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1.
BMJ ; 366: l5021, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31506273

RESUMO

Human respiratory syncytial virus (RSV) belongs to the recently defined Pneumoviridae family, Orthopneumovirus genus. It is a negative sense, single stranded RNA virus that results in epidemics of respiratory infections that typically peak in the winter in temperate climates and during the rainy season in tropical climates. Generally, one of the two genotypes (A and B) predominates in a single season, alternating annually, although regional variation occurs. RSV is a cause of disease and death in children, older people, and immunocompromised patients, and its clinical effect on adults admitted to hospital is clarified with expanded use of multiplex molecular assays. Among adults, RSV produces a wide range of clinical symptoms including upper respiratory tract infections, severe lower respiratory tract infections, and exacerbations of underlying disease. Here we discuss the latest evidence on the burden of RSV related disease in adults, especially in those with immunocompromise or other comorbidities. We review current therapeutic and prevention options, as well as those in development.


Assuntos
Carga Global da Doença , Infecções por Vírus Respiratório Sincicial/epidemiologia , Vírus Sinciciais Respiratórios/genética , Infecções Respiratórias/epidemiologia , Adulto , Antivirais/uso terapêutico , Epidemias , Genótipo , Humanos , Hospedeiro Imunocomprometido , Imunoglobulinas Intravenosas/uso terapêutico , Infecções por Vírus Respiratório Sincicial/imunologia , Infecções por Vírus Respiratório Sincicial/terapia , Infecções por Vírus Respiratório Sincicial/virologia , Vírus Sinciciais Respiratórios/patogenicidade , Infecções Respiratórias/imunologia , Infecções Respiratórias/terapia , Infecções Respiratórias/virologia , Ribavirina/uso terapêutico , Estações do Ano
2.
Pediatr Int ; 61(7): 688-696, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31107995

RESUMO

BACKGROUND: We investigated the characteristics and clinical outcomes of respiratory syncytial virus (RSV)-related pediatric intensive care unit (PICU) hospitalization and assessed the palivizumab (PZ) prophylaxis eligibility according to different guidelines from Korea, EU, and USA. METHODS: In this multicenter study, children <18 years of age hospitalized in six PICU from different hospitals due to severe RSV infection between September 2008 and March 2013 were included. A retrospective chart review was performed. RESULTS: A total of 92 patients were identified. The median length of PICU stay was 6 days (range, 1-154 days) and median PICU care cost was USD2,741 (range, USD556-98 243). Of 62 patients who were <2 years old at the beginning of the RSV season, 33 (53.2%) were high-risk patients for severe RSV infection. Hemodynamically significant congenital heart disease (22.6%) was the most common risk factor, followed by chronic lung disease (11.3%), neuromuscular disease or congenital abnormality of the airway (NMD/CAA) (11.3%), and prematurity (8.1%). The percentage of patients eligible for PZ prophylaxis ranged from 38.7% to 48.4% based on the guidelines, but only two (2.2%) received PZ ≤30 days prior to PICU admission. The median duration of mechanical ventilation was longer in children with NDM/CAA than in those without risk factors (26 days; range, 24-139 days vs 6 days, range, 2-68 days, P = 0.033). RSV-attributable mortality was 5.4%. CONCLUSIONS: Children <2 years old with already well-known high risks represent a significant proportion of RSV-related PICU admissions. Increasing of the compliance for PZ prophylaxis practice among physicians is needed. Further studies are needed to investigate the burden of RSV infection in patients hospitalized in PICU, including children with NMD/CAA.


Assuntos
Hospitalização , Unidades de Terapia Intensiva Pediátrica , Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Antivirais/economia , Antivirais/uso terapêutico , Criança , Pré-Escolar , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica/economia , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Modelos Lineares , Modelos Logísticos , Masculino , Palivizumab/economia , Palivizumab/uso terapêutico , Guias de Prática Clínica como Assunto , República da Coreia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/economia , Infecções por Vírus Respiratório Sincicial/etiologia , Infecções por Vírus Respiratório Sincicial/terapia , Estudos Retrospectivos , Fatores de Risco , Estações do Ano
3.
Rev Soc Bras Med Trop ; 52: e20180329, 2019 Mar 28.
Artigo em Português | MEDLINE | ID: mdl-30942259

RESUMO

INTRODUCTION: Because the antibody neutralizing respiratory syncytial virus (anti-RSV) has a short period of immunization and high cost, the identification of regions and months of highest occurrence of bronchiolitis is very important. METHODS: An Autoregressive Conditional Poisson model was constructed for count data and compared to the standard time-series Poisson regression model. RESULTS: The metropolitan area of Paraná presented the highest average occurrence from May to July. CONCLUSIONS: The constructed model presented a better fit and allowed prediction of when and where the bronchiolitis hospitalizations are distributed.


