Respiratory system

The risk factors for developing Respiratory Syncytial Virus, also known as RSV are infants who are born prematurely, infants younger than six months of age, and children who have underlying medical conditions such as congenital heart or lung disease. Children who have older siblings that are school aged or attend day care are also more at risk due to the amount of germs and the amount of contact that they are exposed to. Studies are still being conducted to detect whether heredity plays any role in the development of the virus. Almost all children will have developed RSV by age two, although males are more susceptible to the virus.

RSV affects the entire United States and outbreaks usually occur during the late fall, winter, and spring months of the year. The RSV virus can live on any hard surface such as a table, toys, or cups for four to seven hours. The virus can then enter the body through the nose, eyes, and mouth attaching itself to the upper respiratory tract and then traveling by a cell by cell transfer into the lower respiratory and then into the lungs. RSV is a member of the paramyxovirus family containing a single strand RNA and is related to the parainfluenza, mumps, and measles virus.

The two major strains of RSV are A and B. The A strain is responsible for the majority of more severe forms of RSV bronchiolitis (Martinello, Chen, Weibel, & Kahn, 2002; Walsh, McConnochie, Long, & Hall, 1997). In a recent study by Martinello et al. (2002), the investigators found a subgroup of the A strain (GA3) was associated with more severe disease. The different strains of RSV often circulate at the same time, and season-to-season variation is found in the predominant strain (American Academy of Pediatrics [AAP], 2003; Martinello et al. , 2002).

Cross section of the RSV virus (www.medscape. com) RSV invades the bronchiolar epithelial cells causing inflammation and edema. The membranes of the infected cells fuse with adjacent cells to form a large, multinucleated cell creating large masses of cells or “syncytia” (McIntosh, 2000; Wong et al. , 2003). The bronchiole mucosa ultimately begins to swell, and the lumina fill with mucus and exudate. Inflammatory cells infiltrate the area resulting in the shedding of dead epithelial cells, which causes obstruction of small airway passages resulting in hyperinflation and areas of atelectasis (Linzer & Guthrie, 2003).

Bronchiole passages normally dilate on inspiration, allowing for adequate air intake, but narrow on expiration. The inflammation and exudate caused by the RSV infection results in bronchiole obstruction during expiration, air trapping, poor exchange of gases, increased work of breathing, and a characteristic expiratory wheeze (Sandritter & Kraus, 1997; Wong et al. , 2003). The symptoms of RSV are similar to the common cold as it affects the upper respiratory tract. They can include a fever, runny nose, nasal congestion, cough, decreased appetite, irritability, and rapid breathing.

As it travels to the lower respiratory tract the symptoms can worsen because of the airways becoming blocked in the lungs. The symptoms resulting are a worsening cough, wheezing, and difficulty breathing. In some cases short spells of apnea can occur lasting between fifteen and twenty seconds at a time. The symptoms of RSV are closely related to the signs of the virus. They include most of the signs. Only a doctor can assess the child’s wheezing and confirm it and diagnose whether or not the RSV has developed into bronchiolitis or pneumonia.

At the Doctors office the pediatrician will perform a physical exam and auscultate the childs lungs to identify wheezing or other abnormal sounds to determine the degree of the childs difficulty of breathing. Chest x-rays are also performed to identify pneumonia or bronchiolitis. In some cases a skin test is performed to check the level of oxygen in the bloodstream. Blood can also be drawn to check the WBC count to identify any infection that has not already been identified. The pediatrician will also obtain a small amount of respiratory secretions from the nose.

There is also a forty percent that a child will develop otitis media(ear infection) that could be bacterial or viral that the pediatrician will treat in association to RSV. The childs hydration status is also assessed to determine the need for intravenous fluid. The usual antibiotics used to treat bacterial infections are ineffective in the treatment of RSV because it is a viral infection. Over the counter medications such as Tylenol or ibuprofen are recommended to treat the fever associated with RSV. In severe cases of RSV the child may be hospitalized to provide IV’s and in the worst cases a ventilator is used to make breathing easier.

A bronchodilator (albuterol) is also prescribed to treat wheezing and some children are given a nebulizer with ribavirun to help reopen the air passages in the lungs. The doctor may also recommend an injection of epinephrine to relieve some of the symptoms of RSV. At home it is suggested to use a cool mist vaporizer to keep the air cooler to help with the childs breathing. Some doctors have used a combination of immune globulin intravenous (IGIV) with high titers of neutralizing RSV antibody (RSV-IGIV) and ribavirin to treat patients with compromised immune systems.

RSV infection usually runs its course in seven to fourteen days. The cough may linger weeks longer. There are no medications that can speed the body’s production of antibodies against the virus. Most RSV infections go away completely with no lasting effects. With prompt diagnosis and appropriate treatment, most infants and children recover from serious respiratory illnesses caused by RSV infections. The majority of children hospitalized for an RSV infection are under six months of age. Most children recover from RSV in eight to fifteen days. In some cases the child may develop asthma later on in life.

In the worst case scenario RSV can be life threatening. Over 4,500 deaths per year in children below the age of two are the result of RSV and there are over 90,000 children hospitalized per year. In 1996, the FDA approved a preventative treatment for RSV called RespiGam(RSV-IGIV). RespiGam is made from plasma taken from large numbers of normal, healthy individuals, and contains a high concentration of protective antibodies against RSV. These antibodies do not prevent the RSV infections, but do help to protect children against the most serious consequences of the virus.

Right now RespiGam is only available to the children at highest risk of contracting RSV. It is a monthly intravenous infusion that takes six hours to administer that begins during the fall months before there is an outbreak. Palivizumab is a monoclonal antibody produced by recombinant DNA technology. It is used in the prevention of Respiratory Syncytial Virus (RSV) infections. It is also recommended for certain infants that are high-risk. Palivizumab is a humanized monoclonal antibody (IgG) directed against an epitope in the A antigenic site of the F protein of the Respiratory Syncytial Virus (RSV).

In two Phase III clinical trials in the pediatric population, Palivizumab reduced the risk of hospitalization due to RSV infection by fifty five percent and forty five percent. Palivizumab is dosed once a month via intramuscular (IM) injection, to be administered throughout the duration of the RSV season. Palivizumab targets the fusion protein of RSV, inhibiting its entry into the cell and thereby preventing infection. At this time there are no vaccines available although there is research and studies still going on.

Frequent handwashing and not sharing items such as cups, glasses, and utensils with persons who have RSV illness is the easiest way to help prevent the virus from spreading. A child who develops RSV will usually have a decreased appetite and almost be lethargic. The child will not want to play or do anything that they would do normally when they are healthy. They are also more likely to get more upset and cry more than normal because they do not understand what is wrong with them and why they don’t have any energy. They could almost be considered depressed to an extent.

The childs family could also become more aggravated easily because RSV is a waiting game since there are not any medications to actually treat the virus. The parents could miss up to two weeks of work which can add more stress to the family because of the financial stress of mounting doctors bills, possible hospital bills, and the cost of all the prescriptions that the child has to take. There is also stress involved in giving some of the medications, trying to get the child still enough to give them a shot or trying to give then their inhaler or breathing treatments which can scare the child because it is foreign to them.

Both parents and children are severely affected by RSV. Works Cited: Goldenring MD, John. “Respiratory Syncytial Virus . ” Medline Plus. 2005. Medline Plus. 02 July 2007 . “Respiratory Syncytial Virus . ” Centers for Disease Control. Centers for Disease Control. 02 July 2007 . “Respiratory Syncytial Virus . ” Medical Library. 2003. Medem. 02 July 2007 . “Respiratory Syncytial Virus Antibodies. ” Medline Plus.

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