Syncytial virus bronchiolitis

Ribavirin (tribavirin) Severe respiratory syncytial virus bronchiolitis in infants and children... 

Sigurs N, Bjarnason R, Sigurbeigsson F, Kjellman B Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7. Am J Respir Crit Care Med 2000 161 1501-1507. 

Gurkan F, Kiral A, Dagli E, Karakoc F The effect of passive smoking on the development of respiratory syncytial virus bronchiolitis. Eur J Epidemiol 2000 16 465 468. 

Flamant C, Hallelel F, Nolent P et al (2005) Severe respiratory syncytial virus bronchiolitis in children from short mechanical ventilation to extracorporeal membrane oxygenation. Eur J Pediatr 164 93-98... 

Ribavirin is a synthetic guanosine analogue, with in vitro activity against a broad spectrum of DNA and RNA viruses, and retroviruses, including HIV. Ribavirin has been used for treatment of a variety of viral infections, including respiratory syncytial virus bronchiolitis and pneumonia, measles, influenza types A and B, Lassa fever, hemorrhagic fever with renal syndrome (Hantaviruses), hepatitis C, and HIV infection. It is used commonly now along with interferon alpha for treatment of hepatitis C infection. There is no known direct nephrotoxicity of ribavirin. 

Wennergren G, Kristjansson S. Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases. Eur Respir J 2001 18(6) 1044-58. 

De Boeck K, van der Aa N, van Lierde S et al. Respiratory syncytial virus bronchiolitis a double blind dexamethasone efficacy study. J Pediatr 1997 131 919-21. 

Garofalo RP, Patti J, Hintz KA et al. Macrophage inflammatory protein-lalpha (not t helper type 2 cytokines) is associated with severe forms of respiratory syncytial virus bronchiolitis. J Infect Dis... 

Noah, T. L., Ivins, S. S., Murphy, P., Kazachkova, I., Moats-Staats, B., and Henderson, F. W. (2002). Chemokines and inflammation in the nasal passages of infants with respiratory syncytial virus bronchiolitis. Clin. Immunol 104, 86. 

Smyth, R. L., Mobbs, K. J., O Hea, U., Ashby, D., and Hart, C. A. (2002). Respiratory syncytial virus bronchiolitis Disease severity, interleukin-8, and virus genotype. Pediatr. Pulmonol 33, 339. 

Belderbos, M. E., Houben, M. L., Wilbrink, B. et al. 2011. Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis. Pediatrics 127 el513-20. Bennett, J. H. 1853 The Pathology and Treatment of Pulmonary Tuberculosis. 1st ed. Southerland and Knox, Edinburgh. 

Placebo-controlled studies In a randomized placebo-controlled study of montelukast 4 or 8 mg in infants aged 3-24 months with symptoms of post-respiratory syncytial virus bronchiolitis over 20 months there was no benefit and no significant differences in clinical or laboratow adverse events compared with placebo [98 ]. 

Bisgaard H, Flores-Nunez A, Goh A, Azimi P, Halkas A, Malice MP, Marchal JL, Dass SB, Reiss TF, Knorr BA. Study of montelukast for the treatment of respiratory symptoms of post-respiratory syncytial virus bronchiolitis in children. Am J Respir Crit Care Med 2008 178(8) 854-60. 

Respiratory syncytial virus is the most common cause of bronchiolitis, accounting for up to 70% of all cases. Parainfluenza viruses are the second most common cause. Bacteria serve as secondary pathogens in only a small minority of cases. 

Ribavirin may be considered for bronchiolitis caused by respiratory syncytial virus in a subset of patients (those with underlying pulmonary or cardiac disease or with severe acute infection). Use of the drug requires special equipment (small-particle aerosol generator) and specifically trained personnel for administration via oxygen hood or mist tent. 

An infant with severe respiratory syncytial virus (RSV) bronchiolitis is best treated with... 

