N Engl J Med 331:285-289, 1994.