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RSV (respiratory syncytial virus) infection is the main cause of respiratory diseases in young children, especially dangerous under the age of 2.
RSV – how does it get infected?
RSV is spreading by droplets as a result of close contact with an infected person or objects contaminated with secretions from the respiratory tract. The mucosa of the nose (but not the mouth) and the conjunctiva is the gateway of infection. The RSV incubation period is 2-8 days, and the patient excretion period is about 8 days, in infants and immunocompromised people this time may be extended up to 4 weeks.
RSV infection is common – in about 95 percent. children in 2 years of age have antibodies indicating contact with the virus. Surviving an infection does not protect against reinfection, which is common at all ages. Infection can occur very early, under 6 months of age. The group of special risks includes:
- newborns with low birth weight,
- artificially fed infants,
- children with bronchopulmonary dysplasia, congenital heart defects and immune system deficiencies.
The course of infection in these cases is usually severe and requires treatment in an intensive care unit. RSV infection is the most common cause of hospital admission for respiratory infections in children.
RSV infection is characterized by seasonality. In temperate climates, the number is highest in late autumn to early spring. During epidemic periods, RSV infection is diagnosed in about 90 percent. young children with acute inflammation of the lower respiratory tract.
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A few words about the RSV virus
The RSV virus belongs to the family Paramyxoviridaewhich includes enveloped, single-stranded RNA viruses. Unlike most members of this family, RSV does not contain haemagglutinin or neuraminidase. In cell cultures, it causes the merging of cells and the formation of syncytia, which is caused by one of the 3 surface glycoproteins of the virus – the F protein (fusion protein). The other 2 glycoproteins – G and SH proteins – are responsible for attaching the viral particle to the cell and for penetration. F and G glycoproteins have strong immunogenic properties, and antigenic differences, mainly related to G protein, are the basis for distinguishing two types of RSV – A and B.
Pathogenesis of the RSV virus
The most severe forms of RSV infections are observed in children up to 6 months of age. They fall ill despite high levels of specific maternally derived antibodies. Severe cases have also been seen in children with high levels of antibodies induced by an inactivated vaccine. These observations suggest that the pathogenesis of RSV infection may have immunological basis. Among the attempts to explain this phenomenon, the contribution of immune complexes formed by passively acquired IgG was raised, especially in the absence of secreted IgA, the role of RSV-specific IgE and impaired cell type response. It also takes into account the immaturity of the immune system in newborns and infants, and the suggestion that inflammation in the bronchioles, in combination with the low lumen of the airways, causes more severe clinical symptoms than in children later in life.
RSV infection – clinical symptoms
In young children, RSV infection may involve the lower respiratory tract and develop as inflammation of the bronchioles (bronchiolitis) and the lungs (pneumonia), less commonly as inflammation of the trachea and bronchi (tracheobronchitis). Infections of the upper respiratory tract are similar to the common cold and their main symptom is cough. Very rarely (less than 1%), the first RSV infection is asymptomatic.
A common complication of RSV infection is otitis media, occasionally inflammation of the heart muscle. In older children and adults, RSV infections are usually the result of reinfection and their course varies from asymptomatic infections to severe forms of lower respiratory tract infections in the high-risk group of elderly people with immune system disorders and coexisting chronic diseases.
RSV virus – laboratory diagnosis
Laboratory confirmation of RSV infection may be based on:
- positive virus isolation result (virus isolation is a certain confirmation of the clinical diagnosis, but due to the long waiting time for the result, this method is rarely used in routine diagnostics);
- detection of viral antigens or nucleic acid (the most common methods are the detection of viral antigens by immunofluorescence or enzyme immunoassay technique (EIA), or the determination of viral RNA by PCR in epithelial cells of the upper respiratory tract. Nasopharyngeal washings or tracheal secretions are the appropriate material for these determinations) ;
- serological tests (serological determinations are more appropriate for epidemiological studies than to obtain confirmation only after examining 2 serum samples taken in the acute phase and after about 2 weeks (increase in antibody titer)).
RSV infection in young children and immunosuppressed individuals may not increase IgG titers.
RSV infection – treatment
For most RSV infections, treatment is limited to drinking the right amount of fluids and controlling body temperature. In severe cases of inflammation of the lower respiratory tract, oxygen therapy under gasometry or assisted respiration may be required. The efficacy of antiviral therapy (ribavirin) as well as corticosteroids has not been clearly confirmed. It was assumed that their intake should be limited to justified cases, as well as the administration of antibiotics (bacterial superinfections rarely occur in the course of RSV infection). Your doctor may prescribe the drug to be taken by inhalation. A home electric inhaler will then turn out to be a very useful equipment. Below are some of our proposals with links to favorable offers:
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How to protect yourself from RSV?
In the 60s, an attempt was made to use an inactivated vaccine against RSV infection. As a result of natural infection, severe course of the disease was noted in immunized children. The inactivated vaccine has been withdrawn – work is currently underway to develop a subunit, attenuated and polypeptide vaccine.
Literature
1. Collins P.L., McIntosh K., Chanock R.M.: Respiratory Syncytial Virus, [w:] Fields B.N., Knipe D.M., Howley P.M. (red.): Fields Virology, Lippincott-Raven Publishers, Philadelphia 1996, 1313-1351.
2. Hall C.B., McCarthy C.A.: Respiratory Syncytial Virus, [w:] Mandell G.L., Bennett J.E., Dolin R. (red.): Prin ciples and Practice of Infectious Diseasses, Elsevier, 2005, 2008-2021 (wyd. VI).
3. Wilczyński J., Torbicka E., Brzozowska-Binda A., Szymańska U .: Viral respiratory infections in young children in the season 1996-1997, Przegl Epidemiol 1998; 52: 455-462.
Source: J. Cianciara, J. Juszczyk, Infectious and parasitic diseases; Czelej Publishing House