Other high-risk groups for severe RSV LRTI for whom RSV immunoprophylaxis is recommended by the American Academy of Pediatrics include children under 2 years of age with chronic lung disease or with congenital heart disease (e.g., congestive heart failure, pulmonary hypertension, and cyanotic heart disease). Antibiotic use can also lead to resistance. There are also more recently identified viruses including bocavirus (BoV) and polyomaviruses. A large number of candidate gene association studies have been performed for both RSV (231) and SARS-CoV, but studies have also been performed for influenza virus and RV (Table 2). 2A). Viral infection enhances bacterial infection in two ways, altering physical barriers and altering immune system barriers. The relative importance of individual viral agents in early life is open to debate. hMPV certainly has clinical impact, and there is evidence to suggest that BoV is pathogenic (46, 225), but data from previously reported studies suggested that the new polyomaviruses are not pathogenic on their own (2, 244). Babies Who Get Sick a Lot May Be at Higher Risk for Celiac Disease, Primary Ciliary Dyskinesia Diagnosis and Treatment. Recurrent respiratory tract infections are thought to result in 2 million deaths yearly., The signs and symptoms of upper respiratory infections are familiar to many people and can include:. Viral infection can also skew the immune response, allowing greater infection. A recent trial of this treatment, which has been successfully used for patients with cystic fibrosis, reported a reduction of 26% in the length of hospitalization for infants with acute viral bronchiolitis (182, 361). Bacterial CoinfectionOne interesting side effect of respiratory viral infection is increased susceptibility to bacterial coinfection. A particular problem with antivirals is that they are prone to inducing viral escape mutants, particularly for the highly plastic RNA viruses; for example, escape mutants associated with oseltamivir require only a single point mutation (76). Sex: Male children are more likely to experience recurrent respiratory infections than females. For other viruses, there are a number of roadblocks to the development of a vaccine. CD25+ CD4+ regulatory T cells (Tregs) were shown to inhibit the murine neonatal immune response to herpes simplex virus (96). 362:k2698. The protein DAI (DNA-dependent activator of IFN-regulatory factors; DLM-1/ZBP1) is a cytosolic DNA sensor and may also be of importance for the detection of viruses (321), and it is likely that there are other DNA receptors that are critical for the detection of viruses. That said, there are several conditions that may predispose a child to develop an infection, and knowing when to search for an underlying cause is challenging. As discussed below, infants have reduced type I IFN responses (195), which may lead to increased disease severity following viral infection. GeneticsAs well as environmental risk factors, genetic risk factors have been identified. One issue with treatments that dampen the immune response is their nonspecific effect; for example, long-term anti-TNF treatment has been shown to lead to tuberculosis reactivation. The effect may vary according to the infecting virus. International Journal of Molecular Sciences. Elsevier. Viruses can hide their PAMPs; for example, the influenza virus NS1 protein conceals the viral genome from detection (200). Our goal was to investigate the effects of Pidotimod on RI prevention in children with DS, comparing immune and clinical parameters before (T0) and after (T1) the treatment with Pidotimod. LKS Is a Rare Childhood Speech and Seizure Disorder, The Form of Potentially Fatal HPV You Probably Don't Know About, Why the Flu Is Different for People With Asthma, Diagnosis and management of recurrent respiratory tract infections in children: A practical guide, Recurrent lower respiratory tract infections in children, Burden of recurrent respiratory infections in children. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Enter multiple addresses on separate lines or separate them with commas. While increased levels of exposure may be the source for some people, structural problems such as lung cancer or a primary immunodeficiency disorder are sometimes the cause. These factors act in combination with small body size and small airways to further increase disease severity. Congenital abnormalities of the upper or lower airways, such as bronchial hypoplasia or bronchial stenosis, Foreign body in the airways (either in the nasal/sinus passages or bronchial tree), Abnormalities of the head/face (craniofacial abnormalities), Ciliary dyskinesis or immotile cilia syndrome: When the tiny hairs that line the airways do not function properly to remove debri from the airways, Neurological conditions that interfere with swallowing (which can lead to aspiration), Infections, such as HIV, Epstein-Barre virus (EBV, the virus that causes "mono"), cytomegalovirus (CMV), Medications, such as corticosteroids (such as prednisone), chemotherapy, Blood-related cancers such as leukemia and lymphoma, Asplenia (lack of a spleen or splenic function), such as with hereditary spherocytosis, sickle cell disease, or children who have had a splenectomy due to trauma, Eight or more ear infections (otitis media) in a one-year period, Two or more sinus infections in 12 months, Two or more episodes of pneumonia in 12 