Respiratory Syncytial

Respiratory Syncytial
Virus
infections
Dr.T.V.Rao MD
Discovery of Respiratory
Syncytial Virus
 In 1956, Morris and colleagues initially
isolated RSV from chimpanzees with upper
respiratory tract (URT) infections as the
causative agent of most epidemic
Bronchiolitis cases. Subsequently,
Channock et al associated this agent with
Bronchiolitis and LRT infection in infants.
Since then, multiple epidemiologic studies
have confirmed the role of this virus as the
leading cause of LRT infection in infants
and young children.
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RS virus major cause of
Respiratory Infections.
 Human
respiratory
Syncytial virus
(RSV) was quickly
determined to be
of human origin
and was shown to
be the leading
worldwide viral
agent of serious
paediatric
respiratory tract
disease.
RSV – Viral structure
 RSV is Plemomorphic and
ranges in size from 150 –
300nm
 The viral envelope has two
glycoprotein's- the G
protein by which the virus
attaches to cell surfaces,
and fusion (F) protein
which brings about fusion
between viral and host cell
membranes.
 The F protein is also
responsible for cell to cell
fusion, which is responsible
for typical syncytial
cytopathic changes in
RSV infection.
virus
 Respiratory
syncytial virus (RSV)
is a leading cause of
severe respiratory
infection in infants and
children. RSV is an
RNA virus whose
genome encodes 10
proteins. The G
protein is responsible
for viral attachment to
cells whilst the F
protein promotes
syncytia formation.
Differs from
Paramyxoviruses
 Unlike Paramyxoviruses it does not posses
Haemagglutinnin activity.
 Do not posses neuraminidase or hemolytic
properties
 The size of nucelocapsid diameter is less
than Paramyxoviruses.
 RS virus are placed in a separate Genus
Pneumovirus

RS virus do not withstand
freezing
 The virus is
relatively fragile
and may not
survive even snap
–freezing at -700c
 Specimens for
isolation
should not be
frozen
Propagation of RSV
 It can be
propagated in He
La and Hep-2 cell
culture lines.
 Highly labile virus
and promptly
inactivated at room
temperatures
Sero typing of Respiratory
Syncytial virus
 For all practical purposes
there is only one
serotype
 With the use of
monoclonal antibodies
that there are two
subtypes A and B
strains.
 In Newcastle upon
Tyne, strains of
subtype A have
been prevalent
every year since
1974
 But subgroup B strains
were erratic and have not
been isolated every winter.

Infects Animals too
 RS virus infects
cattle and
chimpanzees
 Both goats and
sheep may be
infected naturally
 Even rodents can
be adopted after
some adoption.
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Majority of Children are
Infected
 Almost all children
will be infected
with RSV by their
second birthday.
 RSV causes
respiratory illness
in infants and
young children,
and is the most
important cause of
Bronchiolitis.
RS virus is major cause of
Respiratory Infection -
Globally
 Respiratory Syncytial virus (RSV) is
recognized as the most important cause of
serious lower respiratory tract illness in
infants and young children worldwide
causing repeat infections throughout life
with serious complications occurring in the
elderly and immune compromised patient.

Involvement of Alveoli and
Alveolar space - A significant
feature
Major areas of Infection
in RS viruses
 Clinical diagnosis
will be supported
with presence of
RS virus in the
Nasopharynx and
there is clinical
evidence of lower
respiratory tract
involvement.

Clinical Features
 The peak incidence is
in those under 1 year
of age.
 The most serious
illness manifest with
Bronchiolitis in
young babies
 Leads to
hyperinflation of lungs
secondary to
bronchiolar
inflamation acting as
a on way valve.

