Review Question - QID 100893

This patient's presentation is consistent with respiratory syncytial virus (RSV) infection. RSV can be treated with ribavirin, a viral RNA polymerase inhibitor. Ribavarin is also used to treat hepatitis C.

Ribavirin acts by inhibiting the production of guanine nucleotides via competitive inhibition of IMP dehydrogenase. Ribavirin can be used to treat hepatitis C (in conjunction with IFN-alpha), RSV, and viral hemorrhagic fevers. However, research has not conclusively shown whether ribavirin provides a clinical benefit in RSV bronchiolitis.

Jeng et al. review respiratory syncytial virus (RSV) bronchiolitis. RSV remains a major health problem throughout the world and can result in significant morbidity and mortality in young patients. It is characteristically associated with clinical signs and symptoms of small airway obstruction. Most commonly treatment involves supportive measures, including fluid hydration and aerosolized bronchodilators. The administration of ribavirin is typically reserved for severely ill children or those with significant other underlying illnesses.

Krilov reviews the current treatment options for RSV. Overall treatment remains geared towards supportive therapy targeting specific symptoms, as trials of bronchodilators and corticosteroids have failed to consistently demonstrate clinical benefit. Ribavirin has demonstrated marginal clinical benefit. Palivizumab has been shown to be effective as prophylaxis in high-risk infants.

Illustration A displays a radiograph of an infant with RSV bronchiloitis. Note the hyperinflated lungs and depressed diaphragm.

Incorrect Answers:
Answer 1: Protease inhibitors, reverse transcriptase inhibitors, and many other classes of drugs are used to treat HIV infection. Ribavirin has not been shown to be effective against HIV.
Answer 2: Lamivudine and IFN-alpha are used to treat hepatitis B, a DNA virus.
Answer 4: There is no specific treatment for rhinovirus. Rhinovirus is the most common cause of the common cold. The virus is destroyed by stomach acid and therefore cannot cause gastroenteritis.
Answer 5: Acyclovir is used to treat herpes simplex virus.