Assuntos
Bronquiolite/epidemiologia , Hospitalização/estatística & dados numéricos , Infecções por Vírus Respiratório Sincicial/epidemiologia , Brasil/epidemiologia , Bronquiolite/terapia , Bronquiolite/virologia , Feminino , Mapeamento Geográfico , Humanos , Lactente , Distribuição de Poisson , Infecções por Vírus Respiratório Sincicial/terapia , Estações do Ano
4.
Jpn J Infect Dis ; 72(4): 237-242, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-30814460

RESUMO

Human metapneumovirus (HMPV) and respiratory syncytial virus (RSV) are the leading causes of acute respiratory tract infection in children, and clinical manifestations of these virus infections are considered similar. To investigate the differences in clinical characteristics between HMPV and RSV infections in young children, we prospectively enrolled children < 3 years old who required hospitalization with acute respiratory tract infection due to HMPV or RSV at 10 hospitals in Japan. We enrolled 48 children with HMPV infection and 141 with RSV infection. Patients with HMPV infection were older than those with RSV infection. High-grade fever was more frequently observed in patients with HMPV infection, whereas no significant differences in respiratory symptoms were apparent. Abnormal serum lactate dehydrogenase values and consolidation shadows on chest X-ray were more frequently observed in patients with HMPV infection. During hospitalization, nasal mucus suction was more frequently required in patients with RSV infection. On the other hand, ß2-adrenergic agonists, corticosteroids, and leukotriene receptor antagonists were more frequently used in patients with HMPV infection. These findings suggest that HMPV and RSV infections show similar respiratory symptoms, but HMPV infection is more likely to lead to the development of pneumonia, at least among hospitalized young children.


Assuntos
Metapneumovirus , Infecções por Paramyxoviridae/patologia , Infecções por Vírus Respiratório Sincicial/patologia , Vírus Sincicial Respiratório Humano , Infecções Respiratórias/patologia , Infecções Respiratórias/virologia , Doença Aguda , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Japão , Masculino , Nasofaringe/virologia , Infecções por Paramyxoviridae/terapia , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Infecções por Vírus Respiratório Sincicial/terapia , Infecções Respiratórias/terapia
5.
PLoS One ; 14(3): e0213501, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845274

RESUMO

Human respiratory syncytial virus (HRSV) is the main cause of bronchiolitis during the first year of life, when infections by other viruses, such as rhinovirus, also occur and are clinically indistinguishable from those caused by HRSV. In hospitalized infants with bronchiolitis, the analysis of gene expression profiles from peripheral blood mononuclear cells (PBMC) may be useful for the rapid identification of etiological factors, as well as for developing diagnostic tests, and elucidating pathogenic mechanisms triggered by different viral agents. In this study we conducted a comparative global gene expression analysis of PBMC obtained from two groups of infants with acute viral bronchiolitis who were infected by HRSV (HRSV group) or by HRV (HRV group). We employed a weighted gene co-expression network analysis (WGCNA) which allows the identification of transcriptional modules and their correlations with HRSV or HRV groups. This approach permitted the identification of distinct transcription modules for the HRSV and HRV groups. According to these data, the immune response to HRSV infection-comparatively to HRV infection-was more associated to the activation of the interferon gamma signaling pathways and less related to neutrophil activation mechanisms. Moreover, we also identified host-response molecular markers that could be used for etiopathogenic diagnosis. These results may contribute to the development of new tests for respiratory virus identification. The finding that distinct transcriptional profiles are associated to specific host responses to HRSV or to HRV may also contribute to the elucidation of the pathogenic mechanisms triggered by different respiratory viruses, paving the way for new therapeutic strategies.


