Human respiratory syncytial virus
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| Human respiratory syncytial virus | ||||||||||
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| Human respiratory syncytial virus Classification and external resources |
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| ICD-10 | B97.4 |
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| ICD-9 | 079.6 |
| DiseasesDB | 11387 |
| MedlinePlus | 001564 |
| eMedicine | ped/2706 |
| MeSH | D018357 |
Human respiratory syncytial virus (RSV) is a negative-sense, single-stranded RNA virus of the family Paramyxoviridae, which includes common respiratory viruses such as those causing measles and mumps. RSV is a member of the paramyxovirus subfamily Pneumovirinae.
RSV causes respiratory tract infections in patients of all ages. It is the major cause of lower respiratory tract infection during infancy and childhood. In temperate climates there is an annual epidemic during the winter months. In tropical climates, infection is most common during the rainy season. In the United States, 60% of infants are infected during their first RSV season{[1]}, and nearly all children will have been infected with the virus by 2-3 years of age{[2]}. Natural infection with RSV does not induce protective immunity, and thus people can be infected multiple times. Sometimes an infant can become symptomatically infected more than once even within a single RSV season. More recently, severe RSV infections have increasingly been found among elderly patients as well.
For most people, RSV produces only mild symptoms, often indistinguishable from common colds and minor illnesses. The Centers for Disease Control consider RSV to be the "most common cause of bronchiolitis and pneumonia among infants and children under 1 year of age."[3] For some children, RSV can cause bronchiolitis, leading to severe respiratory illness requiring hospitalization and, rarely, causing death. This is more likely to occur in patients that are immunocompromised or infants born prematurely. Other RSV symptoms common among infants include listlessness, poor or diminished appetite, and a possible fever.[1].
Recurrent wheezing and asthma are more common among individuals who suffered severe RSV infection during the first few months of life than among controls; whether RSV infection sets up a process that leads to recurrent wheezing or whether those already predisposed to asthma are more likely to become severely ill with RSV is a matter of considerable debate.
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[edit] Prevention
As the virus is ubiquitous in all parts of the world, avoidance of infection is not possible. Epidemiologically, a vaccine would be the best answer. Unfortunately, vaccine development has been fraught with spectacular failure and with difficult obstacles. There is much active investigation into the development of a new vaccine, but at present no vaccine exists. However, palivizumab (brand name Synagis), a moderately effective prophylactic drug is available for infants at high risk. Palivizumab is a monoclonal antibody directed against RSV surface fusion protein. It is given by monthly injections, which are begun just prior to the RSV season and are usually continued for five months. RSV prophylaxis is indicated for infants that are premature or have either cardiac or lung disease, but the cost of prevention limits use in many parts of the world.
Prophylactic treatment may be provided by intravenous RSV-IGIV infusion.[4]
[edit] Treatment
Ribavirin, a broad-spectrum antiviral agent, was once employed as adjunctive therapy for the sickest patients; however, its efficacy has been called into question by multiple studies, and most institutions no longer use it. Nebulized racemic epinephrine and bronchodilators may work on a case-by-case basis. Treatment is otherwise supportive care only with fluids and oxygen until the illness runs its course.[5]
[edit] References
- ^ Glezen WP, Taber LH, Frank AL, Kasel JA. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child. 1986;140:543-6.
- ^ Glezen WP, Taber LH, Frank AL, Kasel JA. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child. 1986;140:543-6.
- ^ Respiratory Syncytial Virus. CDC, Respiratory and Enteric Viruses Branch (Reviewed on January 21, 2005). Retrieved on 2007-03-01.
- ^ Siegel, R. M: "Bronchiolitis", Pediatric Primary Care: Ill-Child Care, 1st Edition, 2001, Lippincott Williams & Wilkins, Baker, R. C. (ed.)
- ^ Siegel, R. M: "Bronchiolitis", Pediatric Primary Care: Ill-Child Care, 1st Edition, 2001, Lippincott Williams & Wilkins, Baker, R. C. (ed.)
[edit] External links
- PreemieCare information and support on premature infants including in-depth resources on RSV and our comprehensive NICU Glossary.
- Synagis (registered to MedImmune, manufacturer of Synagis)
- Virazole (registered to Valeant Pharmaceuticals, manufacturer of Virazole)
- The Family Doctor
- RSV in Infants: Information includes symptoms, treatment, and prevention.
- Biotrin providers of RSV kits
- Control of Communicable Diseases in Man. American Public Health Association.
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