months, Three or more episodes of bronchitis or bronchiolitis, A productive (wet) cough that lasts more than four weeks (a wet cough could be a symptom of bronchiectasis, cystic fibrosis, immunodeficiencies, foreign body aspiration, congenital lung abnormalities, and more), An infection that is persisting despite two months on antibiotics, The need for intravenous antibiotics to resolve an infection, A family history of primary immunodeficiency (most children who have a primary immunodeficiency do not have a family history), A history of alternating diarrhea and constipation combined with repeated respiratory infections (often seen with cystic fibrosis), A history of infections with uncommon organisms, Height and weight: These are extremely important measurements. However, the lack of internationally agreed-upon definitions makes the use of these pathological descriptions as clinical diagnoses contentious and, since the treatment is the same regardless of these distinctions, probably irrelevant. Immunizations to prevent primary and secondary infections should also be up to date, and are safe and effective even for most children who have immunodeficiency disorders. Vaccines exist for several of the infections that are common in children with recurrent infections. Studies published since the Cochrane review was performed support the argument that bronchodilators have no benefit for infant bronchiolitis (159, 193, 292). Recurrent respiratory papillomatosis (RRP) is a disease in which benign (noncancerous) tumors called papillomas grow in the air passages leading from the nose and mouth into the lungs (respiratory tract). A reduction in lung function is a serious concern with recurrent lower respiratory tract infections.. First, are they truly new or only newly discovered? Immature immune system, the … These challenges are compounded by specific problems associated with pediatric vaccination caused by the limitations of the infant immune system (298). Underlying Causes . TLR2, TLR4, and TLR6 are all extracellular receptors that have been characterized principally for the detection of bacterial products, both lipopolysaccharides (LPSs) and lipoproteins. 2016. Underlying causes can be divided into categories: 22q11.2 deletion syndrome. 4(1):45. doi:10.1038/s41572-018-0042-3, Toivonen L, Karppinene S, Schuez-Havupalo L, et al. However, opinion is mixed as to whether this would be effective. 2017. Risk is also higher among children whose mothers smoked during pregnancy. Follow-up of these infants will reveal whether the presence of HRV in the bronchial biopsy … In the original study, premature infants of ≤35 weeks of gestation with and without bronchopulmonary dysplasia were treated with palivizumab during their first winter season, resulting in 39% and 78% reductions in RSV-associated hospitalizations, respectively. Recurrent pneumonia in children: A reasoned diagnostic approach and a aingle centre experience. The early-life immune system appears to be suppressed; how this suppression is relaxed over time and the role of infection in the development of normal immune responses are of critical importance. There appear to be two loose groups of genes that are important for altering the outcome following respiratory viral infection. The level of the response may depend upon the effector molecule that is being used as a readout: the level of IL-6 appears to be increased (15), while the level of tumor necrosis factor (TNF) (196) or type I IFNs (78, 79) is decreased. doi:10.1097/INF.0000000000001304, Loenen MHM, van Montfrans JMJ, Sanders EAM, et al. Respiratory viruses are detected extracellularly by TLR2, TLR4, and TLR6; in the endosome by TLR3, TLR7, and TLR9; and in the cytoplasm by RIG-I (retinoic acid-inducible gene I), MDA-5 (melanoma differentiation-associated gene 5), and NLRP3 (NLR family, pyrin domain-containing 3). If the upper respiratory infection is bacterial, these same bacteria may spread to the middle ear; if the upper respiratory infection is caused by a virus, such as a cold, bacteria may be drawn to the microbe-friendly environment and move into the middle ear as a secondary … The RIG-I-like receptor (RLR) family is a recently described group of intracellular proteins that are able to detect the viral genome in the cytoplasm. Furthermore, bronchial epithelial cells from asthmatics, who are at an increased risk of severe viral infection, have been shown to have deficient type I IFN (347) and type III IFN (66) production. RSV leader negative-strand RNA binds the La antigen, which inhibits the RIG-I detection of RSV (27). If viral infection is causative, what is the mechanism? Immunopathology versus Viral PathologyA core question about respiratory viral infection is, how is disease caused? These factors have been identified as being determinants of the mucosal antibody response to RSV infection (276). A bulb suction should be used on infants to help clear nasal passages, especially before feedings. Links between infant infection with hMPV (105), RV (147, 192), and RSV (99, 301, 313) and later-life wheezing have been demonstrated. P T. 2016;41(7):426–436. RSV-infected HIV-positive infants had increased viral shedding but decreased bronchiolitis (52). Children born to mothers with placental Plasmodium falciparum infection are more susceptible to malaria (189), and this may be associated with the enhanced development of P.falciparum-specific Tregs in cord blood (39). In other words, is the child healthy, growing well, and free from symptoms when he does not have an infection? Recurrent chest infections are a common reason for children to be seen by their general practitioner (GP) or a paediatrician. PY - 2015/12/27. ASM journals are the most prominent publications in the field, delivering up-to-date and authoritative coverage of both basic and clinical microbiology. Recurrent fever is one of the main symptoms of a collection of conditions called periodic fever syndromes. Young age acts as a metafactor reflecting the interplay of factors causing disease following viral infection (Fig. This may be a downstream consequence of the failure to initiate type I IFN responses and therefore minimal DC activation, but other mechanisms may be involved. The mechanistic links between viral infections and asthma, however, are not well understood. Supportive Treatment and Inhalation of Hypertonic SalineGiven the lack of effective medications, current treatment for severe viral LRTI in infants relies on supportive measures only. Second, what is the clinical impact of these viruses? 2017. U.S. National Library of Medicine. Two questions arise about these new viruses. recurrent respiratory tract infections in childhood Recurrent respiratory tract infections (RRTI) are very frequent in childhood and have the potential to be extremely severe. In analogy to asthma treatment, bronchodilators have been used widely, including β2 agonists, nebulized epinephrine, and antimuscarinics such as ipatropium bromide. tuomas.jartti@tyks.fi Comment in Eur Respir J. They are responsible for significant morbidity measured by school days lost. Pulmonary infections remain a major cause of infant and child mortality worldwide and are responsible for a substantial burden of morbidity. BMJ. Furthermore, anti-RSV antibody escape mutants have been isolated (364), and studies indicated that this treatment is cost-effective only for the highest-risk infants (89, 90). Children who experience recurrent respiratory infections also require antibiotics frequently, and antibiotic use has recently been shown to adversely affect the gut microbiome or flora (gut bacteria) and even increase the risk of colon cancer. Y1 - 2015/12/27. The paradox of early-childhood immune hyporesponsiveness and virally induced immunopathology. This is a critical adaptation to survive early-life exposure to previously unseen nonpathogenic antigens of both self and foreign origins. To the Point People with immunodeficiency get the same kinds of infections other people get ear infections, sinusitis and pneumonia. In this review we explore the complete picture from epidemiology and virology to clinical impact and immunology. Michael Menna, DO, is board-certified in emergency medicine. He is an attending emergency medicine physician at White Plains Hospital in White Plains, New York and also works at an urgent care center and a telemedicine company that provides care to patients across the country. There may be other methods of viral detection that are also important, for example, the NOD-like receptor inflammasome, which was recently demonstrated to be required for the immune response to influenza virus (10, 141, 328), and β-3 integrins have been shown to be important for the detection of adenovirus (83). A diagnosis usually requires a fever (with a rectal temperature greater than or equal to 38 degrees Celsius) alone with at least one respiratory symptom such as a runny nose, congestion, sore throat, cough, earache, or wheezing, and symptoms should have lasted at least two to three days. Broad-range anti-inflammatory treatments have been shown to reduce disease severity of influenza infection: gabexate (a synthetic protease inhibitor, which inhibits cytokines) reduced inflammation but did not alter survival (172), and gemfibrozil (another broad-range cytokine inhibitor) increased rates of survival for mice infected with influenza from 26% to 52% (41). After 6 months of age children still have a relative immune deficiency until their immune systems mature at the age of 5 or 6 years old. Diagnosis and management of recurrent respiratory tract infections in children: A practical guide. Significant correlations between genes of the immune system and the risk of severe respiratory viral infection have been observed. The possibility therefore arises that viral infection of epithelial cells in the context of a Th2-skewed background induces TSLP, leading to the amplification of the Th2-skewed response. There is a lot of confusion about when to treat, what to treat, and why. A recent Cochrane review found only one study comparing ampicillin to placebo that met the inclusion criteria. Children with Down syndrome (DS) show a high susceptibility to recurrent infections (RI), caused by immune defects and abnormalities of the airways. Abstract: In healthy infants and young children, the development of respiratory tract infections (RTIs) is extremely common. Second, of these viruses, RSV has most commonly been reported to be the main cause of hospitalization due to bronchiolitis and increased disease severity, followed by RV and then by influenza virus. This suggests that these findings may be particular to immunodeficient or immunosuppressed individuals, for whom RSV infection is known to be a major clinical problem, e.g., after bone marrow transplantation (229). Why Do You Keep Getting Respiratory Infections