Human Respiratory Syncytial Virus Infection
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RSV infection causes neurological complications in approximately 1. Neurological manifestations include convulsions, central apnoeas, lethargy, feeding and swallowing difficulties, changes in muscle tone, strabismus, cerebrospinal fluid abnormalities, and encephalopathy 6 , 7. The neurological complications have been attributed to overproduction of cytokines and free radicals. Neuroimaging findings of RSV acute encephalopathy include generalised oedema, abnormal fluid distribution in the brain parenchyma, involving the cerebral cortex, and development of diffuse cerebral atrophy with loss of neurons and their connections 6 , 7.
Two types of convulsions have been described: generalised tonic-clonic and focal seizures.
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As with RSV encephalopathy, seizures have been attributed to the overproduction of cytokines and free radicals. Hyponatraemia a common finding in bronchiolitis by RSV contributes to seizure risk. Direct infestation of the cranial nerves may lead to some rarer clinical manifestations such as strabismus with isotropy 6. RSV can affect the heart in multiple ways. RSV has been isolated from myocardial tissue biopsies in patients with myocarditis suggesting direct organ invasion. In addition, the virus can cause the development of significant pericardial effusion in some children, which if severe may result in cardiac tamponade.
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With regards to cardiac rhythm disturbances, in infants with RSV pneumonitis the following have been reported: supraventricular tachycardia, multifocal atrial tachycardia and atrial flutter, ventricular tachycardia with torsades des pointes, ventricular fibrillation and rarely slow junctional escape rhythm and advanced degree atrioventricular block 11 , However, the mechanisms that lead to cardiovascular compromise remain still largely hypothetical 1.
The development of pulmonary hypertension in severe respiratory RSV infections is a potential mechanism of secondary myocardial dysfunction, hypotension and arrhythmias 13 , 14 Direct heart invasion by RSV is possible, as there are a few reports in which the virus has been isolated from biopsy material 1. However, the involvement of the cardiovascular system is most probably due to immunological mechanisms which seem to account for the majority of the non-pulmonary manifestations of RSV disease and are briefly described later on in this editorial. As for the endocrine system, anti-diuretic hormone levels are significantly higher in patients with RSV bronchiolitis compared to subjects with upper respiratory tract infection and higher concentrations have been documented in those who require mechanical ventilation, a finding which is not correlated to sodium levels Moreover, intubated children were found to have higher concentrations of prolactin and growth hormone and lower concentrations of leptin and IGF-1 compared to ward inpatients The latter might suggest a relationship between the neuroendocrine response in acute RSV infection and the severity of illness.
Bronchiolitis is generally characterised by increased secretion of anti-diuretic hormone and hyper-reninaemia with secondary hyperaldosteronism, which cause water retention, but counter-balance each other with respect to serum sodium However, one should bear in mind that hyponatraemia and secondary hyponatraemic convulsions can be iatrogenic and related to the administration of hypotonic solutions In addition, in those severely affected infants an increase in glucocorticoid beta receptor expression was observed, resulting in decreased in alpha:beta glucocorticoid receptor ratio.
Respiratory Syncytial Virus (RSV) Infection
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Reviewed by Karen Gill, MD. Table of contents What is it? Fast facts on respiratory syncytial virus Here are some key points about respiratory syncytial virus. Most children experience respiratory syncytial virus by the age of 2 years. The virus can spread through both direct and indirect contact with secretions from people with the infection.
It can survive on hard surfaces, such as tabletops and toys, for several hours.
Full recovery from infection usually takes 1 to 2 weeks. Treatment typically involves relieving the symptoms.
Human orthopneumovirus - Wikipedia
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The first population-based study of its kind examines the association between onion and garlic consumption and breast cancer risk. This search strategy was adapted to fit with other databases. A manual search which consists in scanning the reference lists of eligible papers and other relevant review articles was conducted. The search in electronic databases was conducted on September 6, We considered studies including patients with clinical diagnosis of acute respiratory tract infection as defined in each study.
Studies among populations with underlying medical conditions, studies conducted during an outbreak period, case series or studies in which HRSV was imported cases were excluded. The search for HRSV had to be conducted systematically or by sampling of the population in the presence of defined inclusion criteria respiratory signs and HRSV detection by polymerase chain reaction PCR technique on respiratory samples. In the case of missing data, we contacted authors of the paper. Two investigators independently screened records based on titles and abstracts for eligibility.
Full texts of articles deemed potentially eligible were retrieved. Further, these investigators independently assessed the full text of each study for eligibility and consensually retained studies to be included. Disagreements when existing were solved through a discussion. Data were extracted using a preconceived and tested data abstraction form. In the cases of missing data, authors were directly contacted to provide missing information.
Two investigators independently extracted data including name of the first author, publication year, study design, setting, sampling method, respiratory samples collection period, timing of data analysis, number of viruses screened, site of recruitment location country, city, latitude, longitude, and altitude , clinical presentation, number of patients screened, number of patients infected with HRSV, diagnostic techniques used, and proportion of male participants.
We assigned a United Nations Statistics Division UNSD African region central, eastern, northern, southern, and western to each study regarding the country of recruitment. Using Google Global Positioning System, we assigned altitude, latitude, and longitude according to the cities and country of recruitment.
Disagreements between investigators were reconciled through discussion and consensus or an arbitration of a third investigator. Each item was assigned a score of 1 Yes or 0 No , and each score was summed across items to generate an overall study quality score. Unadjusted prevalence and standard errors of HRSV infection were recalculated based on the information of crude numerators and denominators provided by individual studies.
The value of H close to 1 is indicative of some homogeneity between studies. For categorical variables, the global P value was considered for the inclusion in multivariable models. Following crude overall prevalence, two sensitivity analyses were conducted: one considering only studies with low risk of bias and another one considering only studies conducted in complete season s. The Centre for Reviews and Dissemination guidelines was used for the methodology of this review. We identified records; after elimination of duplicates, records remained. After screening of titles and abstracts, we found records to be irrelevant and excluded them.
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Finally, 66 full texts including 67 studies were included one paper included two studies. Studies were published between and Data were from 20 countries. Respiratory samples were collected between January and April Most of studies included only children with proportion of males varying between Individual characteristics of included studies are in the Table S3. The prevalence varied widely from 0.
The overall prevalence was The prevalence was higher among children Variables included in the multivariable model clinical presentation, age groups, diagnostic method explained Sensitivity analysis including only studies with low risk of bias and another one including only studies conducted in complete seasons gave similar results. Our review included studies using only reverse transcriptase PCR. The interpretation of the prevalence found in our study should consider the involvement of other infectious agents in the occurrence of ARTI.
Indeed, the presence of coinfection with other viruses should be considered. These coinfections may have a synergistic effect in the occurrence of ARTI.