Respiratory syncytial virus (RSV) High Yield Facts: Human respiratory syncytial virus (RSV) is a single-stranded RNA virus of the Paramyxoviridae family whose genome includes 10 genes that encode 11 proteins RSV is the most frequent cause of bronchiolitis in infants and young children 2nd most common cause of bronchiolitis in infants and young children is Human metapneumovirus The virus remains viable on hard surfaces for up to 6 hours, on rubber gloves for 90 minutes, and on skin for 20 minutes. This prolonged survival highlights the need for hand washing and contact precautions as an essential (and cost-effective) practice to limit the spread of infection, especially in clinic settings Apnea is a well-known complication of RSV infection in infants, and its incidence is as high as 20% in infants younger than 6 months Significant complication: Respiratory distress, hypoxemia, atelectasis, respiratory distress syndrome, pneumonia, and respiratory failure Can be associated with otitis media, fever, fatigue, and lethargy Chest radiography may show: Bilateral hyperinflation from air trapping, patchy atelectasis from airway plugging, and peribronchial thickening from lymphomonocytic infiltration. Patients with severe disease may also have features more consistent with pneumonia, with areas of interstitial parenchymal infiltration Treatment is mainly supportive, regardless of the setting (inpatient or outpatient) in which the patient is treated, the mainstay of therapy remains supportive care, which includes respiratory support combined with appropriate fluid and nutrition management Albuterol, steroids (inhaled, oral or IV), epinephrine, has no effect in the treatment of bronchiolitis A brief trial of Albuterol with objective evaluation of the response may be warranted, but this therapy should be discontinued if no improvement occurs because of the significant adverse effects, including tachycardia, tremor, hypokalemia, and hyperglycemia Nebulization of 3% saline improves mucociliary clearance and is increasingly being used in airway diseases that involve mucous plugging the administration of hypertonic saline for bronchiolitis should be limited to hospitalized infant and children. Palivizumab prophylaxis with a maximum of 5 monthly doses is now recommended only in the first year after birth for otherwise healthy infants born before 29 weeks’ gestation and for infants born before 32 weeks’ gestation with chronic lung disease of prematurity defined as a requirement for supplemental oxygen for at least 28 days after birth
Posted on: Sat, 24 Jan 2015 04:51:54 +0000
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