as an Adult? Finally, both the virus and the immune response contribute to damage to the lungs and subsequent disease, and therefore, any prevention or treatment needs to address both of these factors. This increased output of viruses, along with typically lesser attention to hygiene, makes children more likely to spread their infection to others. The discovery of new agents of infection is important because they may play a role as coinfecting agents, altering disease severity. The treatment and care for viral lower respiratory tract infection (LRTI) depend on the assessment of the severity of respiratory compromise by using measurements of O2 saturation and of blood gases and the clinical assessment of the severity of respiratory distress and of respiratory exhaustion with decreased respiratory effort, increasing CO2 retention, and respiratory acidosis. However, the level of expression of proteins downstream of these receptors, including MyD88 (285), IRF3 (5), and IRF7 (74), is decreased in cord blood-derived DC. Copyright © 2020 American Society for Microbiology | Privacy Policy | Website feedback, Print ISSN: 0893-8512; Online ISSN: 1098-6618, Respiratory Viral Infections in Infants: Causes, Clinical Symptoms, Virology, and Immunology, Sign In to Email Alerts with your Email Address. 2B). Another concern is the impact on what is already seen as a fragile economic recovery, by affecting consumer confidence and spending. The causes of vomiting vary with age and range from relatively benign to potentially life threatening (see Table: Some Causes of Vomiting in Infants, Children, and Adolescents). Please type the correct Captcha word to see email ID. They tend to be recurrent, often causing multiple episodes of illness within a single year. Blocking viral infection with drugs (53) or a prophylactic antibody (303) may reduce the incidence of asthma and wheeze in later life. SUMMARY In global terms, respiratory viral infection is a major cause of morbidity and mortality. Kashish Khanna, Verify Captcha × Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Pulmonary infections remain a major cause of infant and child mortality worldwide and are responsible for a substantial burden of morbidity. Disease Primers. There are a variety of diagnostic test kits based on antigen detection that are used for the rapid identification of virus. Both RSV and RV are characterized by neutrophilic infiltrate (227, 261). Early life has an effect on both virus- and immune-mediated damage. There are four principal ways in which respiratory viruses are diagnosed: virus culture, serology, immunofluorescence/antigen detection, and nucleic acid/PCR-based tests. He was a postdoctoral research fellow at the Department of Respiratory Medicine, Imperial College London, studying the delayed effects of neonatal respiratory syncytial virus infection. What’s the difference between a recurrent fever and a classic fever? Potentially, toe use of anti-inflammatory drugs and treatments might be effective, especially if disease following respiratory infection is immune mediated. Bronchiectasis. Infection/colonization with normal flora may be necessary in shaping normal immune responses. Second, there is a failure of signaling for the crucial B-cell survival factors BAFF (B-cell activating factor of the TNF family) and APRIL (a proliferation-inducing ligand), with reduced levels of APRIL expression (25) and reduced levels of expression of the receptors TACI (transmembrane activator and calcium modulator and cyclophilin ligand interactor), BCMA, and BAFF-R (162) leading to the rapid waning of the antibody response observed. However, the occurrence of persistent respiratory viral infection, particularly the persistence of RNA viruses, is controversial. The second group contains genes that are involved in the control of viral load. Signaling from the IFN-α receptor by elements of the JAK-STAT pathway is inhibited by RSV (274), hMPV (82), SARS-CoV (170), and adenovirus (AV) (296). Viral acute respiratory infections (ARIs) may lead to oxidative stress in some infants, and play a major role in the development of recurrent wheezing in early childhood, according to a new study. RSV infection of these infants often leads to severe LRTI, requiring close monitoring of disease and, in the case of deterioration, early hospitalization. Many of the fatalities due to the 1918-1919 flu pandemic were caused by secondary bacterial pneumonia (166). 4(1):e31039. There are differences in the susceptibility of inbred mouse strains to respiratory viral infection, which allow comparative studies. One epithelial product of particular interest is thymic stromal lymphopoietin (TSLP), an interleukin-7-like cytokine identified as being a murine B-cell-line growth factor (304). However, the molecules that transduce the signal, e.g., IRF3 and IRF7, have reduced function. (For comparison purposes, costs have been converted from original data into U.S. dollars using the values US$1 = AUD$1.3 = €0.75 = £0.5 [summer 2008].) Background: Congenital cystic lung disease (CCLD), which includes congenital cystic adenomatoid malformation, bronchopulmonary sequestration, and congenital lobar emphysema, has been reported to increase the risk of recurrent respiratory infection. This higher viral load may be exacerbated by the lack of previous exposure and therefore the lack of protection against the infectious agent. Alternatively, mouse