Wendy Vuong
Reza Parhizlear
Joseph Martin del Campo
Gen. Virology; Dr. Lee
10.30.12
Case Study #5: Respiratory Syncytial Virus
A 13-month-old child had a runny nose, mild cough, and low-grade fever
for several days. The cough got worse and sounded like "barking." The child made
a wheezing sound when agitated. The child appeared well except for the cough. A
lateral radiograph of the neck showed a subglottic narrowing.
1. What is the specific and common name for these symptoms?
Respiratory syncytial virus (RSV) is responsible for infection in respiratory
system, including lungs and breathing passages. Recovery time of this virus could take up
to two weeks however, this can vary by other factors such as age and immune responds
of the individuals. Infants and elderly could experience sever symptoms, in fact RSV in
the most common cause of bronchiolitis and pneumonia in premature and children under
age of two. In our case, thirteen months child is experiencing some of the common side
symptoms of RSV, including runny nose, mild cough, low grade fever, and over some of
these symptoms gets worst, such as high pitch sounds and wheezing sound known as
stridor. Barking cough is or Croup also known as Laryngotracheobronchitis is usually
triggered by acute viral infection such as RSV. Croup is a condition due to upper
respiratory infection. The larynx and trachea may be become inflamed or swollen from
upper respiratory viral infection. The barking cough usually begins at night and is not
accompanied by fever. Other symptoms such as Rhinitis and runny nose or Rhinorrhea
are common. In Rhinitis, the mucous membranes becomes irritated and producing a
discharge, congestion and swelling tissues. Rhinorrhea is characterized by excess amount
of mucus produced by mucous membrane. This excess amount of mucus is producing
faster than it is process and would therefore, cause a blockage in the nasal cavity. This
extra mucus fills up and causes difficulty breathing through the nose. Rhinitis is
associated directly with rhinorrhea, although a low-grade fever is also a regular
contributor as well. Wheezing sound which appears when the child gets agitated is caused
by blockage in larynx and throat. This high pitch sound is known as Stridor and is more
common in young children since they have narrower airways than adult.
2. What other agents would cause a similar clinical presentation (differential
diagnosis)?
Respiratory Syncytial virus belongs to the Paramyxoviruses family and
Mononegavirales order. Paramyxoviruses are single stranded RNA viruses and are
responsible for upper respiratory infections in human and animals. One of the common
human diseases is Respiratory Syncytial virus. RSV is number one cause of bronchiolitis
and pneumonia in young children and infants. The second most common human virus is
human parainfluenza virus (HPIV). HPIVs have been categorized into four different
types depending on their infectious intensities and their symptoms. HPIV-1 and HPIV-2
are known for causing viral infections such as croups, which is common viral infection in
upper respiratory system, among children aged between 6 months to 48 months. HPIV-1
and HPIV-2 have periodic out break during the fall in united state. HPIV-3 targets
children less than one year of age, and causes similar infectious such as bronchiolitis and
pneumonia. HPIV-4 symptoms are less severe and may be indicative o a large portion of
asymptomatic or mild infections. Other major microorganisms causes similar symptoms
are including, Influenza virus, Adenovirus, Rhinovirus, Enterovirus. Influenza viral
infection could have some sever symptoms such as spasmodic croup, and epiglottitis. In
most cases of spasmodic croup, upper respiratory tract infections are absent and are
associated with low-grade fever. Symptoms of epiglottitis include high fever, dysphagia
and drooling.
HPIV types 2 and 3 can include expression of intercellular adhesion molecules in
some cells of the respiratory tract, providing receptors to which rhinoviruses can bind,
causing infection.
3. Are there readily available laboratory tests to confirm this diagnosis? If so,
what are they?
There are available laboratory tests to verify the type of virus to confirm
this diagnosis. A rapid antigen test detects the RSV antigens taken from nasal aspirate
or a nasopharyngeal swab to obtain a sample of the infected person. Since detectable
amount are only shed during the first few days of an infection, most testing must be done
during this time period. Rapid RSV antigen is one of the most popular testing methods.
RSV antigen testing can be done on site, in doctor office or emergency room, with results
available in less than an hour. The most frequently used sample is nasal aspirate or wash.
Small amount of saline is being push into the nose by using a syringe; follow up by
gentle suction to collect the fluid for sampling. Other method include nasopharyngeal
(NP) swab. In most cases nasal aspirate is preferred to nasopharyngeal swab because of
increase amount of virus quantity in the sample.
A positive rapid RSV test would obviously mean that the suspected individual
have the virus in their system. However, in a healthy individual, the infection should go
away within a week or two. A test is normally administered to those that have a weak
immune system, such as pre-mature babies and the elderly. A negative rapid RSV test
would mean that the suspected patient either does not have the infection or not enough
samples were taken to detect the virus.
There are other available tests that can detect the respiratory syncytial virus, such
as the viral culture. The viral culture can help identify the virus’s genetic material. The
pros of using this type of test are that if there are other viruses involved, it can be
detected. The disadvantage of this test and other similar testing is that it is not always
readily available or produces fast results as the rapid antigen RSV test would.
4. Was there a possible treatment for this child?
Normally for a healthy child, this is considered a mild disease that will go away
by itself within 1-2 weeks and does not need any specific treatment. The best cure that
the guardian can provide is supportive care. By keeping the patient hydrated with
electrolyte replacing fluids and well rested, the patient is sure to get better in no time. If
the child is old enough, it is best to have his/her nostril cleared to breathe better. In
common cases, an infant normally have a problem with breathing that concerns most
parents. Even in this case, parents or guardians can use a bulb syringe to help clear their
nostrils. Tylenol may be taken to help reduce fever symptoms.
In severe cases, the infected child is sent to the hospital. In the hospital, the staff
would take measures to keep everything sanitized. These measures may include wearing
gowns, gloves, and a head net to prevent the spread of the infection to other children.
The infected child is normally isolated in a separate room, with machines to help them
breathe and taking fluid intravenously. Patients normally in need of hospital care are
those with weak immune systems, such as those with lung problems. Doctors may use
anti-inflammatory drugs such as glucocorticoids to reduce the inflammation in upper
respiratory tract. There are no antibiotics or vaccines that are effective or made to
improve the infection.
5. When was this child contagious, and how was the virus transmitted?
RSV has a contagion period that is initiated before symptoms occur and there is
the possibility that it may occur without the sign of any symptoms. The incubation period
is between 4 – 5 days meaning that 4 - 5 days before the 13-month-old child had shown
any symptoms he was contagious. The virus was most likely transmitted from the
inhalation of large droplet aerosols meaning that somewhere along the line of his daily
activities the child had inhaled the virus.