RSVRSVRT 265RT 265

Respiratory Syncytial Respiratory Syncytial VirusVirus

Manifests primarily as:Manifests primarily as:

BronchiolitisBronchiolitis

Viral pneumoniaViral pneumonia

Leading cause of lower respiratory tract Leading cause of lower respiratory tract infection in infantsinfection in infants

SyncytiuSyncytium:m:

Multinucleate mass of Multinucleate mass of protoplasm produced protoplasm produced by the merging of by the merging of neighboring cellsneighboring cells

IncidenceIncidence

Peak ages 2-8monthsPeak ages 2-8months Usually >4years oldUsually >4years old Mid-winter and spring Mid-winter and spring

monthsmonths Virtually all children have Virtually all children have

been exposed by 3been exposed by 3rdrd birthdaybirthday

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

WHY THE LITTLE ONES?WHY THE LITTLE ONES? Smaller airwaysSmaller airways Reduced immune systemReduced immune system

High-risk groups for severe High-risk groups for severe RSV infection include the RSV infection include the following:following: premature infants in their first premature infants in their first

year of life (the younger the year of life (the younger the child is [gestational and child is [gestational and chronological age] at the start chronological age] at the start of RSV season, the greater the of RSV season, the greater the risk)risk)

Infants with chronic lung Infants with chronic lung disease (eg, bronchopulmonary disease (eg, bronchopulmonary dysplasia,cystic fibrosis) during dysplasia,cystic fibrosis) during their first 2 years of lifetheir first 2 years of life

Children with hemodynamically Children with hemodynamically significant congenital heart significant congenital heart disease, especially with disease, especially with increased pulmonary blood increased pulmonary blood flowflow

Immunodeficient statesImmunodeficient states Children with metabolic and Children with metabolic and

neuromuscular disordersneuromuscular disorders Children of multiple births Children of multiple births

(triplets or greater)(triplets or greater)

DiagnosisDiagnosis

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

Specific diagnostics testing:Specific diagnostics testing: Nasal swabsNasal swabs Nasal lavageNasal lavage Nasopharyngeal aspirationNasopharyngeal aspiration

CXR hyperinflation diffuse increase in CXR hyperinflation diffuse increase in interstitial markingsinterstitial markings

PresentationPresentation

FeverFever CoughCough TachypneaTachypnea RetractionsRetractions WheezingWheezing CracklesCrackles Sepsis like symptomsSepsis like symptoms Apneic episodes in the Apneic episodes in the

very youngvery young

Diffuse small airway Diffuse small airway diseasedisease

ManagementManagement

Supportive careSupportive careCan be managed at home Can be managed at home

unless requiring:unless requiring: Supplemental oxygenSupplemental oxygen Fluid replacement – Fluid replacement –

normal feeding or IV if normal feeding or IV if unable unable

Bronchial hygiene - Bronchial hygiene - suctioningsuctioning

Bronchodilators? (alpha Bronchodilators? (alpha and beta agonists)and beta agonists)

Ribavirin (Virazole)Ribavirin (Virazole) Mechanical Mechanical

ventilation/CPAPventilation/CPAP

PreventionPrevention WASH YOUR HANDSWASH YOUR HANDS Avoid mucus Avoid mucus

membrane exposuremembrane exposure Palivizumab (Synagis) Palivizumab (Synagis)

antiviral antiviral immunoglobulins immunoglobulins /motavizumab /motavizumab (investigational – not (investigational – not FDA approved)FDA approved)

The “best” part:The “best” part:

NoNo lifelong immunity lifelong immunity develops!develops!

Reinfection is common Reinfection is common