Assuntos
Bronquiolite Viral/metabolismo , Regulação Viral da Expressão Gênica , Hospitalização , Neutrófilos/metabolismo , Infecções por Picornaviridae/metabolismo , Infecções por Vírus Respiratório Sincicial/metabolismo , Vírus Sinciciais Respiratórios/metabolismo , Rhinovirus/metabolismo , Transcrição Genética , Bronquiolite Viral/terapia , Bronquiolite Viral/virologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Neutrófilos/virologia , Infecções por Picornaviridae/terapia , Infecções por Vírus Respiratório Sincicial/patologia , Infecções por Vírus Respiratório Sincicial/terapia
6.
Nat Rev Microbiol ; 17(4): 233-245, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30723301

RESUMO

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract disease in young children and elderly people. Although the virus was isolated in 1955, an effective RSV vaccine has not been developed, and the only licensed intervention is passive immunoprophylaxis of high-risk infants with a humanized monoclonal antibody. During the past 5 years, however, there has been substantial progress in our understanding of the structure and function of the RSV glycoproteins and their interactions with host cell factors that mediate entry. This period has coincided with renewed interest in developing effective interventions, including the isolation of potent monoclonal antibodies and small molecules and the design of novel vaccine candidates. In this Review, we summarize the recent findings that have begun to elucidate RSV entry mechanisms, describe progress on the development of new interventions and conclude with a perspective on gaps in our knowledge that require further investigation.


Assuntos
Antivirais/farmacologia , Interações entre Hospedeiro e Microrganismos/efeitos dos fármacos , Vírus Sincicial Respiratório Humano/efeitos dos fármacos , Vírus Sincicial Respiratório Humano/fisiologia , Internalização do Vírus/efeitos dos fármacos , Anticorpos Monoclonais/farmacologia , Ensaios Clínicos como Assunto , Humanos , Infecções por Vírus Respiratório Sincicial/terapia , Bibliotecas de Moléculas Pequenas/farmacologia , Vacinas Virais
7.
Eur J Immunol ; 49(1): 157-169, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30427538

RESUMO

Type 2 immunity in the lung is promoted through the release of innate cytokines, including TSLP, from lung structural cells. These cytokines drive Type 2 immunity in part through upregulation of OX40L on dendritic cells (DCs). DCs expressing OX40L are potent inducers of Th2 differentiation. We have shown previously that STAT6 inhibitory peptide (STAT6-IP), a cell penetrating peptide designed to inhibit the STAT6 transcription factor, reduces the induction of Th2 adaptive immunity in murine models of respiratory syncytial virus infection. Here we show that intranasal administration of STAT6-IP at the time of antigen priming with ovalbumin (OVA), in conjunction with the Nod2 agonist, MDP, reduced frequencies of CD11b+ lung DCs expressing OX40L. Consistent with these reductions, fewer activated DCs were localized to the lung draining lymph nodes in STAT6-IP-treated mice. Upon OVA challenge four weeks later, mice treated with STAT6-IP at the time of OVA/MDP priming did not develop airway hyperresponsiveness (AHR) and had reduced influx of eosinophils into the airways, mucus production, and serum OVA-specific IgE levels. Our findings provide evidence that the long-lasting inhibitory effects of STAT6-IP are due in part to inhibition of DC responses that drive maladaptive Th2 adaptive immunity and allergic airways disease.


Assuntos
Células Dendríticas/imunologia , Hipersensibilidade/terapia , Pulmão/imunologia , Linfonodos/imunologia , Peptídeos/uso terapêutico , Infecções por Vírus Respiratório Sincicial/terapia , Vírus Sinciciais Respiratórios/imunologia , Células Th2/imunologia , Imunidade Adaptativa , Alérgenos/imunologia , Animais , Células Cultivadas , Modelos Animais de Doenças , Humanos , Hipersensibilidade/imunologia , Imunoglobulina E/sangue , Camundongos , Camundongos Endogâmicos BALB C , Ligante OX40/metabolismo , Ovalbumina/imunologia , Peptídeos/farmacologia , Infecções por Vírus Respiratório Sincicial/imunologia , Fator de Transcrição STAT6/antagonistas & inibidores
8.
Clin Pediatr (Phila) ; 58(2): 177-184, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30387696

