Acute respiratory viral infection (ARVI): A clinical and radiological overview M. Mearadji

Transcription

1

2 Acute respiratory viral infection (ARVI): A clinical and radiological overview M. Mearadji International Foundation for Pediatric Imaging Aid

3 Introduction Acute respiratory viral infection (ARVI) are prevalent worldwide. The disease is responsible for morbidity and mortality mainly in infants and young children. A more severe clinical course is to be expected by different riskfactors. The majority of patients with ARVI require hospitalization because of respiratory failure.

4 RNA virus is a virus that has ribonucleic acid as its genetic material. RNA viruses that cause lower respiratory infection: Respiratoir syncytial virus Influenza virus Para influenza virus Rhinovirus Bocavirus Metapneumovirus Measles virus Human immunodeficiency virus

5 DNA virus has as its genetic material and replicates a DNA dependent polymerase. DNA viruses that cause lower respiratory infection: Adenovirus Cytomegaly virus Varicella Ebstein-Barr virus Papilloma virus

6 Virological examinations are needed to detect viral antigens, antibodies or viral nucleid acids and isolation of viruses. Serological tests, nasopharyngeal wash, sputum or tracheobronchial aspirates should be performed for diagnosis of bacterial super infections. X-chestfilm is absolutely indicated to look for the severity of an ARVI, pulmonary consolidation following bacterial super infection.

7 RSV is a major cause of acute lower respiratory tract infection in young infants RSV does not grant complete immunity RSV occurs via transmission of respiratory secretion or by direct contact RSV infection is globally and occurs in winter and spring RSV related illness occurs with peak incidence ex???? 2 and 3 months of age Bacterial super infection is a frequent complication of RSV (17,5 44 %) Consolidation of lung is radiologically typical sign of bacterial super infection by RSV however superinfected atelectasis as a bronchopneumonia is more a diagnostic dilemma.

8 Respiratory syncytical virus (RVS) in 41 patients Nr. Age: 1 week 2,5 years Average: 8 months Male 22 Female 19 Risk factor 21 Premature 1 day old ECMO 5 Intubation 20 Hyperinflation 37 Bronchial wall thickening 38 Atelectasis 31 Consolidation 15 Age 13 months

9 Dysmature 1 month old Premature 2 months old 1 day later 2 weeks later

10 Mature 3 months old 5 days later. Patient on ECMO therapy.

11 Influenza in 14 patients Nr. Age: 3 months 15 years Average: 8,5 years Male 8 Female 6 Risk factor 8 15 year old girl ECMO 4 CT 2 Hyperinflation 2 Bronchial wall thickening 7 Atelectasis 4 Consolidation 10

12 5 year old boy 14 year old boy with swine flu

13 Adenovirus (7 patients) Nr. Age: 1 month 2 years Average: 1 year Male 0 Female 7 Risk factor 4 2 year old girl Intubation 2 CT 2 Hyperinflation 3 Bronchial wall thickening 6 Atelectasis 2 Consolidation 2 11 months old girl

14 Rhinovirus (3 patients) Nr. Age: 2 7 months Male 3 Female 0 Risk factor 2 2 months old boy Intubation 3 Hyperinflation 2 Bronchial wall thickening 3 Atelectasis 3 Consolidation 2 vervangen

15 Human Boca Virus (3 patients) Age: 3 11 months Nr. Male 2 Female 1 Risk factor 3 vervangen ECMO 1 Hyperinflation 2 Bronchial wall thickening 1 Atelectasis 1 Consolidation 0 6 months old boy

16 Epstein Barr Virus (EBV) in 3 patients Nr. Age: 7 15 years Male 2 Female 1 Risk factor 1 15 year old girl Intubation 1 Hyperinflation 1 Bronchial wall thickening 1 Atelectasis 0 Consolidation 1

17 Metapneumo virus (2 patients) Age: 3 months 5 years Nr. Male 2 Female 0 Risk factor 2 3 months old boy Hyperinflation 1 Bronchial wall thickening 2 Atelectasis 1 Consolidation 1 5 year old boy

18 Para influenza virus (2 patients) Age: 2 4 months Nr. Male 0 Female 2 Risk factor 2 1 month old girl Hyperinflation 2 Bronchial wall thickening 2 Atelectasis 2 Consolidation 1 1 month later

19 Varicella (4 patients) Nr. Age: 2 months 5 years Male 3 Female 1 Risk factor 2 5 year old boy Pleural effusion 2 Hyperinflation 2 Bronchial wall thickening 1 Atelectasis 1 Consolidation 2 2 year old girl

20 Child with measles and pulmonary complications

21 CMV (1 patient) Nr. Age: 3 years Male 0 Female 1 Risk factor 1 CT 1 Hyperinflation 0 Bronchial wall thickening 1 Atelectasis 0 Consolidation 1 3 year old girl with immunodeficiency

22 Conclusion An acute respiratory viral infection in young children is a life threatening event Hospitalization, intubation and mechanical ventilation is specially needed by lower respiratory infection Super bacterial infection is a frequent complication in different type of respiratory viral infection

23 Conclusion Serial chest films are needed to confirm the diagnosis and follow the pulmonal conditions Atelectases occurs more frequently in association with bacterial super infection A positive bacterial culture and an elevated CRP are important findings to confirm the diagnosis of bacterial super infection.