Myocarditis in the Presence of Respiratory Syncytial Virus (RSV) Infection: A Case Study

Background/Objective: Respiratory syncytial virus (RSV) causes acute respiratory infections in children and adults. RSV has many non-specific symptoms such as cough and dyspnea. RSV is associated with high mortality in children, the elderly, and immunocompromised individuals. Although rare, RSV has been reported to cause extrapulmonary complications such as arrhythmias and myocarditis. This case focuses on a patient infected with RSV who presents with acute sustained monomorphic ventricular tachycardia (SMVT). Case Overview: An 83 year-old patient with a history of type 2 diabetes mellitus, hypertension, persistent atrial fibrillation, and asthma presented to the emergency department with concerns of cough, malaise, and a syncopal episode. Upon admission, the patient tested positive for RSV and was diagnosed with acute bronchitis exacerbated by history of asthma. The patient soon developed SMVT with heart rates as high as 235 beats per minute. After consultation with an electrophysiologist, the VT was attributed to myocarditis as a result of the RSV infection. Oral amiodarone was prescribed, and the patient was discharged two weeks later. In a follow-up visit, no SMVT was reported, and the dosage of amiodarone was decreased. Discussion: With the onset of the SARS-CoV2 pandemic in early 2020, myocarditis associated with viral infection has been of interest in recent literature. Many cases of cardiovascular complications have been reported in patients infected with SARS-CoV2. Consequently, it is important to discuss cases of other respiratory viruses also presenting with arrhythmia and myocarditis. In the current case, a patient with RSV developed new onset VT. VT can be life-threatening and can cause further cardiovascular complications. Conclusion: RSV can cause new onset cardiovascular complications, albeit rare. It is important for clinicians to be aware of such complications especially in cases in which patients have preexisting cardiovascular conditions. Patients infected with RSV should be closely monitored for new onset complications.

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Respiratory Syncytial Virus Immunoprophylaxis with Palivizumab: 12-Year Observational Study of Usage and Outcomes in Canada

American Journal of Perinatology ◽

10.1055/s-0041-1725146 ◽

2021 ◽

Author(s):

Ian Mitchell ◽

Abby Li ◽

Candice L. Bjornson ◽

Krista L. Lanctot ◽

Bosco A. Paes ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Syncytial Virus ◽

Burden Of Illness ◽

Respiratory Illness ◽

Smoking Exposure ◽

Key Points ◽

Rsv Infection ◽

History Of ◽

Syncytial Virus ◽

Airway Anomalies

Objective This study aimed to evaluate palivizumab (PVZ) use, trends in indications, and outcomes of respiratory illness hospitalizations (RIH) and respiratory syncytial virus hospitalizations (RSVH). Study Design It involves a large, Canadian prospective (2005–2017) observational multicenter study of children at high risk for RSV infection. Results A total of 25,003 infants (56.3% male) were enrolled at 32 sites; 109,579 PVZ injections were administered. Indications included: prematurity (63.3%); “miscellaneous” (17.8%); hemodynamically significant congenital heart disease (10.5%); bronchopulmonary dysplasia/chronic lung disease (8.4%). The “miscellaneous” group increased over time (4.4% in 2005–2006 to 22.5% in 2016–2017) and included: trisomy 21, airway anomalies, pulmonary disorders, cystic fibrosis, neurological impairments, immunocompromised, cardiac aged >2 years, multiple conditions, and a residual “unclassified” group. Adherence measured by expected versus actual doses plus correct interdose interval was 64.7%. A total of 2,054 RIH occurred (6.9%); 198 (9.6%) required intubation. Three hundred thirty-seven hospitalized children were RSV-positive (overall RSVH 1.6%). Risk factors for RSVH included having siblings, attending daycare, family history of atopy, smoking exposure, and crowded household. Infants with 5 risk factors were 9.0 times (95% CI or confidence interval 4.4–18.2; p < 0.0005) more likely to have RSVH than infants without risk factors. Three adverse events occurred; none were fatal. Conclusion Results are relevant to both clinicians and decision-makers. We confirmed the safety of PVZ. Use of PVZ increased steadily for children with miscellaneous conditions and medical complexity. Medical and social factors pose a risk for severe RIH and RSVH with accompanying burden of illness. A vaccine that protects against RSV is urgently required. Key Points

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Respiratory syncytial virus in severe lower respiratory infections in previously healthy young Ethiopian infants

BMC Pediatrics ◽

10.1186/s12887-021-02675-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Abate Yeshidinber Weldetsadik ◽

