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  • Snapshot
    • A 1-year-old toddler is brought to the emergency room for trouble breathing. His parents report that for the past few days, he has had low-grade fevers, nasal congestion, and a cough. Today, he did not appear to want to eat or drink any water. On physical exam, he is saturating 88% on room air. He has a prolonged expiratory phase and diffuse wheezes bilaterally. He has nasal flaring and intercostal retractions. He is given supplemental oxygen and admitted for further management.
  • Introduction
    • Classification
      • respiratory syncytial virus (RSV)
        • an enveloped, linear, single-stranded, negative-sense RNA virus with a helical capsid
        • a paramyxovirus
        • causes bronchiolitis in infants and atypical pneumonia
    • Epidemiology
      • incidence
        • more common in the winter
      • demographics
        • children < 2 years of age
      • risk factors
        • daycare centers
        • exposure to air pollutants such as cigarette smoke
        • cardiopulmonary disease
        • immunodeficiency
        • premature infants
    • Pathogenesis
      • the virus contains surface protein F (fusion), which induces respiratory epithelial cells to form multinucleated giant cells
      • the virus initially infects the upper respiratory tract and travels to the lower respiratory tract within a few days
      • edema of submucosa causes an obstructive pathology in the lungs, causing wheezing and respiratory distress
    • Prevention
      • palivizumab
        • mechanism
          • monoclonal antibody against F protein
        • indication
          • premature infants
          • babies at risk of severe infection (i.e., immunocompromised status)
    • Prognosis
      • typically self-limited
      • more severe in infants < 6 months of age
  • Presentation
    • Symptoms
      • low-grade fever
        • a high fever may indicate pneumonia
      • congestion
      • cough
      • poor feeding
      • grunting
    • Physical exam
      • tachypnea
      • bilateral wheezing
      • prolonged expiratory phase
      • increased work of breath
        • nasal flaring
        • intercostal retractions
      • focal crackles
        • in patients with pneumonia
  • Imaging
    • Chest radiography
      • indication
        • suspected pneumonia
      • findings
        • diffuse patchy infiltrates
  • Studies
    • Making the diagnosis
      • most cases are clinically diagnosed
  • Differential
    • Asthma
      • distinguishing factors
        • typically recurrent episodes with identifiable triggers
        • history of atopy in the patient or family
    • Foreign body aspiration
      • distinguishing factor
        • unilateral wheezing
  • Treatment
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • hydration
          • supplemental oxygen
          • superficial nasal suctioning
  • Complications
    • Hypoxemic respiratory failure
      • treatments
        • oxygen
        • mechanical ventilation
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