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RSV
Breanna Fretwell
History of RSV
DISCOVERED IN 1956
ONE OF THE MOST COMMON CAUSES OF CHILDHOOD ILLNESS
A MEMBER OF THE FAMILY PARAMYXOVIRIDAE AND THE SUBFAMILY PNEUMOVIRINAE
IT IS AN ENVELOPED RNA VIRUS AND TWO STRAINS (SUBGROUPS A AND B) ARE RECOGNIZED
Case Study – Twin A
Our patient is an ex-36 wk, now 1-month old (twin A) girl with a 3-day history of cough and nasal congestion.
She presented to her PMD with decreased activity, sleepiness, cough and nasal congestion
On the day of her admission, she was seen by her doctor and noted to be hypothermic to 101.3 F, lethargic
She was admitted for further evaluation and treatment.
Because of her nasal discharge and cough, RSV and Flu-A nasal washings were sent.
Nasopharyngeal washing for RSV was positive
The team initiated racemic epinephrine and nasal suctioning
Her respiratory symptoms resolved over the course of a week
The child was discharged home
Paramyxoviridae Pneumovirinae
Morphology: Spherical or filamentous, pleomorphic
Envelope: Yes
Diameter (nm): 90-350
Length (nm): 90-10,000
Structural components:Nucleocapsid, envelope with transmembrane viral spikes
Buoyant density (g/mL): 1.18-1.20
Lipid composition:Envelope lipids are derived from plasma membrane of host cell
Additional information:Surface glycoprotein spikes are 11-20 nm long; dense internal nucleocapsid; infectivity unstable
FAMILY SUBFAMILY
Virulence
Nucleocapsid protein associates with genomic RNA
protects the RNA from nuclease digestion
Requirement for a neutral pH for fusogenic activity.
The cell attachment proteins span the viral envelope
project from the surface as spikes
bind to proteins on the surface of target cells to facilitate cell entry
Can survive on hard surfaces such as tables and crib rails for many hours
Softer surfaces like tissues and clothes for shorter period of time
What does RSV do?
Attacks: Mucous membranes of nose and throat especially
trachea, bronchi, bronchioles, and alveoli
Speed: 3-5 day incubation; progression over 1-7 days
Who does it affect? Can affect anyone of any age. The severest
infections usually occur in infants, the elderly, or people with weakened immune systems
RSV can cause: upper respiratory infections (such as colds)
lower respiratory tract infections (such as bronchiolitis and pneumonia).
In children under 1 year of age, RSV is the most important cause of bronchiolitis, an inflammation of the small airways in the lung.
Show symptoms within 4 to 6 days of infection. Most recover in 1 to 2 weeks Even after recovery, very young infants and children with weakened
immune systems can continue to spread the virus for 1 to 3 weeks.
How RSV affects human cells
How do you catch RSV?
often introduced into the home by school-aged children who have a mild upper respiratory tract infection, such as a cold.
RSV can be spread when droplets containing the virus are sneezed or coughed into the air by an infected person
direct and indirect contact with nasal or oral secretions from infected persons.
Direct contact: wiping childs nose
Indirect contact: touching door knob that the person with RSV touched and then wiping your eyes, nose or mouth
How do you know if you have it?
Nasopharyngeal washing for RSV
Dr. cultures a sample of mucous from your nose
Usually diagnosed by symptoms and by knowing whether there is an outbreak of the infection in your area
Prevention
Wash your hands often
Disinfect hard surfaces
Do not share cups or eating utensils
Isolate person with RSV
Treatment
Palivizumab
Drug for the prevention of RSV in high risk people
Does not lessen the infection if it has already been transmitted
Drug treatments are in progress, but none are available yet
Prop up your child's head to make it easier to breathe and sleep.
Suction your baby's nose if he or she can't breathe well enough
Infection will go away on its own in a week or so
Prevalence of RSV
Almost all children will have had an RSV infection by their second birthday.
When infants and children are exposed to RSV for the first time, 25% to 40% of them have signs or symptoms of bronchiolitis or pneumonia, and 0.5% to 2% will require hospitalization.
Most children hospitalized for RSV infection are under 6 months of age.
Specific number of people with this infection is unknown, but about 125,000 per year diagnosed
In temperate climates, tends to be an epidemic during winter season
In tropical climates, tends to be an epidemic during rainy season
In the United States…
In Oregon…
Why is RSV important?
RSV will affect the majority of people in their lifetimes at least once if not multiple times
Anybody of any age can get RSV
Though many cases are not serious, they are just seriously uncomfortable, some cases are very serious with the possibility or occuring of death. If death is even a possibility, it should be researched
References Case Presentation: Respiratory Synctial Virus (RSV) Infection. Sutter
Health CPMC. May 2003. Accessed July 14, 2013. http://www.cpmc.org/advanced/pediatrics/physicians/pedpage-503rsv.html
History of RSV. Center for Disease Control and Prevention. January 14, 2010. Accessed July 15, 2013. http://www.cdc.gov/rsv/research/history.html
SpringerReference. Pneumovirus. 2013. Accessed July 14, 2013 http://www.springerreference.com/docs/html/chapterdbid/311139.html
Stanford edu. 2000. Accessed July 15, 2013. http://www.stanford.edu/group/virus/rhabdo/2000/RSV.html
Center for Disease Control and Prevention. January 14, 2010. Accessed July 15, 2013. http://www.cdc.gov/rsv/about/symptoms.html