Frank Riedel

Keyword(s):

Respiratory Syncytial Virus ◽

Rainy Season ◽

Clinical Laboratory ◽

Respiratory Infections ◽

Clinical Parameter ◽

Imaging Data ◽

Chi Square ◽

Young Infants ◽

Rsv Infection ◽

Syncytial Virus

Abstract Background Respiratory Syncytial Virus (RSV) is the commonest cause of acute lower respiratory infections (ALRI) in infants. However, the burden of RSV is unknown in Ethiopia. We aimed to determine the prevalence, seasonality and predictors of RSV infection in young infants with ALRI for the first time in Ethiopia. Methods We performed RSV immuno-chromatographic assay from nasopharyngeal swabs of infants, 29 days to 6 months of age. We included the first 10 eligible infants in each month from June 2018 to May 2019 admitted in a tertiary pediatric center. Clinical, laboratory and imaging data were also collected, and chi-square test and regression were used to assess associated factors with RSV infection. Results Among a total of 117 study children, 65% were male and mean age was 3 months. Bronchiolitis was the commonest diagnosis (49%). RSV was isolated from 26 subjects (22.2%) of all ALRI, 37% of bronchiolitis and 11% of pneumonia patients. Although RSV infection occurred year round, highest rate extended from June to November. No clinical or laboratory parameter predicted RSV infection and only rainy season (Adjusted Odds Ratio (AOR) 10.46 [95%. C.I. 1.95, 56.18]) was independent predictor of RSV infection. Conclusions RSV was isolated in a fifth of young infants with severe ALRI, mostly in the rainy season. Diagnosis of RSV infection in our setting require specific tests as no clinical parameter predicted RSV infection. Since RSV caused less than a quarter of ALRI in our setting, the other causes should be looked for in future studies.

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Infantile respiratory syncytial virus and human rhinovirus infections: respective role in inception and persistence of wheezing

European Respiratory Journal ◽

10.1183/09031936.00062714 ◽

2014 ◽

Vol 45 (3) ◽

pp. 774-789 ◽

Cited By ~ 62

Author(s):

Giovanni A. Rossi ◽

Andrew A. Colin

Keyword(s):

Respiratory Syncytial Virus ◽

Airway Disease ◽

Epidemiological Studies ◽

Human Rhinovirus ◽

Allergic Sensitisation ◽

Cytokines And Chemokines ◽

Rsv Infection ◽

History Of ◽

Syncytial Virus

There is evidence that respiratory viruses play a key role in the development and exacerbation of obstructive respiratory diseases in children. This review attempts to juxtapose the separate profiles and prototypes of pathogenenetic mechanisms represented by the two most common amongst such viruses: respiratory syncytial virus (RSV) and human rhinovirus (HRV).RSV represents the most common agent of severe airway disease in infants and young children, and is predominant in winter months. Large epidemiological studies have revealed an unequivocal relationship between RSV infection and subsequent wheezing into childhood, thought to be related to long-term changes in neuroimmune control of the airways rather than allergic sensitisation.HRV is a highly diverse group of viruses that affect subjects of all ages, is ubiquitous and occurs year-round. In contrast to RSV, infections with HRV cause minimal cytotoxicity but induce a rapid production of cytokines and chemokines with amplification of the inflammatory response. The susceptibility to HRV-induced bronchiolitis and subsequent wheezing appears to be linked to individual predisposition since it is often associated with a family or personal history of asthma/atopy.Thus, RSV probably serves as an “inducer” rather than a “trigger”. Conversely, HRVs seem to serve as a “trigger” rather than an “inducer” in predisposed individuals.

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Manifestations and Risk Factors in Children Hospitalized with Respiratory Syncytial Virus Infection

Archives of Pediatric Infectious Diseases ◽

10.5812/pedinfect.108723 ◽

2020 ◽

Vol In Press (In Press) ◽

Author(s):

Karolina Kuczborska ◽

Agnieszka Rustecka ◽

Agata Wawrzyniak ◽

Agata Będzichowska ◽

Bolesław Kalicki

Keyword(s):

