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CR - Resp Viruses (ii) (RSV (bronchiolitis (acute inflamm injury of…
CR - Resp Viruses (ii)
RSV
most common severe LRTI in infants + young children (80% of bronchiolitis in young children + 20% of pneumonia in young children)
may affect adults (severe if immunocompromised)
world-wide distribution
reinfection normal
URTI in older children + adults (often source of infection for young children)
spread facilitated by overcrowding @ creches, schools
highly infectious
most common cause of resp hospitalisations in young children
most cases not specifically Dxed as RSV
bronchiolitis
acute inflamm injury of bronchioles
common cause of hospitalisation in under 1s
resp distress, tachypnoea, nasal flaring, wheeze, apnoea, cyanosis, irritability, predominant intercostal retraction (suggests lower airway obstruction)
CXR: evidence of hyperinflation (flat diaphragm + hyperlucent i.e. glowing lower lung fields)
Tx mainly supportive
antipyretics + O2
could use antiviral (ribavirin) for high risk infants with severe disease, but not much evidence for benefit
no effective vaccine
consider passive immunisation with palivizumab (monoclonal Ig) during peak season for highly immunocompromised children (must be given monthly)
isolate with droplet precautions
Severe acute resp syndrome (SARS)
new strain of coronavirus
difficult to Dx due to non-specific symptoms
fever of 38+
headache
general discomfort
severe body/muscle aches
fatigue
mild resp symptoms @ first, drug cough +/- SOB after 2-7 days, most develop pneumonia
10-20% get diarrhoea
intermediate host thought to be palm civet
started in Hong Kong, spread by air travel
Middle Eastern resp syndrome (MERS)
novel coronavirus
started in Saudi Arabia
most cases due to human-human transmission
must have close contact (i.e. no standard precautions - often nosocomial acquisition or family clusters)
camels are likely the main reservoir (exact transmission role unknown)
affects more males
3/4 cases have underlying disease
12 day incubation period
cough, fever, SOB, acute resp distress
screen all ICU pneumonia patients for this
Dx = 2 PCR tests (screening + confirmatory)
case fatality = 36%
serology unreliable