Respiratory syncytial virus

Respiratory syncytial virusPeople who are affected by respiratory syncytial virus are mostly small children, but also adults can get sick. The symptoms can be harmless and resemble a simple cold. Severe courses can be fatal. However, the disease heals itself within a few days in most cases.

The term RS virus (or RSV) stands for the English term respiratory syncytial virus: it is a virus that leads to the fusion of cells (syncytia) in the respiratory tract. The pathogen resembles the flu virus and occurs worldwide.

A seasonal accumulation of outbreaks can be observed: In Europe, most people develop the respiratory syncytial virus between November and April, most often in January and February.

Respiratory syncytial virus in children

In principle, people of all ages can get sick through respiratory syncytial virus. It is more common for small children. An infection with the respiratory syncytial virus is the most common cause of the hospital treatment of a respiratory disease of infants and small children.

Especially in premature babies and infants, the disease can take a difficult course. In premature babies with lung damage or children with heart defects, the RSV infection is even fatal in one of 100 cases.

About 50 to 70 percent of all children develop at least one respiratory syncytial virus infection during their first year of life. After the second year of life, almost all children have already passed an RS virus infection. Girls and boys are equally affected. The risk of a severe course is twice more in girls than boys.

Respiratory syncytial virus is considered to be highly infective. This means that you can easily get infected with patients. If the respiratory syncytial virus present in the hospital, the risk of infection is high for patients and staff in the hospital. Therefore, patients with RS virus should be isolated to avoid the spread of the disease.


Respiratory syncytial virus symptoms

The symptoms of respiratory syncytial virus infection can vary greatly from patient to patient. Adults who are healthy often have no complaints. Then, doctors speak of an asymptomatic or even clinically RSV infection. In addition, RS virus disease can be mild. Then patients have similar to symptoms to colds.

These are:

  • Sniff
  • Dry cough
  • Sneeze
  • Sore throat

Especially in small children, an RSV infection can affect the lower respiratory tract (bronchi and lungs) in addition to the upper respiratory tract (nose, mouth, throat). Frequently, symptoms occur one to three days after the onset of the disease. Febrile fever may occur, which may be as follows:

  • Accelerated breathing
  • Noises when breathing
  • Cough with expectoration
  • Heavy breathing with the use of the respiratory musculature (supporting the arms)

The disease can be reminiscent of whooping cough. In addition, there is a high liquid loss. It is expressed by:

  • Dry, cold and pale skin
  • Sunken Fontanelle in children under 18 months

In addition, general symptoms such as lack of strength, feeling for sickness, lack of appetite and drinking can be observed. Symptoms of respiratory syncytial virus infection can worsen within a few hours. In the case of premature infants, respiratory arrest (apnea) can occur repeatedly.


Respiratory syncytial virus causes and risk factors

Respiratory syncytial virus multiplies in the superficial cells of the mucous membranes lining the airways. A special protein, the fusion (F) protein is anchored in the virus envelope. It causes a fusion of cells (formation of syncytia) in the affected mucous membranes.

The RS virus only occurs in humans. It is transmitted via infection for example by sneezing or coughing when the viruses get into the nasal membranes or ocular membranes. The time between the infection and the outbreak of the disease (incubation period) is two to eight days, on average five days. A patient is contagious (infectious) about three to eight days from the first day after the RSV infection.

Respiratory syncytial virus risk factors

In some cases, infection with RS viruses is difficult. This affects persons who belong to the following risk groups:

  • Premature babies
  • Children with cystic fibrosis, pulmonary disease (bronchopulmonary dysplasia) or congenital heart defects
  • Adults who suffer from heart or lung disease
  • People whose immune system is weakened by a disease or medication (such as AIDS patients, donor organ recipients, patients with malignant diseases of the blood)
  • People with trisomy 21 (Down syndrome)

Respiratory syncytial virus diagnosis

If your child has flu-like symptoms, dyspnea or high fever, consult the pediatrician. In the first place, he will ask you in detail about the history of the disease (anamnesis). He asks you, among other things, the following questions:

  • Since when does your child have a fever?
  • Did your child have difficulty breathing?
  • Does your child drink and eat enough?
  • Is your child suffering from a primary disease, such as heart failure or cystic fibrosis?

Respiratory syncytial virus physical examination

The doctor examines his patients thoroughly. Doctor illuminates with a lamp in the mouth and in the ears, in order to detect possible redness of the throat or the ears. Then doctor scans the lymph nodes at the neck for possible enlargements and then hears the lung with a stethoscope.

RSV bronchiolitis can be heard in the stethoscope as crackling and streaking. The doctor then looks to see if the patient’s fingernails or lips are bluish (cyanosis) – an indication of insufficient oxygen in the blood (hypoxemia).

Respiratory syncytial virus can be detected in a lab test. Antibody detection in the blood is only rarely possible since the body forms only a few antibodies against the RS virus.


How is respiratory syncytial virus treated?

There is no causal therapy for RSV infection. Only the symptoms can be treated (symptomatic therapy). This includes:

  • A sufficient supply of liquid
  • Mucolytic solutions such as steam baths
  • Such as calf wraps or the administration of ibuprofen or paracetamol
  • Keep the nasopharynx clear by flushing or nasal drops
  • Support breathing

Depending on the severity of the patient’s breathing, various methods can be used to facilitate breathing and ensure that the patient receives enough oxygen. If your child gets bad air at home, you can use his pillow to cushion his upper body. In addition, certain medicines (bronchodilators) such as salbutamol can spread the airways. The patient breathes them through an inhaler.

In the case of the doctor or the hospital, oxygen can be given to the patient via a respiratory mask if the oxygen content in the blood drops dangerously (below 94 per cent). It may also be necessary to ventilate via a so-called CPAP mask (continous positive airway pressure) or a tube. If there are respiratory arrestances (apneas) in infants, they must be monitored in a stationary manner.

How to prevent respiratory syncytial virus?

The best way to prevent RS virus infection is hygiene:

  • Wash your hands often
  • Clean children’s toys on a regular basis
  • Sick people should not visit community facilities

There is no active RSV vaccination. For children with risk factors such as premature infants with congenital heart failure, there is a passive vaccination. During the RSV season (November to April) monthly finished antibodies (palivizumab) are injected into a muscle which is directed against the RS virus.

 

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