models can be used to support the findings of human studies. While uncommon, diagnosing and treating some of these conditions may not only reduce the number of infections, but minimize long term lung damage as well. The chest exam also looks for abnormal breath sounds, respiratory rate, and use of accessory muscles for breathing. The chance of a severe infection is highest for: Babies born prematurely When figuring out the number of infections, it's important to note that infections commonly last longer than people realize. RV increases mucus production (23), and in vitro cytotoxicity has been seen for RV infection (37). Thank you for sharing this Clinical Microbiology Reviews article. This should include a detailed account of infections in the past, including the severity and treatments used. We thank Peter Openshaw, Cecilia Johansson, and Charlotte Weller (Imperial College London) for proofreading and advice. In addition, regarding clinical use, ribavirin has generally been thought to be disappointing and to provide little or no benefit, possibly because once developed, the severe inflammation in RSV bronchiolitis may be maintained independently of the presence of live RSV virions. In some cases, however, an underlying medical condition (either present from birth (congenital) or acquired later on) is present. It is spread by direct contact with respiratory secretions like a cough or sneeze. This is justifiable for healthy infants, since the virological diagnosis does not predict the severity or length of disease, nor does it usually lead to specific therapy. It is a unique peculiarity of Ayurveda that Ayurvedic paediatrics start well before conception. Emotionally, recurrent infections can affect the whole family. Infant immune responses are also characterized as being T-helper 2 (Th2) skewed; this is in part reflective of the immune response of the fetus. Our free guide has everything you need to stay healthy this season. The disease that is seen in children is composed of both a virus- and an immune-mediated component. A very important question when considering whether a workup is needed is how a child is doing between infections. Two recent studies of hospitalized children from the United Kingdom indicated that a large proportion of the children had preexisting disorders (31 out of 77 cases [119] and 32 out of 58 cases [203]; in the latter study, 9 out of 58 cases died, all of which had preexisting disorders). John S. Tregoning (Ph.D.) is the lecturer in infection and immunity at St. George's University of London, United Kingdom. Unfortunately, it is very difficult to separate the effects of one component from those of the other. However, as shown in Table 1, there are several factors limiting the ability to draw a definitive conclusion about which virus is the most common or important: differences in the way that data were collected (PCR versus immunoassay) between and within studies and the impact of assay sensitivity (214); differences in study design affecting age, recruitment criteria, and which viruses are studied; skewing of data historically, particularly the ease of in vitro detection of RSV compared to that of RV; changes following the wider introduction of reverse transcription (RT)-PCR; PCR diagnosis of virus that may not necessarily indicate that the virus is causing disease (353) (there is some evidence of viral RNA detection in asymptomatic children [335] and evidence of viral persistence [153]); and the predominance of hospital-based studies, which are skewed toward more severe illness. Respiratory infections account not only for increased mortality but also for increased morbidity in this age group: between 22% (United Kingdom ) and 26.7% (Belgium ) of all hospitalizations and between 33.5% (Italy ) … Most of them are viral upper respiratory tract infections (URTIs) that are self-limiting, and epidemiological studies indicate that up to seven episodes/year in the first three years of life and up to five episodes/year after the age of three years can be considered normal. Another issue is timing; immunity-dampening treatments during the early phase of infection might increase viral load and, therefore, virally induced damage. The most common cause is from a respiratory virus (usually RSV, which is present in the winter and spring months). NOTE: We request your email address only to inform the recipient that it was you who recommended this article, and that it is not junk mail. Outstanding QuestionsOutstanding questions in this field of research include the following. Genes in the first group are involved in the magnitude and type of the immune response but do not necessarily control viral load. SARS-CoV was shown to block NF-κB function (170), and interferon response factor 3 (IRF3) activation is inhibited by RV (174), RSV (309), SARS-CoV (170), and PIV (210). It is this combination of a viral infection and secondary bacterial infection that is responsible for the danger associated with the flu virus. Recurrent or persistent cough may be the only symptom, but often there is also a history of wheeze, breathlessness, sputum production or general ill-health. For example, hMPV was shown to have been circulating for at least 50 years (337). Physically, experiencing recurrent infections in childhood is a leading cause of bronchiectasis, a type of COPD characterized by dilated airways and excess mucus production. On 11 June 2009, the WHO raised