Risk Factors ◽

Respiratory Syncytial Virus ◽

Respiratory Failure ◽

Family History ◽

Inflammatory Markers ◽

Laboratory Test Results ◽

Rsv Infection ◽

History Of ◽

Syncytial Virus ◽

Common Manifestation

Background: Acute lower respiratory infection (ALRI) is one of the main causes of morbidity and mortality in children under five years of age, and the respiratory syncytial virus (RSV) remains its leading etiological factor. Although RSV infections occur in all age groups, the most severe course is observed among children. The clinical manifestations include both mild upper respiratory infections and severe infections of the lower tract, such as bronchiolitis and pneumonia that can lead to hospitalization and severe complications, including respiratory failure. Objectives: The study aimed to evaluate the manifestations of RSV infection in hospitalized children younger than 18 months of age and predictors of disease severity, as well as their comparison with the same age group hospitalized due to ALRI of different etiology. Methods: A retrospective analysis was performed on medical records of 448 children hospitalized due to ALRI. The analysis was performed on the total study group and subgroups of children with positive and negative results of the nasal swab for RSV detection. In each group, clinical data, laboratory test results, and imaging results were analyzed. Results: The most common manifestation was pneumonia (n = 82; 63.08%). Otitis media was observed mainly in children under six months of age with lowered inflammatory markers (P < 0.05), conjunctivitis in those with a positive family history of allergies (P < 0.05), and pneumonia in children under six months of age, with lower blood oxygen saturation and inflammatory markers, features of acidosis, and fever-free course (P < 0.05). Respiratory failure affected 13 children (10%). However, no predictors of this complication were noted. Conclusions: As pneumonia was the most common manifestation in children with both RSV-positive and RSV-negative ALRI, it seems advisable to perform the imaging of the lungs on admission and carefully monitor the child’s condition during hospitalization. In both groups, special attention should be paid to the youngest children with low inflammatory markers on hospital admission, increased clinical symptoms, and family history of allergies. Nevertheless, widely known risk factors of RSV infection itself do not reflect the risk of developing pneumonia or respiratory failure in its course.

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Respiratory syncytial virus prevalence in children admitted to five Kenyan district hospitals: a cross-sectional study

BMJ Paediatrics Open ◽

10.1136/bmjpo-2018-000409 ◽

2019 ◽

Vol 3 (1) ◽

pp. e000409

Author(s):

Jacqueline Le Geyt ◽

Stephanie Hauck ◽

Mark Lee ◽

Jennifer Mackintosh ◽

Jessica Slater ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Respiratory Infections ◽

Cross Sectional Study ◽

Single Centre ◽

Cross Sectional ◽

Virus Prevalence ◽

District Hospitals ◽

Positive Rate ◽

Rsv Infection ◽

Syncytial Virus

Acute respiratory infections (ARIs) are a leading cause of under-five mortality globally. In Kenya, the reported prevalence of respiratory syncytial virus (RSV) infections in single-centre studies has varied widely. Our study sought to determine the prevalence of RSV infection in children admitted with ARI fulfilling the WHO criteria for bronchiolitis. This was a prospective cross-sectional prevalence study in five hospitals across central and highland Kenya from April to June 2015. Two hundred and thirty-four participants were enrolled. The overall RSV positive rate was 8.1%, which is lower than in previous Kenyan studies. RSV-positive cases were on average 5 months younger than RSV-negative cases.

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Association of Viral Load With Disease Severity in Outpatient Children With Respiratory Syncytial Virus Infection

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa076 ◽

2020 ◽

Vol 222 (2) ◽

pp. 298-304 ◽

Cited By ~ 3

Author(s):

Erika Uusitupa ◽

Matti Waris ◽

Terho Heikkinen

Keyword(s):

Viral Load ◽

Respiratory Syncytial Virus ◽

Disease Severity ◽

Respiratory Infections ◽

Respiratory Illness ◽

Lower Viral Load ◽

Primary Analysis ◽

Rsv Infection ◽

Syncytial Virus ◽

Outpatient Children

Abstract Background There are scarce data on whether viral load affects the severity of respiratory syncytial virus (RSV) disease in outpatient children. Methods We analyzed the association between viral load and disease severity among children who participated in a prospective cohort study of respiratory infections. The children were examined and nasal swabs for the detection of RSV were obtained during each respiratory illness. Quantification of RSV load was based on the cycle threshold (Ct) value. For the primary analysis, the children were divided into 2 groups: higher (Ct < 27) and lower viral load (Ct ≥ 27). Results Among 201 episodes of RSV infection, children with higher viral load had significantly longer median durations of rhinitis (8 vs 6 days; P = .0008), cough (8 vs 6 days; P = .034), fever (2 vs 1 days; P = .018), and any symptom (10 vs 8 days; P = .024) than those with lower viral load. There were statistically significant negative correlations between the Ct values and durations of all measured symptoms. Conclusions Our findings support the concept that viral load drives the severity of RSV disease in children. Reducing the viral load by RSV antivirals might provide substantial benefits to outpatient children.