RESUMO

We reviewed the resource utilization of patients with human rhinovirus/enterovirus (HRV/ENT), influenza A/B (FLU), or respiratory syncytial virus (RSV). A total of 2013 patients with nasopharyngeal swabs positive for HRV/ENT, RSV, or FLU were included. Records were reviewed for respiratory support, vascular access procedures, emergency department care only versus admission versus pediatric intensive care unit (PICU) care, antibiotics, length of stay, and billing data. Of the 2013 subjects, 1251 tested positive for HRV/ENT, 558 for RSV, and 204 for FLU. Fewer HRV/ENT patients were discharged from the emergency department ( P < .001); and they were more likely to be admitted to the pediatric intensive care unit ( P < .001). HRV/ENT and RSV patients were more likely to require invasive procedures ( P = .01). Median hospital costs for HRV/ENT patients were more than twice that of FLU patients ( P < .001). HRV/ENT infection in pediatric patients poses a significant resource and cost burden, even when compared with other organisms.


Assuntos
Infecções por Enterovirus/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Influenza Humana/economia , Infecções por Picornaviridae/economia , Infecções por Vírus Respiratório Sincicial/economia , Criança , Pré-Escolar , Infecções por Enterovirus/terapia , Feminino , Humanos , Lactente , Influenza Humana/terapia , Unidades de Terapia Intensiva Pediátrica/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Infecções por Picornaviridae/terapia , Infecções por Vírus Respiratório Sincicial/terapia
9.
Rev Chil Pediatr ; 89(4): 462-470, 2018 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30571819

RESUMO

INTRODUCTION: Considering the high prevalence of respiratory infections in hospitalized infants with Respiratory Syncytial Virus (RSV), the objective of this study is to determine the direct costs of this infection. PATIENTS AND METHOD: Prospective longitudinal study in infants under one year of age hospitalized due to RSV during 2015. The patients were divided into 2 groups, Group 1 pa tients without risk factors and Group 2 patients with risk factors (prematurity, oxygen dependence, bronchopulmonary dysplasia, heart disease, immunocompromised patients), comparing each other variables such as nutritional status, gender, breastfeeding, discharge diagnosis, radiological diagno sis, length of hospital stay, among others. Direct costs for hospitalization were estimated according to the fees of the National Health Fund (FONASA) and the Modality of Institutional Care (MAI). RESULTS: The total patients admitted in the period were 260: 234 (90%) in Group 1 and 26 (10%) in Group 2. The average hospital stay for Group 1 was 7.3 days (SD+5.1) with a median of 6 days, and 13.6 days (SD+16.3) for Group 2 with a median of 7 days (p < 0.05). The direct costs associated with RSV hospitalization were on average CLP $ 413,529 (US$ 632.1) for Group 1, and CLP $ 744,260 (US$ 1,137.6) for Group 2 (p < 0.05). There was also statistically significant higher cost for Group 2 due to tests and drugs (p < 0.05) and costs per day of hospital stay (p < 0.05). CONCLUSION: These values, known for the first time in the national reality, confirm the high cost of these infections and particularly in risk groups.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Infecções por Vírus Respiratório Sincicial/economia , Chile , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Estudos Prospectivos , Infecções por Vírus Respiratório Sincicial/terapia
10.
PLoS One ; 13(11): e0206474, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30439987

RESUMO

OBJECTIVES: Understanding respiratory syncytial virus (RSV) morbidity may help to plan health care and future vaccine recommendations. We aim to describe the characteristics and temporal distribution of children diagnosed with RSV admitted in a Spanish hospital. METHODS: Descriptive study for which the hospital discharges of children < 5 years of age with RSV infection were analyzed. The information was extracted from the hospital discharge database of a reference pediatric hospital in northern Spain for the 2010-2011 to 2014-2015 RSV seasons. RESULTS: Six hundred and forty-seven hospitalizations of children with RSV infection were analyzed, 94% of which occurred between the second week of November and the last week of March. Most children (72%) were under one year of age and 95% were previously healthy infants. Infants born from October to December had the highest risk of hospitalization in the first year of life. The median length of hospital stay of children with and without comorbidities was six and three days, respectively. 6.5% of the hospitalized cases were admitted to the pediatric intensive care unit; this percentage was higher among children < 2 months (adjusted odds ratio 4.15; 95% confidence interval: 1.37-12.61) or with comorbidities (adjusted odds ratio 4.15; 95% confidence interval: 1.53-11.28). The case lethality was 0.3%. CONCLUSIONS: The risk of hospitalizations for RSV is high during the first year of life and increases among infants born in the fall. Being under two months of age and presenting comorbidities are the main risk factors associated to pediatric intensive care unit admission.