the pandemic alert level to 6, signifying the first influenza pandemic since 1968. The removal of the baby from the uterine environment removes this immunosuppression, as observed by the similarity in neonatal immune responses compared by birth rather than gestational age. Respiratory syncytial virus spreads through the air, like after a cough or a sneeze, and through direct contact like touching. Other therapeutic approaches that have also failed to provide benefit to small children with viral LRTI include inhaled furosemide (20), recombinant DNase (32), or helium/oxygen inhalation (199) treatment. Therefore, reduced signaling through the normal type I IFN pathway during infection in early infancy may lead to a more pathogenic immune response. Viral detection and viral evasion. AsthmaAnother aspect of pediatric respiratory viral infection linked to the immune system is the development of asthma following viral bronchiolitis. A general downregulation of pathogen sensing may also occur following viral infection, leading to an increased incidence of bacterial infection (80). Certainly addressing modifiable risk factors is important for all children, such as making sure your child does not have exposure to secondhand smoke. It usually begins as a viral infection in the nose, windpipe, or lungs. These symptoms may be accompanied by clinical signs including nasal flaring; jugular, intercostal, and thoracic indrawings; rarely cyanosis; and, on auscultation of the chest wheeze, crackles, crepitations, and inspiratory rhonchi or generally reduced breath sounds due to air trapping and peripheral hyperinflation of the lung. The Consequences of Pediatric Respiratory Tract Infections The main pathogens that trigger respiratory infections are viruses (such as the respiratory syncytial viruses, rhinoviruses, and influenza viruses) (15). The objective of this study was to … The effect may depend upon which viruses coinfect together. In other words, what may appear to be two infections may actually be the same infection that is just lasting longer. As noted, recurrent respiratory infections are common in children and most often are related to the lack of a fully mature immune system sometimes combined with the risk factors above. However, short-acting β2 agonists need to be used cautiously in infants due to the risk of paradoxical β2 agonist reactions (38). Background: Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract infection in infants and is responsible for 100,000 hospitalizations annually. There are also critical differences in the infant immune system compared to that of adults (discussed below) that directly affect infection. The first is the degree of similarity: although the infecting viruses are all different, the clinical outcome, viral evasion strategies, immune response, and long-term sequelae share many common features. However, as argued above, there is significant evidence that suggests that the immune system does play a role in disease following viral infection. Data from fatal influenza infection are confounded by the regular occurrence of bacterial coinfection (241), but inhibiting the cytokine response in a mouse model had no effect on H5N1 pathogenesis (286), and IL-1 knockout mice had worse pathology for influenza virus (291, 319). That immunizations are available for several of these infections emphasizes the importance of vaccinations in children. However, the use of glucocorticoids has not been demonstrated to have any effect on RSV bronchiolitis (93, 252), although their anti-inflammatory effect may be too slowly mediated for a viral infection. Abbreviations: AV, adenovirus; CoV, SARS coronavirus; hMPV, human metapneumovirus; IV, influenza virus; PIV, parainfluenza virus, RSV, respiratory syncytial virus; RV, rhinovirus; TLR, Toll-like receptor; IFNAR, interferon alpha receptor; ORF, open reading frame; CASP-1, caspase 1; NS, nonstructural. The anti-RSV antibody palivizumab, although not technically an antiviral drug, reduces the number of RSV cases requiring hospitalization for at-risk infants by 55% if given prophylactically (142a). Lower Respiratory Tract InfectionAbout one-third of infants with respiratory viral infections develop lower respiratory tract symptoms such as tachypnea, wheeze, severe cough, breathlessness, and respiratory distress. Ribavirin is an antiviral drug that is very effective against RSV in vitro and is licensed for use by inhalation for severe RSV bronchiolitis. It is increasingly being recognized that there are highly conserved host receptors that recognize basic components of viruses, triggering an immune response. Bronchodilators, Corticosteroids, Antibiotics, and Other TreatmentsIn the absence of effective antivirals for severe infant LRTI, medical treatment is focused on drugs designed to overcome airway obstruction and the resulting respiratory distress. Are there any alternative approaches? This article will help you understand the causes of fevers that recur and what you can do about them. There is limited information about glucocorticoids and influenza in infants, but for H5N1 infection of adults, there appeared to be no beneficial effect (128), and the data for severe acute respiratory syndrome (SARS) are inconclusive (316). The management of recurrent respiratory infections are less susceptible to recurring infections caused by an excess response... 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