RESPIRATORY SYN-

CYTIAL
VIRUS

ROSAL, IJA LOURICE

P.
 CASE
General Data
• A 5-month-old boy
• 3-day history of cough, rhinorrhea, congestion, and fevers.
• breathing faster and taking in less formula than normal.
• His 4-year-old sister has a cold and attends a local day care.
On Physical exam:
• temperature is 38 C,
• heart rate is 140 beats per minute,
• respiratory rate is 60 breaths per minute,
• blood pressure is 90/50 mmHg
• oxygen saturation is 95%.
• tachypneic and coughing.
• subcostal and intercostal retractions.
• On auscultation of his lungs, wheezing is heard on both
inspiration and expiration.
• A prolonged expiratory phase is also noted.
SALIENT FEATURES

• 3 Day history of cough, rhinorrhea,

congestion and fever
• fast breathing
• poor feeding
• exposure to infection
On Physical Examination:
• Temperature of 38 C
• tachycardic: HR of 140 bpm
• tachypneic: RR of 60 cpm
• subcostal and intercostal retractions
• wheezing heard on both inspiration and
expiration
RESPIRATORY SYNCY-
TIAL
VIRUS infection
(bronchiolitis)
 Respiratory syncytial virus
• Respiratory syncytial virus (RSV) is the major cause of
bronchiolitis and viral pneumonia in children
younger than 1 yr of age and is the most important
respiratory tract pathogen of early
childhood.
• RSV is an enveloped RNA virus with a single-stranded
negative-sense genome. The virus belongs to the
family Paramyxoviridae, along with parain-
fluenza and measles viruses, It is the only member of
the genus Pneumovirus that in-
• RSV is distributed worldwide and appears in
yearly epidemics. In temperate climates, these
epidemics occur each winter over 4-5 mo.
• In the tropics, the epidemic pattern is less clear.
This pattern of widespread annual outbreaks and
the high incidence of infection during the 1st 3-4
months of life are unique among human viruses.
PATHOPHYSIOLOGY
• RSV is typically confined to the respiratory tract and lymphocytic peri-
bronchiolar infiltration is noted. RSV replicates in the nasopharynx and
then binds to the bronchiolar epithelium causing necrosis of the cell. Hy-
persecretion of mucous occurs and round cells infiltrate causing edema in
the surrounding submucosa. Thus, the lumina of the small airways
become obstructed. Hyperinflation results from air trapping in the pe-
ripheral areas and atelectasis occurs when the trapped air is absorbed. In-
terleukins, chemokines, and leukotrienes are released and cause inflam-
mation and tissue damage during and after the infection. Recovery of the
epithelium starts the first week of the illness but the ciliated cells do not
recover until several weeks later.
HISTORY AND PHYSICAL EXAM
Patients with respiratory syncytial virus (RSV) infection may present with
the following symptoms:
• Fever (typically low-grade)
• Cough
• Tachypnea
• Cyanosis
• Retractions
• Wheezing
• Rales
• Sepsislike presentation or apneic episodes (in very young infants)
 DIAGNOSIS
Clinical judgment is the reasonable way to diagnose RSV.
Although diagnostic tests can be helpful but rarely al-
ter treatment.
• Nasopharyngeal washes or tracheal secretions are better
specimens for confirming RSV than nasalswabs.
• Enzyme immunoassay (EIA)
• RSV cultures
• Chest radiographs
NON PHARMACOLOGICAL TREATMENT

• Supportive care is the mainstay of therapy for respiratory

syncytial virus (RSV) infection.
• Such therapy may include administration of supplemental
oxygen (guided by respiratory rates, work of breathing, oxy-
gen saturation, and arterial blood gas values, as indicated),
mechanical ventilation, and fluid replacement, as necessary.
• IV Fluids is given to hospitalized infants with RSV infec-
tion who are unable to tolerate milk or feedings well and
frequently vomit or spit up.
PHARMACOLOGICAL TREATMENT

• Anti- viral
• Phrophylaxis
RIBAVIRIN
• a broad-spectrum antiviral agent in vitro, is licensed by the US
Food and Drug Administration
• It is synthetic nucleoside analog that appears to act by interfering
with the function of mRNA and has broad antiviral activity against
RNA, DNA and retroviruses for the aerosolized treatment of chil-
dren with severe RSV disease.
• The recommended dose is 6 g of drug in 300 mL of dis-
tilled water via a small-particle aerosol generator (SPAG unit) over
12-18 hours per day for 3-7 days, depending on clinical response.
PREVENTION
PROPHYLAXIS
Immunoglobulins
Immunoglobulin products with high anti-RSV antibody titers have proved benefi-
cial when given monthly for prophylaxis in select groups of high-risk infants.
• Currently, passive protection against RSV is achieved successfully through injec-
tion of the humanized monoclonal anti-RSV antibody palivizumab at a dosage
of 15 mg/kg/month (IM) per month.
• Palivizumab is a humanized monoclonal antibody directed against an epitope
in the A antigen site on the F surface protein of RSV. It is licensed for the
prevention of RSV infection in high-risk infants and children, such as prema-
ture infants and those with bronchopulmonary dysplasia or congenital heart
disease
SAMPLE PRESCRIPTION
• Thankyou