Assuntos
Hospitalização/estatística & dados numéricos , Infecções por Vírus Respiratório Sincicial/epidemiologia , Vírus Sincicial Respiratório Humano/fisiologia , Pré-Escolar , Comorbidade , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação , Masculino , Infecções por Vírus Respiratório Sincicial/terapia , Fatores de Risco , Estações do Ano , Espanha/epidemiologia
11.
Minerva Pediatr ; 70(6): 612-622, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30334625

RESUMO

Bronchiolitis is one of the most frequent reasons for Pediatric Intensive Care Unit (PICU) admission in children less than 1 year of age. It causes a wide spectrum of clinical scenarios from mild to severe respiratory failure and supportive therapy range from high flow nasal cannula (HFNC) to nonconventional ventilation and extra corporeal membrane oxygenation (ECMO) in the most severe forms. Aim of this article is to review the available ventilation mode in children with bronchiolitis and the scientific evidence. The main medical databases were explored to search for clinical trials that address management strategies for respiratory support of infants with respiratory syncytial virus (RSV) infection. HFNC use is increasing and it seems to be useful as first line therapy in the emergency room and in the pediatric ward to prevent PICU admission but it is not clear yet if it is equivalent to noninvasive ventilation (NIV). NIV use in bronchiolitis is well established, mainly in continuous positive airway pressure mode in moderate and severe bronchiolitis. A mild evidence towards use of NIV to prevent endotracheal intubation is raising from few studies. Finally, for patients who failed a NIV trial, endotracheal intubation should be considered as the best option to support ventilation with conventional, nonconventional mode and ECMO in the most severe acute respiratory distress syndromes. There is a lack of quality studies for the use of any of the proposed ventilatory support in infants with bronchiolitis, especially in the severe forms. Nevertheless, in the last two decades daily use of noninvasive positive pressure supports have reached a large consensus based on clinical judgement and weak published evidence. We need specific and clear guidelines on which is the optimal management of these patients, and more robust randomized clinical trials to best evaluate timing and efficacy of HFNC and NIV use.


Assuntos
Bronquiolite/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Respiração Artificial/métodos , Bronquiolite/epidemiologia , Bronquiolite/fisiopatologia , Cânula , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Intubação Intratraqueal , Ventilação não Invasiva/métodos , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/terapia , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/terapia , Índice de Gravidade de Doença
12.
Arch Dis Child ; 103(12): 1163-1167, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30217858

RESUMO

OBJECTIVE: To evaluate the impact of new reimbursement decisions for palivizumab treatment on respiratory syncytial virus (RSV) hospitalisations and the concomitant number of palivizumab prescriptions for infants aged <2 years. DESIGN: We compared the RSV hospitalisation rates in infants before and after implementation of new limitations during three RSV seasons 2014-2017. SETTING: Population aged <2 years at the beginning of each RSV seasons extracted from regional health systems (Lazio region, 2016, 5 898 124 inhabitants and 47 595 births). PATIENTS: Out of 70 323 infants, 5895 (8.4%) premature babies (gestational age (GA) <37 weeks) were followed before-after Italian Medicines Agency (AIFA)-2016 limitations. INTERVENTION: In 2016, AIFA, following the American Academy of Pediatrics guidelines, decided to limit coverage of palivizumab prophylaxis (GA ≤29 weeks). MAIN OUTCOMES MEASURES: Trend of hospitalisations by months and rate of RSV before-after new restrictions were analysed. Palivizumab prescriptions and costs for National Health Service (NHS) were considered. RESULTS: In a population of 284 902 aged <2 years, the number of hospitalisations due to RSV infection was 1729. Following AIFA-2016 limitations, a reduction in the number of RSV infection-based hospitalisations from 6.3/1000 (95% CI 6.0 to 6.7) to 5.5/1000 (95% CI 5.0 to 5.9) was observed. Palivizumab showed a concomitant reduction of 48% in the number of prescriptions (saving €750 000 for the NHS). No differences of GA, age on admission or severity of RSV infection were observed. CONCLUSIONS: Implementation of the new palivizumab reimbursement criteria was not associated with an increase in the RSV hospitalisation rate for children aged <2 years despite a significant reduction in the number of palivizumab prescriptions.


