Severe respiratory syncytial virus pneumonia associated with primary Epstein-Barr virus infection

This is a case report of a child with severe respiratory syncytial virus (RSV) pneumonia and concurrent infection with Epstein-Barr virus. We hypothesize that immunosuppression due to EBV may have contributed to the severity of his RSV infection. The diagnosis of RSV infection was facilitated by bronchoalveolar lavage.     

干扰素和更昔洛韦治疗婴幼儿呼吸道合胞病毒肺炎疗效分析简

目的 探讨干扰素和更昔洛韦治疗婴幼儿呼吸道合胞病毒肺炎疗效分析和对免疫功能的影响.方法 将90例呼吸道合胞病毒肺炎患儿随机分为两组,对照组45例给予干扰素治疗,观察组45例给予更昔洛韦治疗,比较两组疗效.婴幼儿患者T淋巴细胞亚群百分率、IL-2R的百分率、IL-2水平.结果 观察组的临床总有效率达95.6%,明显高于对照组（86.7%）,P＜0.05;两组在治疗RSVP前后,免疫指标大小有明显的差异,P＜0.05,但两组在治疗RSVP后,两组免疫指标大小并无明显差异,P3＞0.05.结论更昔洛韦对于治疗婴幼儿呼吸道合胞病肺炎毒疗效更佳.     

Respiratory syncytial virus,an ongoing medical dilemma: an expert commentary on respiratory syncytial virus prophylactic and therapeutic pharmaceuticals currently in clinical trials

As the most important viral cause of severe respiratory disease in infants and increasing recognition as important in the elderly and immunocompromised, respiratory syncytial virus (RSV) is responsible for a massive health burden worldwide. Prophylactic antibodies were successfully developed against RSV. However, their use is restricted to a small group of infants considered at high risk of severe RSV disease. There is still no specific therapeutics or vaccines to combat RSV. As such, it remains a major unmet medical need for most individuals. The World Health Organisations International Clinical Trials Registry Platform (WHO ICTRP) and PubMed were used to identify and review all RSV vaccine, prophylactic and therapeutic candidates currently in clinical trials. This review presents an expert commentary on all RSV‐specific prophylactic and therapeutic candidates that have entered clinical trials since 2008.     

Seasonal variation in respiratory syncytial virus chest infection in the tropics

Respiratory syncytial virus (RSV) is the most important cause of lower respiratory tract infection (LRTI) in young children. We determined if there was a seasonal variation in Malaysia in the incidence of RSV infection in young children admitted with LRTI, and possible associations of RSV infection with local meteorological parameters. A total of 5,691 children, aged less than 24 months and hospitalized with LRTI (i.e., bronchiolitis and pneumonia) between 1982-1997, were included in this study. Nasopharyngeal samples were collected and examined for RSV by immunofluorescence, viral culture, or both. Seasonal variations were determined by analyzing the monthly RSV-positive isolation rate via time series analysis. Possible correlations with local meteorological parameters were also evaluated.RSV was isolated in 1,047 (18.4%) children. Seasonal variations in RSV infection rate were evident and peaked during the months of November, December, and January (test statistics [T] = 53.7, P < 0.001). This seasonal variation was evident for both bronchiolitis and pneumonia categories (T = 42.8 and 56.9, respectively, P < 0.001). The rate of RSV infection appeared to correlate with the monthly number of rain days (r = 0.26, P < 0.01), and inversely with the monthly mean temperature (r = -0.38, P < 0.001).In the tropics, seasonal variations in the incidence of RSV infection are evident, with an annual peak in November, December, and January. This information provides a guide for healthcare provisions and implementation of RSV prevention.     

