The parainfluenza viruses.
Now we're going to the respiratory
component of the paramyxoviruses.
These, of course, transmitted still by
respiratory droplets and direct contact
with those droplets.
Treatment is supportive for those patients
who have respiratory distress.
One can use nebulized therapy,
especially with those patients
who have croup.
Providing warm, humidified air
is a way to ease the turbulence
of the air flowing through,
and make it easier for the
patients to breath.
Rarely, the patients require intubation
and ventilation to get through the
acute part of the disease.
There are 4 serotypes that we
look at with parainfluenza.
Types 1 and 2, classically, are
associated with croup,
that seal bark cough that anybody who
has children is quite familiar with.
Typically, kids from age 2-5 are the ones
who are affected and infected
by the parainfluenzas.
If the cough, which is due to laryngeal
edema, tracheal swelling,
if the cough progresses, then the patients
may have inspiratory strider,
and that is when they come
to medical attention
and require the humidified air.
The chest X-ray may show a steeple sign
on the frontal images, the PA or AP images.
And the steeple sign, although we don't
have a picture of it in this talk,
looks very much like the middle
of my fingers.
So, right there, if you can see where
my thumb is, is what the trachea
looks like on playing field
looking straight at that.
And that, of course, means that that patient
is in danger of respiratory failure.
Serotype 3 for the parainfluenza
cause croup, but more commonly, it causes
lower respiratory disease.
So bronchiolitis, pneumonia, and the
pneumonia is going to be bilateral
Typically seen in the extremes
of age: the very young,
the very old
And then serotype 4, which is
mostly causes a mild, upper respiratory tract
infection, very much from - it's a cold.
So, then, respiratory syncytial virus.
This is a biggie for anybody who
Transmitted via large respiratory
droplets with direct contact.
In fact, patients with this disease
when they're breathing out
the droplets, typically
spread them on many horizontal surfaces,
which is unfortunate because we,
as healthcare providers,
come into the room, put our hands
right on the horizontal surfaces,
and then we typically scratch your
nose or something, and then
we have probably infected ourselves with
respiratory syncytial virus, RSV.
Reinfection can occur.
There are different serotypes, and so
one could get RSV infection
twice in the season.
The season is the winter season.
When reinfection occurs, thankfully,
it is milder in symptoms,
but adults still suffer from
or lower respiratory tract
infection with RSV,
and they have a pronounced persistent cough.
Treatment is supportive.
There has been lots of evidence
both for and against
the use of bronchodilators, the
use of aerosolized 3% saline.
But when all is said and done,
the current approach
is simply provide what the patient needs:
oxygen, if they need oxygen, albuterol
if they're wheezing, something like that.
For premature infants or patients
with chronic lung disease,
and especially infants in that stage,
they benefit from the use of palivizumab.
It's a monoclonal antibody,
specifically against RSV.
RespiGam was a prior product, which
was a polyclonal approach,
but the palivizumab is the way to go.
And that has been quite protective
against severe disease.
It doesn't prevent those infants
from getting RSV,
but at least if they do get RSV,
they're less likely to have a severe
progression of their disease.
What does RSV look like?
In those of us who are adults,
it's an upper respiratory tract infection
with rare lower respiratory tract
disease, unless we're reinfected.
And if it is upper respiratory, it is
just like the common cold.
But the principal manifestation is
in infants to toddlers
with lower respiratory tract disease
and they have bronchiolitis.
It is self-limited, thankfully.
However, it is an overwhelming
inflammation of the small
airways, the bronchioles, which, as you can
imagine, limits oxygen and gas transport,
which creates respiratory distress,
And in any patient who has an
or preexisting lung disease, this can be an
And these patients will wind up on
aggressive ventilatory support,
where many times,
ECMO, extracorporeal membrane oxygenation.
So, they're very sick and they look like it.
They'll have fevers, tachycardia,
wheezes, or very limited air exchange,
or air entry in their lungs, air trapping,
the whole 9 yards.
So, RSV is a big deal in, especially
So I've given you a rundown
of the paramyxoviruses.
Many viruses, many different effects
depending on the tropism, where the viral
If it's systemic, one gets incredibly
systemic symptoms and signs.
If it's respiratory, one gets very
aggressive respiratory disease.
So, this is a really good session
to come back
to, especially if one ends up
going into a pediatric world
for your career discernment.