Running head: RESPIRATORY SYNCYTIAL VIRUS

Respiratory Syncytial Virus Respiratory Syncytial Virus, most commonly known as RSV, is a virus that causes infection in the lungs. This illness is sometimes overlooked because it mimics the symptoms of a common cold. The virus also attacks the respiratory tract, which includes the mouth, nose, throat, ears, and lungs. RSV is highly contagious, leaving every human being at risk to catch the virus. Although RSV can infect people in any age group, premature infants and elderly adults with heart or lung disease have more severe effects including fatality.

Pathophysiology

RSV infection is limited to the respiratory tract. Initial infection in young infants or children frequently involves the lower respiratory tract and most often manifests as the clinical entity of bronchiolitis. Inoculation of the virus occurs in respiratory epithelial cells of the upper respiratory tract. Spread of the virus down the respiratory tract occurs through cell-to-cell transfer of the virus along intracytoplasmic bridges (syncytia) from the upper to the lower respiratory tract. The illness may begin with upper respiratory symptoms and progress rapidly over 1-2 days to the development of diffuse small airway disease characterized by cough, coryza, wheezing and rales, low-grade fever (< 101F), and decreased oral intake. A family history of asthma or atopy is frequently obtained.[2, 3] In more advanced disease, retractions and cyanosis may be noted, and as many as 20% of patients may develop higher temperatures.

Risk factors for RSV

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RSV comes with several other risk factors such as, immunodeficiency, family history of asthma, multiple birth, daycare attendance, exposure to second hand smoke, and birth that was within 6 months of the onset of RSV season. It is highly likely that when your immune system is not able to fight off illnesses effectively you are at a greater risk to develop potentially dangerous respiratory issues. Children who are not in daycare can also be affected if they have siblings that are of school age that will cause them to have exposure to the RSV virus. Children who are products of multiple births fall back into the category of premature infants who are at higher risk for underdevelopment of their lungs as well as organs that premature infants are sometimes faced with. Spread of RSV RSV is spread by an infected person, who may cough or sneeze. Tiny droplets are then released. Once a person breathes in the tiny droplets, that person may become infected. The virus is also spread by sharing food or drinks with someone who is infected. Children that attend daycare or have older siblings that attend school are at great risk of developing the virus. In fact almost all children become infected with RSV prior to their second birthday. Elderly adults who are in nursing homes fall within a greater risk of acquiring the virus as well.

Vulnerability towards RSV virus Premature infants are more vulnerable towards the virus. When babies are born preterm they are at greater risk for lung infections, since their lungs and immune systems are not fully developed. RSV is the number one cause of hospitalizations for children under the age of one. It is also the leading cause of viral death in children under the age of five (Childhood Illnesss

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RSV- Respiratory Syncytial Virus, n.d., para 4). Elderly adults often have very low immune systems and tend to develop pneumonia from the RSV infection. Once complications such as bronchiolitis or pneumonia occurs, substantial medical intervention is needed.

Symptoms of RSV Symptoms of RSV may include coughing, sneezing, wheezing, fever, sore throat, and runny nose. Babies react by being fussy, unwilling to eat, and acting tired. Many people do not even realize that they may be infected because symptoms be vary and differ depending on the age of the patient. Also babies that are less than one year of age can show symptoms of cyanosis which is a bluish skin color that is caused by a lack of oxygen. Infants may also exhibit nasal flaring and rapid breathing also known as tachypnea. Adults may sometimes think they have a cold or the flu, then symptoms are more severe before they actually seek medical treatment from a licensed healthcare provider. The only way to know for sure if you are infected with RSV is to have your physician obtain a mucous sample from your nasal passages then have it sent to a laboratory for testing.

Prevention of RSV One way to prevent RSV in premature babies is through a vaccine. Synagis, is a monthly injection designed to protect preemies and other high risk babies (Synagis is the only FDA approved medication designed to help high-risk babies lungs from severe RSV disease,n.d., para 1). Other ways to prevent the spread of the virus are to maintain proper hand washing techniques, clean surfaces, and to keep your hands away from your eyes and mouth. Never smoke in the house, in the car, or around your baby as this puts them at greater risk. Do not allow

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people that have a cold to be near your baby. And it is extremely important to keep your baby away from large crowds. Following simple procedures such as those that are listed will reduce the risk of spreading the virus.

Treatment of RSV For children who require hospitalization for RSV infection, the main course of care is supportive therapy. RSV can be treated at home if the symptoms are mild. Parents that have a child who is infected with the virus should make sure that the child is in a very comfortable environment. Children who are infected with RSV needs lots of rest and plenty of fluids. If symptoms are more severe, hospitalization is required. Treatments at the hospital can include nebulizations, oxygen therapy, intravenous fluids to maintain fluid and electrolyte balance, suctioning, and pulse oximetry to monitor the level of oxygen saturation. Supplemental oxygen may be given via oxygen ten, nasal prongs or a common face mask. High risk children are generally treated with medications such as anti-viral aerosols. Adults will follow the same medical care as children. Because RSV is not a bacterial infection, it cannot be treated with antibiotics. Supportive care is the mainstay of therapy for respiratory syncytial virus (RSV) infection. If the child can take in fluids by mouth and tolerate room air, outpatient management (with close physician contact as needed) is reasonable, especially in the absence of significant underlying risk factors. Although bronchodilators have been used, no convincing data as to their efficacy in this setting exist. As for corticosteroids, they are also administered at times to patients with RSV infection but the available clinical data does not support the use of corticosteroids in the treatment of typical RSV bronchiolitis.

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If you ever recognize any of these symptoms for a period of three days or more with no improvement, seek medical attention. The best way to avoid complications is to get help early. A simple trip to your physician can make a difference and in some cases it may save your life.

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References

Childhood Illnesses RSV-Respiratory Syncytial Virus. (2012). Retrieved from http://www.askdrsears.com Respiratory syncytial virus (rsv). (2011) Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/001564.htm

Sommer, C., Resch, B., & Simoes, E. (2011). Risk factors for severe respiratory syncytial virus lower respiratory tract infection. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258650/ Synagis is the only FDA approved medication designed to help high-risk babies lungs from severe RSV disease. (2012). Retrieved September 20,2012 from http:// www.synagis.com Groothuis, J., Makari, D., & Hoopes, M. (2009). Rsv risk: Understanding. Retrieved from http://www.managedcaremag.com/sites/default/files/supplements/0910_RSV_riskfactors/ CB_RSV_riskfactors_MC.pdf