Pulmonary surfactant in respiratory syncytial virus bronchiolitis: The role in pathogenesis and clinical implications

Respiratory syncytial virus (RSV) bronchiolitis is the leading cause of lower respiratory tract infection, and the most frequent reason for hospitalization among infants throughout the world. In addition to the acute consequences of the disease, RSV bronchiolitis in early childhood is related to further development of recurrent wheezing and asthma. Despite the medical and economic burden of the disease, therapeutic options are limited to supportive measures, and mechanical ventilation in severe cases. Growing evidence suggests an important role of changes in pulmonary surfactant content and composition in the pathogenesis of severe RSV bronchiolitis. Besides the well‐known importance of pulmonary surfactant in maintenance of pulmonary homeostasis and lung mechanics, the surfactant proteins SP‐A and SP‐D are essential components of the pulmonary innate immune system. Deficiencies of such proteins, which develop in severe RSV bronchiolitis, may be related to impairment in viral clearance, and exacerbated inflammatory response. A comprehensive understanding of the role of the pulmonary surfactant in the pathogenesis of the disease may help the development of new treatment strategies. We conducted a review of the literature to analyze the evidences of pulmonary surfactant changes in the pathogenesis of severe RSV bronchiolitis, its relation to the inflammatory and immune response, and the possible role of pulmonary surfactant replacement in the treatment of the disease. Pediatr. Pulmonol. 2011; 46:415–420. © 2010 Wiley‐Liss, Inc.     

Importance of nosocomial respiratory syncytial virus infections in an African setting

OBJECTIVE: To define the importance of nosocomial-acquired respiratory syncytial virus (RSV) infection in an area with a high prevalence of paediatric HIV-1 infection. METHODS: A prospective study was performed that involved all children hospitalized to a general paediatric ward during the course of an RSV epidemic. These children were screened within 24 h of admission and subsequently at 3-4 day intervals for RSV infection using a direct immunofluorescence assay. RESULTS: RSV was detected in 36 (11.8%) of the 305 children upon initial investigation. Fourteen (38.9%) of the 36 children with community-acquired RSV infection were HIV-1 infected. Repeat sampling for RSV infection was performed in 130 children who tested negative for RSV infection on initial screening and who were hospitalized for > or =3 days. Nosocomial acquisition of RSV occurred among 11.5% of these children, of whom 33% were HIV-1 infected. Fourteen (93.3%) of the children with nosocomial RSV acquisition were clinically symptomatic and treated for 'nosocomial-sepsis'. Furthermore, RSV was isolated from 54% of all children who were investigated for clinically diagnosed nosocomial sepsis. Two (13%) of 15 children with nosocomial RSV infection died; both had other underlying medical conditions. CONCLUSION: RSV is an important under-recognized cause of nosocomial infection and sepsis among children in this African country. Active interventions are warranted in addressing this problem, as has been successfully undertaken in developed countries.     

肺表面活性蛋白及其基因多态性与呼吸道合胞病毒感染研究进展

呼吸道合胞病毒(RSV)是婴幼儿呼吸道感染常见病原,生命早期的RSV下呼吸道感染与其后的反复喘息及哮喘的危险性增加显著相关,然而其发病机制是复杂的,且很多方面尚不明确.有研究认为肺表面活性蛋白(SP)及其基因多态性与严重的RSV感染有关.SP包括SP-A、SP-B、SP-C、SP-D4种蛋白,它们存在多个等位基因和基因多态性位点.已有的研究发现SP-A、SP-B和SP-D蛋白及其基因多态性与严重的RSV感染相关.     

Severe respiratory syncytial virus pneumonia complicating fludarabine and cyclophosphamide treatment of chronic lymphocytic leukemia

The potential for life-threatening pneumonia due to respiratory syncytial virus (RSV) infection is recognised among patients with acute leukaemia and recipients of allogeneic or autologous bone marrow transplantation. RSV pneumonia has a high mortality rate in these settings. Less intensively treated patients are not usually considered to be at risk for serious RSV pneumonia. We describe the case of a 62-yr-old patient with chronic lymphocytic leukaemia (CLL) treated with fludarabine and cyclophosphamide who developed severe RSV pneumonia and recovered following treatment including intravenous ribavirin.     