Assuntos
Antivirais/economia , Uso de Medicamentos/tendências , Hospitalização/tendências , Reembolso de Seguro de Saúde , Palivizumab/economia , Padrões de Prática Médica/tendências , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Antivirais/uso terapêutico , Custos de Medicamentos/tendências , Uso de Medicamentos/economia , Feminino , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/normas , Palivizumab/uso terapêutico , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/economia , Prevalência , Infecções por Vírus Respiratório Sincicial/economia , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/terapia
13.
J Med Case Rep ; 12(1): 258, 2018 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-30205845

RESUMO

BACKGROUND: Respiratory syncytial virus is the most common cause of lower respiratory tract infections in infants and young children. While the majority of infants display only mild upper respiratory tract infection or occasionally otitis media, around one-third will develop an infection of the lower respiratory tract, usually bronchiolitis. There is now convincing evidence from a number of cohorts that respiratory syncytial virus is a significant, independent risk factor for later wheezing, at least within the first decade of life. The wide variation in response to respiratory syncytial virus infection suggests that susceptibility and disease are influenced by multiple host-intrinsic factors. CASE PRESENTATION: A 2-year-old white girl presented to our Pediatric Allergy Clinic with recurrent crackles in addition to cough, fevers, and labored breathing since her first respiratory syncytial virus infection at the age of 7 months. She had been under the care of pulmonologists, who suspected childhood interstitial lung disease. She was hospitalized eight times due to exacerbation of symptoms and prescribed systemic and inhaled steroids, short-acting ß2-mimetics, and antileukotriene. There was no short-term clinical improvement at that time between hospitalizations. During her hospital stay at the Pneumonology and Cystic Fibrosis Department in Rabka a bronchoscopy with bronchoalveolar lavage was performed. Laboratory bacteriological tests found high colony count of Moraxella catarrhalis (ß-lactamase positive), sensitive to amoxicillin-clavulanate, in bronchial secretions and swabs from her nose. After this, infections were treated with antibiotics; she remained in good condition without symptoms. Crackles and wheezing recurred only during symptoms of infections. Therefore, we hypothesize that respiratory syncytial virus infection at an early age might cause severe damage of the lung epithelium and prolonged clinical symptoms, mainly crackles and wheezing, each time the child has a respiratory infection. CONCLUSIONS: This case illustrates the importance of respiratory syncytial virus infection in an immunocompetent child. Pediatricians need to have a high index of suspicion and knowledge of recurrent symptoms associated with severe damage of the lung epithelium to establish the correct diagnosis.


Assuntos
/isolamento & purificação , Infecções por Moraxellaceae/diagnóstico , Sons Respiratórios/fisiopatologia , Infecções por Vírus Respiratório Sincicial/fisiopatologia , Vírus Sincicial Respiratório Humano/isolamento & purificação , Infecções Respiratórias/complicações , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Bronquiolite/diagnóstico , Bronquiolite/microbiologia , Bronquiolite/terapia , Bronquiolite/virologia , Líquido da Lavagem Broncoalveolar , Pré-Escolar , Feminino , Humanos , Infecções por Moraxellaceae/tratamento farmacológico , Infecções por Moraxellaceae/etiologia , Infecções por Moraxellaceae/microbiologia , Nariz/microbiologia , Sons Respiratórios/etiologia , Infecções por Vírus Respiratório Sincicial/complicações , Infecções por Vírus Respiratório Sincicial/terapia , Infecções Respiratórias/fisiopatologia , Infecções Respiratórias/terapia , Infecções Respiratórias/virologia
14.
J Pediatr ; 203: 92-100.e3, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30266507

