RSV infection
Case Study
Read the following case study and derive what you can to assist the patient. This should involve assessment of the facts, development of a hypothesis, and use of data to resolve the hypothesis. The logic you apply is more important than actually reaching the correct conclusion.
The patient was a 4-month-old female who was admitted to the hospital in March with severe
The patient was a 4-month-old female who was admitted to the hospital in March with severe respiratory distress. Five days prior to admission she had developed a cough and rhinitis. Two days later she began wheezing and was noted to have a fever. She was brought to the emergency room when she became lethargic.
One sibling was reported to be coughing, and her father had a “cold”. On examination she was agitated and coughing. She had a fever of 38.9°C, tachycardia with a pulse rate of 220 beats/min., tachypnea with a respiratory rate of 80/min., and blood pressure of 90/58 mm Hg. Her fontanelles were open, soft and flat. Her throat was clear. She had subcostal retractions and nasal flaring. On auscultation of her lungs, there were rhonchi as well as inspiratory and expiratory wheezes.
A chest radiograph revealed interstitial infiltrates and hyperexpansion. Arterial blood gasses on supplemental oxygen revealed a respiratory acidosis with relative hypoxemia.
She was put in respiratory isolation in the pediatric intensive care unit and was subsequently intubated. Blood and nasopharyngeal cultures were obtained and sent to the bacteriology and virology laboratories.
A rapid diagnostic test for RSV was positive and specific antiviral therapy was begun. She was also given the bronchodilator aminophylline to treat the bronchospasm that was resulting in her wheezing. She was extubated 5 days later and was discharged on day 8.
What is the differential diagnosis for this patient’s pneumonia, and which of the possible viral agents is the most likely etiology? ( explain more about RSV)
It is caused by negative strand RNA virus called respiratory syncytial virus (RSV). The differential diagnosis for patient’s pneumonia can be Influenza A and B viruses, Bordetella pertussis, and Mycoplasma pneumoniae.
Described the epidemiology of the agent causing her infection.
RSV is spread by large droplets and on fomites.Can be spread via contaminated hands. Occurs primarily in winter months(Explain in details and do not use same wording)
Describe diagnostic strategies available for detection of the agent. Why is it important to establish this diagnosis quickly?
Direct Fluorescence Antibody (Explain in details)
What treatment strategies are available for this infection?
Aerosolized Ribavirin, it is nucleoside analogue that inhibits the viral RNA-dependent RNA polymerase. It helps infants by decreasing the viral shedding and increasing the infant`s oxygenation. If administrated orally it may result in bone marrow toxicity or hepatic toxicity. It is only recommended in infants with immunodeficiency or chronic illness (cystic fibrosis or heart disease).
What are the hospital’s infection control issues related to this patient’s diagnosis?
Anyone who comes in contact with patient needs to use gowns and gloves. Patient need to put in respiratory isolation if not hospitalized patients with immunodeficiency can get infected.
(Talk about community outbreaks of RSV)
Besides infection control measures, what strategies are available for prevention of this infection?
For high-risk children immune globin can be used such as RespiGam. Another treatment would be Palivizumab is a humanized monoclonal antibody against F protein of RSV infection.
Describe the patho-physiologic basis for wheezing?
RSV is tropic for bronchial epithelium
Edema and necrosis can lead to collapse and obstruction of a child’s small bronchioles
(please do not use same wording and explain more in details)
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