2009-2016年广州市呼吸道合胞病毒感染的流行特征及临床特点分析北大核心CSCD

目的分析急性上呼吸道感染患者中呼吸道合胞病毒(respiratory syncytial virus,RSV)的流行特征及临床特点。方法以南方医科大学珠江医院2009年11月至2016年6月收治的具有发热呼吸道症状患者为研究对象,采集鼻拭子标本3446份,提取标本RNA,采用qRT-PCR方法进行RSV检测,并对RSV阳性标本进行临床上常见的7种(14个亚型)呼吸道病毒的检测,以了解混合感染情况。结果共检测患者标本3446份,其中RSV阳性标本672份,总阳性率为19.5%。4个季节中RSV检出率差异具有统计学意义(χ2=133.184,P<0.001),并以春节最高,冬季次之,夏秋两季最少。RSV感染患者随着年龄的增长检出率逐渐降低,并以3岁及以下儿童检出率最高,占RSV阳性标本数的90.8%(610/672),儿童患者检出率明显高于成年患者(χ2=266.433,P<0.001),男性患者检出率明显高于女性患者(χ2=4.940,P=0.026),住院患者检出率明显高于门诊患者(χ2=60.433,P<0.001)。混合感染标本160份,其中双病毒感染标本143份,3种病毒混合感染16份,4种病毒混合感染1份,并以鼻病毒和呼吸道合胞病毒混合感染率最高,住院患者混合感染率高于门诊患者(χ2=20.896,P<0.001)。与非RSV感染者相比,RSV感染者咳嗽、咳痰、气促/呼吸困难等临床症状发生率均较高(χ2_(咳嗽)=108.934,χ2_(咳痰)=60.626,χ2_(气促/呼吸困难)=38.139,均P<0.001),而咽喉痛、头痛、乏力、寒战/畏寒和肌肉酸痛等发生率相对较低(χ2_(咽喉痛)=46.499,χ2_(头痛)=29.516,χ2_(乏力)=16.972,χ2_(寒战/畏寒)=9.616,χ2_(肌肉酸痛)=8.801,均P<0.001)。此外,RSV感染组与非RSV感染组在临床诊断上也存在统计学差异(χ2=212.157,P<0.001)。结论RSV是引起3岁以下儿童呼吸道病毒感染的主要病原体,也是引起3岁以下儿童呼吸道病毒感染住院的主要原因,咳嗽、咳痰及气促/呼吸困难的发生率较高,临床上应加强对该年龄段儿童的防护。     

Human metapneumovirus and respiratory syncytial virus infections in older children with cystic fibrosis

BACKGROUND: Human metapneumovirus (hMPV) has been isolated from children with acute respiratory infection worldwide. Its epidemiology remains to be defined in children with cystic fibrosis (CF). We describe the epidemiology and clinical impact of hMPV in CF children and compared it to respiratory syncytial virus (RSV). METHODS: CF children ages 7-18 years were studied prospectively during the 1998 -1999 RSV season. Nasopharyngeal specimens were collected during acute respiratory illnesses and tested for respiratory viruses. Blood specimens were drawn early, mid, and end of the RSV season, and tested for serological evidence of hMPV and RSV infections. Rates of lower respiratory tract illnesses (LRTI) and hospitalizations for pulmonary exacerbations were compared during the time intervals they developed serological evidence of infection to their non-infection intervals. RESULTS: Six of 44 CF children had a virus positive respiratory illness in 56 LTRI events and 18 hospitalizations. Serological evidence of hMPV and RSV infections occurred in 16 and 20 CF children, respectively; 8 had infections with both viruses. A greater proportion of CF children had >or=1 LRTI during their infection intervals compared to their non-infection intervals (13/25 vs. 5/25; P=0.03). A trend for higher rates of LRTI was observed in the infection intervals compared to non-infection intervals (9.5 +/- 11.0 vs. 4.2 +/- 9.9 per 1,000 child-days; P=0.06), and it was significantly greater with a more conservative estimate (one event per child per interval; 7.4 +/- 7.7 vs. 2.6 +/- 5.4 per 1,000 child-days; P 相似文献   

