Respiratory Syncytial Virus

Running head: (RSV)

Respiratory Syncytial Virus

(RSV)

By

Natalie Jache

December 03, 2006

Respiratory Syncytial Virus (RSV)

Introduction

Respiratory Syncytial Virus (RSV) is a very common respiratory virus that displays mild cold like symptoms in adults and older children. In children under two, particularly those born prematurely, are immunocompromised, as well as those with heart and lung disease, RSV can be a potentially life threatening disease. RSV commonly occurs in epidemics in the winter and early spring.

Pathophysiology

RSV is a highly contagious virus and is related to Para influenza, mumps and measles (Cooper, Banasiak & Allen, 2003), which almost every child will have had by the age of three. Reoccurring infections of the disease are very common. There is "a high association between hospitalized infants with bronchiolitis and the development of asthma" (Cooper, et. al, 2003 p.453). RSV is a large contributing factor to wheezing and lower respiratory tract problems in childhood. (Cooper, et. al, 2003)

"The incubation period for RSV is usually 3-6 days but may vary from 2-8 days. The virus enters the body usually through the eye or nose, rarely through the mouth. The virus then spreads along the epithelium of the respiratory tract, mostly by cell to cell transfer. As the virus spreads to the lower respiratory tract, it may produce bronchiolitis and/or pneumonia. Early in bronchiolitis, a peribronchiolar inflammation with lymphocytes occurs, which progresses to the characteristic necrosis and sloughing of the bronchiolar epithelium. This sloughed necrotic material may plug the bronchioles resulting in an obstruction to the flow of air, the hallmark of bronchiolitis. Air may be trapped distal to the sites of occlusion, causing the characteristic hyperinflation of bronchiolitis, which, when absorbed, results in multiple areas of focal atelectasis." (http://virology-online.com/viruses/RSV.htm, p.1-2) "The course of the illness is variable, lasting from one to several weeks. Most infants show signs of improvement within 3 or 4 days after the onset of lower respiratory tract disease" (http://virology-online.com/viruses/RSV.htm, p.2).

RSV is transmitted by close or direct contact with respiratory secretions, droplets or formites. RSV can live on countertops for 30 hours and on hands and clothes for less than 1 hour." (Cooper et al. 2003, p.453). Nosocomial infection from RSV is very common on pediatric wards during the epidemic season. Epidemic season is commonly from November to April with a peak in January or February. Clinical symptoms of RSV are demonstrated in Table 1.

Severe cases of RSV are not as common as in adults as they are with children. There have been, however, cases of epidemics in long term care communities with the virus affecting the elderly population.

Diagnostic Tests or Lab Findings

There are a couple of different diagnostic tests done to identify a Respiratory Syncytial virus diagnosis. One of these tests would be radiographs of the chest to rule out other respiratory problems. "Radiographic examination findings of bronchiolitis reveal hyperinflation, patchy atelectasis and peribronchial wall thickening and can usually differentiate between pneumonia and brochiolitis" (Cooper et al. 2003, p.454).

The second test that would be done is the "enzyme-linked immunosorbent assay (ELISA) that detects antigens." (Cooper et al. 2003, p.454) This test is accomplished by obtaining a specimen by way of nasal wash. This is the most accurate way of diagnosing RSV.

The third diagnostic procedure would be a CBC or complete blood count, but this is not an accurate tool in the definite diagnosis. A combination of all three tests as well as a thorough history defining exposure and symptoms is the best course in an appropriate diagnosis.

Methods of Treatment

The majority of the more mild cases of RSV can be treated at home. Home remedies would include rest and maintaining good fluid and caloric intake. Nasal drops may be used to clear secretions to make breathing easier. Analgesics and antipyretics to can also be used to control pain and fever. Parents should be instructed to monitor for signs of increased breathing difficulty, decreased fluid intake, and fever and pain management. They should further be instructed to contact a health care provider if any of these symptoms worsen or if they have any questions at all. (Cooper, et, al, 2003)

For children with more severe symptoms, hospitalization may be necessary. In these particular cases, respiratory rate may be more than 70 breaths per minute; retractions may be noted, as well as poor fluid intake and lethargy (Cooper, et, al, 2003). "The degree of medical intervention is usually determined by the child's level of oxygenation as indicated by pulse oximetry and/or arterial blood gases" (Cooper et al., 2003, p.454). One treatment would be oxygen therapy by way of "humidified mist therapy combined with oxygen" (Cooper et al., 2003, p.454). This would be delivered by nasal canula, oxygen tent or isolet "in concentrations sufficient to alleviate dyspnea and hypoxia."(Cooper et al., 2003, p.454). "Ventilatory assistance (i.e., intubation) should be considered for infants with recurrent apnea or severe oxygen desaturation" (Cooper et al., 2003, p.454). Other treatments may include intravenous fluids to maintain proper hydration, bronchioldialators to assist in opening up airways to make breathing easier as well as corticosteroids, and antiviral medications. A constant monitor of oxygen levels is necessary as well as heart monitors in some cases.

Patient Teaching

There are several ways to help prevent the spread of RSV. The first and most important step is good hand washing. Washing hands after such things as: