Galarah Golanbar

Christopher Kwon
Vanessa Munoz
Case Study: Parainfluenza Virus
A 13-month-old child has a runny nose, mild cough and low grade e!er or se!eral days"
#he cough got worse and sounded li$e %bar$ing"& #he child made a wheezing sound
when agitated" #he child appeared well, e'cept or the cough" A lateral (-ray
e'amination o the nec$ showed a subglottic narrowing"
1" )hat are the speciic and common names or these symptoms*
#he symptoms o parainluenza !irus can !ary widely, rom cold-li$e symptoms to
se!ere diiculty breathing in rare cases" +ur case only describes a ew o the multitude o
symptoms that can be seen with inection by parainluenza !irus" ,ased on the
description o the case abo!e, we see that the child is suering primarily rom !iral croup
or laryngotracheobronchitis, which accounts or the ma-ority o upper respiratory
obstructions in children" .1,/0 1t is usually preceded by coryza, displaying eatures o the
common head cold" Coryza is associated directly with rhinorrhea, or runny nose,
although a low-grade e!er is also a regular contributor" .30 #he child is also described as
ha!ing a mild cough, which can progress to the bar$ing cough seen in patients with !iral
croup, and is the most common symptom seen in inection by parainluenza !irus" #his
occurs when the mucous membranes lining the nasopharyngeal ca!ities are inlamed"
Additionally, when agitated, the child shows inspiratory stridor, or wheezing,
characterized by a high-pitched sound, which accompanies and oten e'acerbates the
persistent cough" .20 #his may be a sign that the body is trying to clear the airways and
reco!er rom the illness by rele'" 3arainluenza !irus, regardless o the type, is $nown to
cause re4uent episodes o inection throughout one5s lie once it has been contracted"
/" )hat other agents could cause a similar clinical presentation 6dierential
diagnosis7*
#here are three common types o human parainluenza !irus 6831V79 #ype 1, #ype /,
and #ype 3" + these three, #ypes 1 and / ha!e been ound to be ma-or contributors o
!iral croup, and ha!e been $nown to cause biennial outbrea$s in the all" .:0 #ype 3 is
$nown to be associated with bronchiolitis and pneumonia" .;0 A ourth type o 831V has
been reported that is associated with respiratory inections" 8owe!er, inection by this
type is usually mild and inre4uent" .<0 +ther causati!e microorganisms include inluenza
!irus, respiratory syncitial !irus 6=>V7, adeno!irus, rhino!irus, entero!irus and the newly
disco!ered metapneumo!irus .;,<0 )hen croup is caused by inluenza !irus, the
symptoms are usually more se!ere" 1n a ew rare cases, Mycoplasma pneumoniae had
been isolated" .?0 +ther conditions that present similarly are spasmodic croup, and
epiglottitis" 1n most cases o spasmodic croup, an upper respiratory tract inection is
absent and there is no e!er associated with it" Additionally, sudden onset o spasmodic
croup is nocturnal and resol!es by morning" >ymptoms o epiglottitis are much more
se!ere, and include to'icity, high e!er, dysphagia 6ainting7 and drooling" .;,<0 #he
causati!e agents or epiglottitis are usually bacterial in nature, and can be conirmed by
laryngoscopy, where the arytenoids and epiglottis can be seen as ha!ing an inlamed,
cherry-red appearance" As a deiniti!e test o the presence o epiglottitis, a lateral C-spine
(-ray o the nec$ re!eals the trademar$ thumbprint sign" .@0 Additionally, 831V #ypes /
and 3 can induce e'pression o intercellular adhesion molecules-1 61CAM-17 in some
cells o the respiratory tract, pro!iding receptors to which rhino!iruses can bind, causing
superinection" .1A0
3" )ere there readily a!ailable laboratory tests to conirm this diagnosis* 1 so, what
were they*
Biagnosis ollows a pattern, and immunological and radiological testing is done to
conirm" Cateral posteroanterior 63A7 (-rays o the sot tissues o the nec$ show the
classic %steeple sign& o subglottic narrowing oten caused by 831V inection" 8owe!er,
only :AD o cases will show this pattern upon routine (-ray e'aminations" Eaturally, the
subglottic region o the nec$ shows a narrow passage or airlowF thus, in some cases
where the classic steeple sign can be !isualized, inlammation o this area signiicantly
reduces airlow, and contributes to respiratory diiculties" .110
Moreo!er, a presumpti!e diagnosis o 831V can be made based on the trends in
community !iral sur!eillance, history, age, and indings rom physical e'amination"
Beiniti!e diagnosis re4uires identiication o the !irus" #here are / methods currently
a!ailable or identiication o 831V9 rapid identiication techni4ues perormed directly on
respiratory secretions and !iral culture o respiratory samples" #he best clinical samples
are nasal washes or nasal swabs that are immediately placed into sterile containers with
!iral media and are transported on ice to the !irology laboratory" #hese principles o
specimen collection are true or many o the respiratory !iruses in clinical medicine, and
are essential to the successul identiication o !iruses" .1/0
=apid identiication o !iral antigens by immunoluorescence or detection o !iral
=EA by ampliication methods is possible, using respiratory tract secretions" .13,12,1:0
Birect antigen detection with commercially a!ailable luorescent monoclonal antibody
reagents, howe!er, has low sensiti!ity and speciicity" .1:0 Eew =EA ampliication
methods ha!e been promising, with a reported sensiti!ity o @2D to 1AAD and a
speciicity o @:D, but they ser!e only as research tools at this time" .13,120
Viral culture is the gold standard or detection" 831Vs may grow as early as / days or
as long as 12 days ater primary inection with the !irus" 831Vs may produce a subtle
cytopathic eect in cell culture that is detected by light microscopy" #hey may also
demonstrate a hemadsorption phenomenon that is detected by adsorption o guinea pig
red blood cells onto the surace o inected cells" +ther hemadsorbing !iruses include
inluenza, measles, and mumps" Ater demonstration o the cytopathic eects or
hemadsorption, immunoluorescent monoclonal antibodies are used to dierentiate 31V
rom other hemadsorbing !iruses and to identiy the speciic 31V type"
2" )as there a possible treatment or this child*
#here ha!e been no clinically controlled trials pro!ing eecti!e anti!iral treatment or
31VF howe!er, riba!irin has demonstrated both in !i!o and in !itro acti!ity against 31V"
.1;,1<,1?,1@,/A0 #he use o inhaled riba!irin in immunocompromised patients or in those
with se!ere disease could be helpul to these indi!iduals" >ymptomatic treatment o
clinical syndromes is the only a!ailable treatment at this time" >ymptomatic treatment o
laryngotracheitis includes humidiied cool air and inhalation o racemic epinephrine"
Also, the use o high-dose systemic corticosteroids 6i"e" de'amethasone7 could be used in
the treatment o moderate and se!ere disease, which shortens the course o clinical
symptoms and reduces the incidence o endotracheal intubation" ./10 Eebulized steroids
6budesonide7 ha!e been recommended or use in children with moderate-to-se!ere
laryngotracheitis" .//0 Gor other clinical syndromes, the only a!ailable treatment consists
o supporti!e therapy with o'ygen, bronchodilators, and antibiotics used wisely in
instances o bacterial superinection"
=eerences
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