Patients with respiratory syncytial
virus (RSV) may present with the
following Symptoms:
 Fever (typically
low-grade)
 Cough
 Tachypnea
 Cyanosis
 Retractions
 Wheezing
 Rales

Can be Life Threatening
 The RS viral
infection is
potentially in
those with or
congenital heart
disease
Bronchopulmonary
dysplasia defects,
or in those who are
Immunosupressed
or
Immunodeficient.
Sudden Infant Death
syndrome
( SIDS )
 RS virus has been
recovered from
some victims of the
Sudden infant
death syndrome
 Although it may
have been
contributed to
death, other factor
are also
significantly
contributed.
Active Clinical
manifestations
 The majority of infected present with
clinical features of Bronchiolitis
 In majority of cases recovery is
complete.
 In older children, and adults the virus
cause minor illness,
 Reinfections are common and in
adults may cause no more than
cold.

RS virus infections can
predispose to….
Some reports suggest

the infection can
predispose to Chronic
respiratory tract
disease,
Asthma,Bronchectasis
etc
Several studies in
progress to prove the
predisposition with
RS virus
RS virus can infect old aged
groups
 There are upcoming reports of severe
illness with some fatalities in old people’s
homes as well as in elderly living in a
community
 The under diagnosis can be attributed
lack of confirming Virological
diagnosis in adults and elderly.

Factors have been associated with
increased risk of acquiring RSV
disease,
 Attending child care centres.
 Older siblings in preschool or school
 Exposure to environmental pollutants
(eg, cigarette smoke)
 Multiple birth sets (especially triplets
or greater)
 Minimal breastfeeding
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Other contributing factors in
Respiratory syncitical virus
Infection
 Premature children , especially birth at less than
35 weeks' gestation
 Age younger than 3 months at time of infection
 Chronic lung disease
 Congenital heart disease
 Toxic appearance at time of presentation
 Respiratory rate more than 70 per minute in room
air
 Atelectasis and/or pneumonitis on chest
radiography
 Oxygen less than 95% on room air

Laboratory Diagnosis of RS
viral infection.
Viral detection
and Isolation
In acute phase virus

may be
demonostrated by
Immunofluoresce
nce, Enzyme
immuno assays
and Culture
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Rapid Diagnosis in RS Viral
infections
 In acute phase of
illness, a Rapid
diagnosis in > than 1
hour by
Immunofluorescenc
e with conjugated
monoclonal
antibodies with
adequate number of
desquamated
respiratory cell is
reliable.
 However antigen
detection and culture
methods are good for
Serology
 Serological
assessment using
complement fixation is
generally not helpful.
 Immunoassays for G
and F proteins may
offer more reliable
serological tests, in
adults where other
options are limited.

Molecular Methods in RS
viral infection
 The emerging
molecular methods
such as reverse
transcription-
polymerase chain
reaction, either for
a single virus or
multiplexed to
detect a panel of
viruses
Treatment
A supportive management with tube
feeding in cases of difficulty in
suckling
 Use of oxygen if indicated.
 Ribavirin is a specific antiviral
drug, proved to effective when given
as a small particle aerosol although it
is apparently not effective
intravenous infusion.

Indication for
Chemotherapy
 The chemotherapy with Ribavirin is expensive
and its recommended use is confined to those
babies who are at risk from rampant RS virus,
because they have congenital heart or lung
abnormalities
 The use os Hyper immune RS virus
immunoglobulin and humanized monoclonal
antibodies have become available for treatment
and prevention of RS infection. In view of higher
costs they are warranted in selected infants born
with low birth weight or preexisting
bronchopulmonary dysplasia

Epidemics and Seasonal
Variation
 In temperate climates in both the northern
and southern hemisphere, RS virus causes
a substantial winter epidemic every year.
 In tropical regions the epidemics manifest
in hot periods of summer.
 However sporadic cases occur throughout
the year
 The RS virus produces infections all over
the world
Vaccine - Failures
 A formalin inactivated
crude, whole virus vaccine
was tried in 1960, but
failed to produce immunity
in the recipients
 The difficulties in preparing
safe vaccine for RSV lie
with young and
immunologically immature
recipients.
 Yet to date there is
safe vaccine
avialble for
universal use
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Created for awarness on
Viral Infections in
Developing world
Dr.T.V.Rao MD
Email
[email protected]

Respiratory Syncytial

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Respiratory Syncytial

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Some reports suggest

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In acute phase virus

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