Pediatrics provides specialized medical care for infants, children, and adolescents. Learn about routine screenings, vaccinations, and treatments.
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The clinical spectrum of Respiratory Syncytial Virus infection is vast, ranging from a minor upper respiratory tract infection to life-threatening respiratory failure. The patient’s age heavily influences presentation, airway anatomy, and immunological status. In the neonate and young infant, the transition from mild symptoms to severe distress can occur rapidly, necessitating vigilant monitoring. The virus infects the respiratory epithelium from the nasopharynx to the alveoli, triggering a cascade of inflammation that disrupts gas exchange. At Liv Hospital, clinical assessment prioritizes the early recognition of “red flag” signs such as apnea and feeding intolerance, which often precede frank respiratory failure.
In the initial phase of illness, RSV is indistinguishable from the common cold. The virus replicates in the nasopharynx, causing local inflammation and cytokine release. This phase typically lasts for 2 to 4 days before lower tract progression occurs. In older children and adults, the infection may remain confined to this stage.
Bronchiolitis is the signature clinical syndrome of RSV in children under two years of age. It represents inflammation of the bronchioles, the small airways lacking cartilage support. The pathophysiology involves edema of the airway wall, increased mucus secretion, and the sloughing of necrotic epithelial cells.
When RSV extends beyond the bronchioles into the lung parenchyma (alveoli), it causes viral pneumonia. This condition is marked by interstitial inflammation and alveolar fluid accumulation, which directly impairs oxygen diffusion into the blood. Unlike bacterial pneumonia, which often presents with lobar consolidation, RSV pneumonia typically presents with diffuse, patchy infiltrates on both sides of the chest.
In very young infants, particularly those born prematurely or those under 6 weeks of age, apnea may the first or only sign of RSV infection. The virus can affect the respiratory control centers in the brainstem, leading to episodes where the infant stops breathing.
While RSV is primarily a respiratory virus, severe infection can lead to systemic complications and affect organs outside the lungs. The systemic inflammatory response can mimic sepsis, leading to cardiovascular instability.
The intense nasal congestion and inflammation associated with RSV frequently obstruct the Eustachian tubes, leading to fluid accumulation in the middle ear. This creates a fertile ground for secondary bacterial infections.
Severe RSV infection in early life has potential long-term consequences for respiratory health. The intense inflammation during a critical period of lung development may alter the structure of the airways.
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RSV typically follows a pattern in which symptoms peak and become most severe around days 3 to 5 of the illness. The cough worsens as the virus moves from the nose down into the lungs.
Retractions happen when a baby has to use extra muscles to breathe. You will see the skin sucking in between the ribs, under the rib cage, or at the base of the neck with every breath.
Yes, coughing fits can be so forceful that they trigger the gag reflex, causing the child to vomit. Swallowing large amounts of mucus can also upset the stomach.
Grunting is a noise babies make to keep their lungs open when they are having trouble breathing. It is a sign of respiratory distress and means you should seek medical help immediately.
Fever with RSV usually lasts 2 to 4 days. If a high fever persists or recurs after resolving, it could be a sign of a new bacterial infection, such as pneumonia or an ear infection.
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