RESUMO

OBJECTIVES: To compare the respiratory syncytial virus (RSV)-related hospitalization rate, hospital length of stay (LOS), and need for assisted ventilation in children aged <2 years with Down syndrome and those without Down syndrome. STUDY DESIGN: MEDLINE, Embase, and CINAHL databases were searched from inception up to December 2017. Studies that provided data on RSV-related hospitalization in children aged <2 years with Down syndrome and those without Down syndrome were included. Data were independently extracted in pairs by 2 reviewers and synthesized with random-effects meta-analysis. RESULTS: In 10 studies including a total of 1 748 209 children, 12.6% of the children with Down syndrome (491 of 3882) were hospitalized with RSV infection. The presence of Down syndrome was associated with a significantly higher risk of RSV-related hospitalization (relative risk [RR], 6.06; 95% CI, 4.93-7.45; I2 = 65%; Grading of Recommendations, Assessment, Development and Evaluation [GRADE], moderate). RSV-related LOS (mean difference, 2.11 days; 95% CI, 1.47-2.75 days; I2 = 0%; GRADE, low), and the need for assisted ventilation (RR, 5.82; 95% CI, 1.81-18.69; I2 = 84%; GRADE, low). Children with Down syndrome without congenital heart disease (RR, 6.31; 95% CI, 4.83-8.23; GRADE, moderate) also had a significantly higher risk of RSV-related hospitalization. The risk of RSV-related hospitalization remained significant in the subgroup of children aged <1 year (RR, 6.25; 95% CI, 4.71-8.28; GRADE, high). CONCLUSION: RSV-related hospitalization, hospital LOS, and the need for assisted ventilation are significantly higher in children with Down syndrome aged <2 years compared with those without Down syndrome. The results should prompt reconsideration of the need for routine RSV prophylaxis in children with Down syndrome up to 2 years of age.


Assuntos
Síndrome de Down/complicações , Hospitalização/estatística & dados numéricos , Infecções por Vírus Respiratório Sincicial/complicações , Humanos , Tempo de Internação/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Infecções por Vírus Respiratório Sincicial/terapia
15.
Clin Pediatr (Phila) ; 57(14): 1686-1692, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30173563

RESUMO

INTRODUCTION: We performed a retrospective study to evaluate demographics, clinical course, outcome, and radiological findings of children with respiratory syncytial virus (RSV) infection. METHODS: Four hundred patients admitted between October 2013 and May 2016 were enrolled. Clinical and radiographic trends were evaluated for association with severity of RSV presentation. Severity was defined as hospitalization >2 days, pediatric intensive care unit admission, or need for mechanical ventilation. RESULTS: Common clinical findings included fever (78.5%), coughing (97%), rhinorrhea/congestion (93%), and hypoxia (44.8%). Hypoxia was seen in 64.7% of the severe group compared with 32.0% in the nonsevere group ( P < .001). Airspace opacification was seen in 49.2% of chest X-rays of the severe group compared with 26.4% in the nonsevere group ( P < .001). CONCLUSION: Higher incidence of hypoxia or airspace opacification on chest X-ray may be predictors of poorer outcomes for patients with RSV infection.


Assuntos
Infecções por Vírus Respiratório Sincicial/complicações , Infecções por Vírus Respiratório Sincicial/diagnóstico por imagem , Pré-Escolar , Feminino , Hospitais Comunitários , Humanos , Lactente , Tempo de Internação , Masculino , Radiografia Torácica , Infecções por Vírus Respiratório Sincicial/terapia , Estudos Retrospectivos , Índice de Gravidade de Doença , Avaliação de Sintomas
17.
Nurse Pract ; 43(9): 20-26, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30134433

RESUMO

Respiratory syncytial virus (RSV) is a common viral infection affecting many children in the United States. This seasonal virus is the leading cause of hospitalization of infants and neonates. This article reviews the current recommendations for diagnostic testing, treatment options, and prevention of RSV.


Assuntos
Guias de Prática Clínica como Assunto , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/terapia , Coinfecção , Testes Diagnósticos de Rotina , Humanos , Infecções por Vírus Respiratório Sincicial/fisiopatologia , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Fatores de Risco , Índice de Gravidade de Doença
18.
Artigo em Inglês | MEDLINE | ID: mdl-29932038

