Atypical Extrapulmonary Presentations Of Severe Respiratory Syncytial Virus Infection Requiring Intensive Care

Abstract

The patterns and nature of a four-month epidemic of severe respiratory syncytial virus (RSV)-associated disease were analyzed using presenting, demographic, clinical, and therapeutic data. Of 218 infants with RSV infection admitted to Rainbow Babies and Childrens Hospital, 49 (22.4%), most born prematurely, entered the pediatric intensive care unit (PICU). Fluorescent antibody and/or enzyme-linked immunosorbent assay documented RSV infection. PICU patients underwent airway stabilization; 53.5% were intubated and evaluated for sepsis. Patients with positive bacterial cultures received antibiotics; 18% were given ribavirin. Patterns of infection included hypothermia, septic shock appearance, apnea, pneumonia, and wheezing due to bronchiolitis. The average age difference between patients with hypothermia (23.3 days) and those with pneumonia (11.2 months) was statistically significant. There were no significant differences in average age, gestational age at birth, number intubated, worst pH and PCO₂, duration of intensive care, or treatment modalities between infants with bronchopulmonary dysplasia who received ribavirin and those who did not.

Get full access to this article

View all access options for this article.

References

Mandell G. , Douglas R. , Bennett J. Principles and Practice of Infectious Diseases. 3rd ed. New York, NY John F. Wiley ; 1989:1265-1275.

Glenzen P. , Denny F. Epidemiology of acute lower respiratory disease in children. N Engl J Med. 1973;288:498-505.

Jackson G. , Muldoon R. Viruses causing common respiratory infections in man. Part 3: Respiratory syncytial viruses and corona viruses. J Infect Dis. 1973 ;128:674-692.

Hall C. , Douglas R. Jr, Geiman J. , Messner M. Nosocomial respiratory syncytial virus infections. N Engl J Med. 1975; 293:1343-1346.

Hall C. , Hall W. , Speers D. Clinical and physiological manifestations of bronchiolitis and pneumonia . Am J Dis Child. 1979;133:798-802.

Outwater K. , Crone R. Management of respiratory failure in infants with acute viral bronchiolitis . Am J Dis Child. 1984;138:1071-1075.

Krasinski, K. Severe respiratory virus infection: clinical features, nosocomial acquisition and outcome. Pediatr Infect Dis J. 1985;4:250-257.

MacDonald N. , Hall C. , Suffin S. , et al. Respiratory syncytial viral infection in infants with congenital heart disease. N Engl J Med. 1982;307:397-400.

Mlinaric-Galinovic G. , Ugrcic I. , Bozikov J. Respiratory syncytial virus infections in SR Croatia, Yugoslavia. Pediatr Pulmonol. 1987;3:304-308.

10.

Green M. , Brayer A. , Schenkman K. , Wald E. Duration of hospitalization in previously well infants with respiratory virus infection. Pediatr Infect Dis J. 1989;8:601-605.

11.

Groothuis J. , Salbenblatt C. , Lauer B. Severe respiratory syncytial virus infection in older children. Am J Dis Child. 1990;144:346-348.

12.

Flanders R. , Lindsay P. , Chairez R. , et al. Evaluation of clinical specimens for the presence of respiratory syncytial virus antigens using an enzyme immunoassay . J Med Virol. 1986;19:1-9.

13.

Swenson P. , Kaplan M. Rapid detection of respiratory syncytial virus in nasopharyngeal aspirates by a commercial enzyme immunoassay. J Clin Microbiol. 1986;23:485-488.

14.

Sterner G. , Wolontis S. , Bloth B. , De Hevesy G. Respiratory syncytial virus: an outbreak of acute respiratory illness in a home for infants. Acta Paediatr Scand. 1966 ;55:273-279.

15.

Fraser R. , Pare S. Diagnosis of Diseases of the Chest. 2nd ed, vol 2. Philadelphia, PA: WB Saunders; 1978:831-832.

16.

Berglund B. Studies on respiratory syncytial virus infection . Acta Pediatr Scand. 1967(suppl);176:321-326.

17.

Spinelli M. , Ciardullo-Geraci K. , Palumbo P. , et al. Efficacy of ribavirin for treating respiratory syncytial virus (RSV) pneumonia in high risk infants. Pediatr Res. 1985;19:304A.

18.

Leggiadro R. , Darras B. Viral and bacterial pathogens of suspected sepsis in young infants. Pediatr Infect Dis J. 1983;2:287-289.

19.

Dagan R. , Hall C. , Powell K. , Menegus M. Epidemiology and laboratory diagnosis of infection with viral and bacterial pathogens in infants hospitalized for suspected sepsis. JPediatr. 1989;115: 351-356.

20.

Church N. , Anas N. , Hall C. , Brooks J. Respiratory syncytial virus-related apnea in infants. Am J Dis Child. 1984; 138:247-250.

21.

Roorda R. , Schreuder H. , Van Aalderen W. , et al. De RSV affaire nogmaals besproken (Another discussion of the RSV affair) . Tijdschr Kindergeneeskd. 1990 ;58:18-23. English abstract.

22.

Jacobs R. , Sowell M. , Moss M. , Fiser D. Septic shock in children. Bacterial etiologies and temporal relationships . Pediatr Infect Dis J. 1990;9:196-200.

23.

Clardy C. , Edwards K. , Gay J. Increased susceptibility to infection in hypothermic children: possible role of acquired neutrophil dysfunction. Pediatr Infect Dis J. 1985;4:379-382.

24.

Hall C. Ribavirin: beginning the blitz on respiratory viruses? Pediatr Infect Dis J. 1985;4:668-671.

25.

Hall C. , McBride J. , Gala C. , et al. Ribavirin treatment of respiratory syncytial viral infections in infants with underlying cardiopulmonary disease. JAMA. 1985;254:3047-3051.

26.

Groothuis J. , Woodin K. , Katz R. , et al. Early ribavirin treatment of respiratory syncytial viral infection in high-risk children. J Pediatr. 1990; 117:792-798.

27.

Smith D. , Frankel L. , Mathers L. , et al. A controlled trial of aerosolized ribavirin in infants receiving mechanical ventilation for severe respiratory syncytial virus infection. N Engl J Med. 1991 ;325: 24-29.