Respiratory syncytial virus infection


Respiratory syncytial virus infection

Description, Causes and Risk Factors:

Respiratory syncytial virus infection results from a subgroup of myxoviruses that resembles paramyxovirus. Respiratory syncytial virus is the leading cause of lower respiratory tract infections [LRTI] in infants and young children. It is the major cause of pneumonia, tracheobronchitis, and bronchiolitis, in the age group and a suspected cause of fetal respiratory disease of infancy.

The organism that cause respiratory syncytial virus is transmitted from person-to-person by respiratory secretion and has an incubation period of 4 to 5 days. Respiratory syncytial virus infection spread when an infected person coughs or sneezes into the air. Coughing and sneezing send virus-containing droplets into the air, where they can infect a person if they inhale these droplets or these droplets come in contact with their mouth, nose, or eye. Antibody titers seem to indicate the few children younger than age 4 escape contracting some form of respiratory syncytial virus, even if it is mild. In fact, respiratory syncytial virus is the only viral disease that has its maximum impact during the first few months of life. School age children, adolescents, and young adults with mild re-infections are probably the source of infection for infants and young children. Respiratory syncytial virus infection has also been identified in patients with variety of central nervous system [CNS] disorders such as meningitis and myelitis.

Premature infants, children less than 2 years of age with congenital heart or chronic lung disease, and children with compromised immune systems due to a medical condition or medical treatment are at highest risk for severe disease. Adults with compromised immune systems and those 65 and older are also at increased risk of severe disease.

This virus occurs in annual epidemics during the late winter and early spring in temperate climates and during the rainy season in the tropics. It can also be seen in the immunocompromized adults, especially patients with bone marrow transplants.

Precautionary Measures:

    Monitor respiratory status including rate and pattern. Watch for nasal flaring or retraction, cyanosis, pallor, and dyspnea; listen or auscultate for wheezing, rhonchi, or other signs of respiratory distress. Monitor arterial blood gas [ABG] level and oxygen saturation.

  • 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. Use a croup tent to provide a high humidity atmosphere.

  • Monitor intake and output carefully. Observe signs of dehydration such as decreased skin turgor. Encourage the patient to drink plenty of high calorie fluids. Administer IV fluids as needed.

  • Promote bed rest. Plan your nursing care to allow uninterrupted rest.

  • Hold and cuddle infants; talk to and play with toddlers. Offer diversionary activities that are appropriate for the child's condition and age. Encourage parental visits and cuddling. Restrain the child only as necessary.

  • Impose droplet precaution. Enforce strict hand hygiene, because respiratory syncytial virus may be transmitted from fomites. Avoid hand contact with nose or eyes; wear a surgical mask and eye protection. Make sure that staff members with respiratory illnesses do not care for infants.

Symptoms:

Clinical features of respiratory syncytial virus infection vary in severity from mild cold like symptoms to bronchiolitis or bronchopneumonia and in a few patients, severe, life-threatening lower respiratory tract infection. Symptoms usually include coughing, wheezing, malaise, pharyngitis, dyspnea, and inflamed mucous membrane in the nose and throat. Re-infection is common, producing milder symptoms that the primary infection.Otitis media is a common complication of respiratory syncytial virus infection in infants.

Diagnosis:

Diagnosis is usually based on clinical findings and epidemiologic information. Many facilities can perform rapid tests for the virus using fluid obtained from the nose. Cultures of nasal and pharyngeal secretions may show respiratory syncytial virus infection; however, the virus is labile, so cultures are not always reliable. Chest x-ray help detect pneumonia.Blood tests will be needed to check white cell counts and to look for the presence of viruses, bacteria or other organisms which may trigger the condition.

Treatment:

Treatment for respiratory syncytial virus generally involves self-care measures to make your child more comfortable (supportive care). But in severe cases, hospital care may be needed.

Supportive care: Your doctor may recommend an over-the-counter medication such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to reduce fever. He/she may also prescribe an antibiotic if there is a bacterial complication, such as bacterial pneumonia.

Hospital care: Hospital care for respiratory syncytial virus in severe cases may be necessary to provide intravenous (IV) fluids and humidified oxygen. Hospitalized infants and children may also be hooked up to mechanical ventilation — a breathing machine — to ease breathing.

In some severe cases, a nebulized bronchodilator such as albuterol (Proventil, Ventolin) may be used to relieve wheezing. This medication opens air passages in the lungs. Nebulized means it is administered as a fine mist that you breathe in. Occasionally, a nebulized form of ribavirin (Rebetol), an antiviral agent, may be used. Your doctor may also recommend an injection of epinephrine or a form of epinephrine that can be inhaled through a nebulizer (racemic epinephrine) to relieve symptoms of respiratory syncytial virus infection.

Offer plenty of fluids and watch for signs of dehydration, such as dry mouth, little to no urine output, sunken eyes and extreme fussiness or sleepiness.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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