In addition to oral administration for hepatitis C infection in combination with interferon alfa, aerosolized ribavirin is administered by nebulizer (20 mg/mL for 12-18 hours per day) to children and infants with severe respiratory syncytial virus (RSV) bronchiolitis or pneumonia to reduce the severity and duration of illness. Aerosolized ribavirin has also been used to treat influenza A and infections but has not gained widespread use. Systemic absorption is low (< 1%). Aerosolized ribavirin is generally well tolerated but may cause conjunctival or bronchial irritation. Health care workers should be protected against extended inhalation exposure. The aerosolized drug may precipitate on contact lenses. 

Respiratory syncytial virus (RSV) infection is a major cause of bronchiolitis in infants, whereas influenza A infection usually manifests as an upper respiratory tract infection. The immunological responses of infants to RSV infection and influenza A infection are different. In our studies of the cytokine responses during these infections, we found that the serum concentrations of IL-4, IL-5, RANTES, and soluble intercellular adhesion molecule-1 (sICAM-1) in infants with RSV infection were significantly higher than those with influenza A infection (S8). The concentration of TNF-a in nasopharyngeal aspirates was significantly lower in infants with RSV infection. Therefore, a predominant T helper cell type 2 (Th2) cytokine and related immunological response was observed in infants with RSV infection, whereas a predominantly proinflammatory cytokine response was observed in infants with influenza A infection. This may explain the different clinical manifestations of the two viral infections in infants (S8). 

Respiratory Syncytial Virus. Respiratory syncytial virus (RSV) has warranted special consideration because it is the commonest cause of bronchiolitis, an acute wheezy illness of infants. A study of children in Sweden, which used a case-control methodology, showed a positive association between RSV infection in infancy requiring hospitalisation, and allergic sensitisation at age... 

Some early respiratory infections, e.g. pertussis and bronchiolitis caused by respiratory syncytial virus, as well as some forms of gastro-enteritis may enhance the development of allergic diseases and asthma. 

Effect of anti-viral agents to treat bronchiolitis induced by respiratory syncytial virus and to prevent asthma in young children at high risk. 

Respiratory syncytial virus is the most common cause of acute bronchiolitis, an infection that mostly affects infants during their first year of life. In the well infant, bronchiolitis is usually a self-limiting viral illness, whereas in the child with underlying respiratory or cardiac disease or both, the child may develop severe respiratory compromise (failure) necessitating in-hospital treatment, such as rehydration, oxygen, and in select patients, bronchodilators, ribavirin aerosol, or both. 

Respiratory syncytial virus is a member of the paramyxovirus family, a genera that includes metapneumovirus, measles and Newcastle disease viruses [21]. The discovery of RSV as a human pathogen began with an outbreak of coryza in chimpanzees, documented in 1956, which was quickly followed by the identification of the vims in infants presenting with bronchiolitis and pneumonia [22-25]. Epidemiological studies have established the patterns of outbreaks of RSV... 

Respiratory syncytial virus (RSV) causes bronchiolitis in children, usually during the winter months. Most RSV infections clear without treatment. Ribavirin is recommended for infected children who are at risk for cardiopulmonary complications. The utility of such treatment has not been clearly demonstrated. 

Shay DK, Holman RC, Roosevelt GE et al. Bronchiolitis-associated mortality and estimates of respiratory syncytial virus-associated deaths among US children, 1979-1997. J Infect Dis 2001 183(l) l6-22. 

Wang SZ, Smith PK, Lovejoy M et al. The apoptosis of neutrophils is accelerated in respiratory syncytial virus (RSV)-induccd bronchiolitis. Clin Exp Immunol 1998 1 l4(l) 49-54. 

Kneyber, M. C. J., Steyerberg, E. W., de Groot, R., and Moll, H. A. (2000). Long-term effects of respiratory syncytial virus (RSV) bronchiolitis in infants and young children A quantitative review. Acta. Paediatr. 89, 654. 

Bronchiolitis-associated hospitalizations among US children, 1980-1996. Jama 282,1440. Sheeran, P., Jafri, H., Carubelli, C., Saavedra, J., Johnson, C., Krisher, K., Sanchez, P. J., and Ramilo, O. (1999). Elevated cytokine concentrations in the nasopharyngeal and tracheal secretions of children with respiratory syncytial virus disease. Pediatr. Infect. Dis. J. 18,115. 

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