Absence of human metapneumovirus co-infection in cases of severe respiratory syncytial virus infection

It has been suggested that co-infection of human metapneumovirus (hMPV) in severe respiratory syncytial (RSV) virus bronchiolitis is very common. To evaluate the epidemiology of hMPV co-infection in children with severe lower respiratory tract infection caused by RSV virus. This was an observational cohort study in which hMPV and RSV viral load was measured by RT-PCR in tracheal specimens from the target population. hMPV could not be detected in any of the 30 mechanically ventilated children with RSV lower respiratory tract infection. Our study suggests that hMPV co-infection is not very common in severe RSV lower respiratory tract infection.     

肺表面活性蛋白及其基因多态性在呼吸道合胞病毒感染中的作用

呼吸道合胞病毒(respiratory syncytial virus,RSV)是婴幼儿呼吸道感染最常见的病原,但发病机制尚未明了.近年研究发现,肺表面活性蛋白介导的天然免疫应答在RSV感染中发挥重要作用,而调控这些蛋白表达的基因存在多态性.因此,研究肺表面活性蛋白及其基因多态性在RSV感染发病中的作用,将为开发新的RSV感染治疗方法提供理论依据.     

Successful therapy with ribavarin of late onset respiratory syncytial virus pneumonitis complicating allogeneic bone transplantation

Summary A 21-year-old patient developed interstitial pneumonitis nine months post bone marrow transplant for acute myeloblastic leukaemia. Immunofluorescence of broncheoalveolar lavage fluid revealed the presence of respiratory syncytial virus (RSV). Aerosolized ribavarin therapy resulted in rapid resolution of the pneumonitis with full recovery without any side effects. Ribavarin therapy should be considered early in the management of BMT patients who develop RSV pneumonitis.     

Retrospective comparison of respiratory syncytial virus and metapneumovirus clinical presentation in hospitalized children

Respiratory syncytial virus (RSV) and Human metapneumovirus (hMPV), members of Pneumoviridae family are common causes of acute respiratory tract infections (ARTI) among children. Study material includes routine nasopharyngeal samples obtained during 8-year period for hMPV and one single season for RSV in children hospitalized for ARTI between 0 and 15 years at the Center Hospitalier Universitaire (CHU) Saint Pierre in Brussels. Positive samples for RSV or hMPV identified by viral culture, lateral flow chromatography test for RSV or direct fluorescent assay for hMPV were selected retrospectively. Characteristics of children hospitalized for RSV or hMPV infections were compared. Children hospitalized for RSV infection were significantly younger and requiring more respiratory support, longer hospital stay and transfers in Pediatric intensive Care Units than those hospitalized for hMPV infection. Pneumonia diagnostic and antibiotics therapies were more significantly associated with hMPV infections. In conclusion, despite their genetic similarities, RSV, and hMPV present epidemiological and clinical differences in pediatric infections. Our results should be confirmed prospectively.     

Modulation of monocyte Mo2 surface antigen expression by exposure to respiratory syncytial virus

The Mo2 antibody recognizes a monocyte-specific cell surface antigen of unknown function. Upward modulation of Mo2 surface epitope density was demonstrated in response to 72-hr culture of monocytes with respiratory syncytial virus (RSV), but this was not seen after culture with phytohemagglutinin or other respiratory viruses. Monoclonal antibody probes for RSV proteins were used to demonstrate probable replication of RSV proteins in peripheral blood monocytes and pulmonary alveolar macrophages. These data provide possible clues to the biologic role of the Mo2 antigen.