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RSV which is the short form for Respiratory syncytial virus is an important cause of respiratory infections in infants and young children. Majority of children are exposed to this virus before completing 2 years of age.
The infection is more common in cold weather and the incidence goes up every year during that season.
The virus undergoes changes is its antigenic structure and hence an attack does not confer lifelong immunity. Re-infections do occur but are usually milder in nature.
Children with weak immune system, those with congenital heart disease with increased blood flow to lungs (VSD, ASD), premature babies and those with chronic lung disease like cystic fibrosis are at higher risk of developing severe infection.
Symptoms and signs: The disease starts with symptoms of upper respiratory infection like cough cold sneezing with or without fever. As the virus spreads into the lower airways the child will suffer from bronchiolitis with rapid breathing, difficulty in feeding and worsening of cough.
Fever may be absent even with significant involvement of lungs. Indrawing of chest is usually seen in young babies. Premature babies may have apnea (brief cessation of breathing).
Laboratory investigations: The RSV antigen can be detected in nasal secretions using florescent antibody staining or ELISA technique. Viral culture takes about 48 hours.
X ray chest may show hyperinflation of lungs. Patchy opacities may be seen in some children.
Other viruses may also cause a similar clinical picture. Wheezing may also be due to asthma or foreign body in airways. Cystic fibrosis may also resemble RSV infection. Pertussis is another cause of severe cough.
In a few children bacterial pneumonia can occur. Rarely respiratory failure or severe apnea may necessitate mechanical ventilation.
Myocarditis (inflammation of heart muscle) is another serious complication which may lead to heart failure. Respiratory Syncytial Virus infection may cause exacerbation of bronchial asthma.
Treatment: Children with mild disease may be treated at home. They may only need medicine for fever and steam inhalation.
Those with respiratory distress who are not able to feed should be hospitalized. They will need intravenous fluids or tube feeds. Humidified oxygen should be given for hypoxia.
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