RESUMO

BACKGROUND: Community-acquired pneumonia is an important cause of morbidity in developed countries and an important cause of morbidity and mortality in developing countries. Prompt diagnosis and appropriate treatment are very important. OBJECTIVE: To provide an update on the evaluation, diagnosis, and treatment of community-acquired pneumonia in children. METHODS: A PubMed search was completed in Clinical Queries using the key term "communityacquired pneumonia". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Patents were searched using the key term "community-acquired pneumonia" from www.google.com/patents, http://espacenet.com, and www. freepatentsonline.com. RESULTS: Generally, viruses, notably respiratory syncytial virus, are the most common cause of community- acquired pneumonia in children younger than 5 years. Streptococcus pneumoniae is the most common bacterial cause across all age groups. Other important bacterial causes in children younger than 5 years include Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus aureus, and Moraxella catarrhalis. In children 5 years or older, in addition to S. pneumoniae, other important bacterial causes include Mycoplasma pneumoniae and Chlamydophila pneumonia. In the majority of cases, bacterial and viral pneumonia cannot be reliably distinguished from each other on clinical grounds. In practice, most children with pneumonia are treated empirically with antibiotics; the choice of which depends on the patient's age and most likely pathogen. Recent patents related to the management of community-acquired pneumonia are discussed. CONCLUSION: In previously healthy children under the age of 5 years, high dose amoxicillin is the treatment of choice. For those with type 1 hypersensitivity to penicillin, clindamycin, azithromycin, clarithromycin, and levofloxacin are reasonable alternatives. For children with a non-type 1 hypersensitivity to penicillin, cephalosporins such as cefixime, cefprozil, cefdinir, cefpodoxime, and cefuroxime should be considered. In previously healthy children over the age of 5 years, macrolides such as azithromycin and clarithromycin are the drugs of choice.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Infecções Pneumocócicas/diagnóstico , Pneumonia/diagnóstico , Infecções por Vírus Respiratório Sincicial/diagnóstico , Vírus Sinciciais Respiratórios/fisiologia , Streptococcus pneumoniae/imunologia , Antibacterianos/uso terapêutico , Criança , Infecções Comunitárias Adquiridas/terapia , Diagnóstico Diferencial , Humanos , Patentes como Assunto , Infecções Pneumocócicas/terapia , Pneumonia/terapia , Infecções por Vírus Respiratório Sincicial/terapia
20.
BMC Infect Dis ; 18(1): 111, 2018 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-29510663

RESUMO

BACKGROUND: Respiratory syncytial virus (RSV) is associated with significant mortality rates amongst hematopoietic stem cell transplant (HSCT) recipients, with less known about other immunocompromised patients. METHODS: Ten-year retrospective cohort study of immunocompromised patients presenting with RSV disease documented at University Hospitals of Lausanne and Geneva. Severe RSV-related outcomes referred to RSV documented respiratory conditions requiring hospital admission, presenting as lower respiratory tract infection (LRTI) or pneumonia. We used multivariable logistic regression to assess clinical and laboratory correlates of severe RSV disease. RESULTS: From 239 RSV-positive immunocompromised in and out-patients 175 were adults and 64 children of whom 111 (47.8%) presented with LRTI, which resulted in a 38% (89/239) admission rate to hospital. While immunocompromised children were more likely to be admitted to hospital compared to adults (75% vs 62.9%, p = 0.090), inpatients admitted to the intensive care unit (17/19) or those who died (11/11) were mainly adults. From multivariable analyses, adults with solid tumors (OR 5.2; 95% CI: 1.4-20.9 P = 0.015) or those requiring chronic immunosuppressive treatments mainly for rheumatologic conditions (OR 4.1; 95% CI: 1.1-16.0; P = 0.034) were significantly more likely to be admitted to hospital compared to hematopoietic stem cell (HSCT) recipients. Bacterial co-infection was significantly and consistently associated with viral LRTI and pneumonia. CONCLUSIONS: From our findings, RSV-related disease results in a significant burden among adults requiring chronic immunosuppressive treatments for rheumatological conditions and those with solid tumors. As such, systematic screening for respiratory viruses, should be extended to other immunocompromised populations than HSCT recipients.


Assuntos
Hospedeiro Imunocomprometido , Pneumonia Viral/virologia , Infecções por Vírus Respiratório Sincicial/etiologia , Infecções por Vírus Respiratório Sincicial/terapia , Infecções Respiratórias/virologia , Adolescente , Adulto , Criança , Pré-Escolar , Coinfecção , Feminino , Hospitalização , Humanos , Lactente , Modelos Logísticos , Masculino , Pneumonia Viral/terapia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções Respiratórias/terapia , Estudos Retrospectivos , Adulto Jovem
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