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Depletion of TAX1BP1 amplifies innate immune responses during respiratory syncytial virus infection

Journal of Virology ◽

10.1128/jvi.00912-21 ◽

2021 ◽

Author(s):

Delphyne Descamps ◽

Andressa Peres de Oliveira ◽

Lorène Gonnin ◽

Sarah Madrières ◽

Jenna Fix ◽

...

Keyword(s):

Immune Response ◽

Respiratory Syncytial Virus ◽

Respiratory Infections ◽

The Elderly ◽

Cellular Protein ◽

Innate Immune ◽

Efficient Treatment ◽

Rsv Infection ◽

Syncytial Virus ◽

Nucleoprotein N

Respiratory syncytial virus (RSV) is the main cause of acute respiratory infections in young children, and also has a major impact on the elderly and immunocompromised people. In the absence of a vaccine or efficient treatment, a better understanding of RSV interactions with the host antiviral response during infection is needed. Previous studies revealed that cytoplasmic inclusion bodies (IBs) where viral replication and transcription occur could play a major role in the control of innate immunity during infection by recruiting cellular proteins involved in the host antiviral response. We recently showed that the morphogenesis of IBs relies on a liquid-liquid phase separation mechanism depending on the interaction between viral nucleoprotein (N) and phosphoprotein (P). These scaffold proteins are expected to play a central role in the recruitment of cellular proteins to IBs. Here, we performed a yeast two-hybrid screen using RSV N protein as a bait, and identified the cellular protein TAX1BP1 as a potential partner of this viral protein. This interaction was validated by pulldown and immunoprecipitation assays. We showed that TAX1BP1 suppression has only a limited impact on RSV infection in cell cultures. However, RSV replication is decreased in TAX1BP1-deficient mice (TAX1BP1 KO ), whereas the production of inflammatory and antiviral cytokines is enhanced. In vitro infection of wild-type or TAX1BP1 KO alveolar macrophages confirmed that the innate immune response to RSV infection is enhanced in the absence of TAX1BP1. Altogether, our results suggest that RSV could hijack TAX1BP1 to restrain the host immune response during infection. Importance Respiratory syncytial virus (RSV), which is the leading cause of lower respiratory tract illness in infants, still remains a medical problem in the absence of vaccine or efficient treatment. This virus is also recognized as a main pathogen in the elderly and immunocompromised people, and the occurrence of co-infections (with other respiratory viruses and bacteria) amplifies the risks of developing respiratory distress. In this context, a better understanding of the pathogenesis associated to viral respiratory infections, which depends on both viral replication and the host immune response, is needed. The present study reveals that the cellular protein TAX1BP1, which interacts with the RSV nucleoprotein N, participates in the control of the innate immune response during RSV infection, suggesting that N-TAX1BP1 interaction represents a new target for the development of antivirals.

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The Prevention of Respiratory Syncytial Virus Infection in Children: Focus on Palivizumab

Clinical Medicine Therapeutics ◽

10.4137/cmt.s2072 ◽

2009 ◽

Vol 1 ◽

pp. CMT.S2072

Author(s):

Michael E. Speer ◽

Amy B. Good

Keyword(s):

Respiratory Syncytial Virus ◽

Respiratory Infections ◽

The United States ◽

Humanized Monoclonal Antibody ◽

Post Marketing ◽

Rsv Infection ◽

Upper Respiratory ◽

Syncytial Virus ◽

One Year ◽

High Risk Infants

Recurrent upper respiratory infections caused by respiratory syncytial virus (RSV) and other respiratory viruses occur throughout life. During the first 2 years of life, RSV infected children have up to a 40% risk of a lower respiratory tract infection (LRTI). In turn LRTI, including bronchiolitis, due to RSV is the most common cause of hospitalization among infants less than one year of age. While mortality from RSV infection has fallen over the last 2 decades, approximately 400-500 deaths occur annually in the United States again primarily in infants less than 1 year of age. Palivizumab, a humanized monoclonal antibody, has been shown to reduce the risk of hospitalization in high risk infants if given monthly during RSV season. Post marketing safety surveillance originating from a variety of sources, mostly active surveillance, has confirmed the prelicensure safety profile of palivizumab. Other than very rare anaphylactic reactions (<1/100000), no significant adverse reactions have been noted.

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Seroepidemiology of respiratory syncytial virus infection in rural and semi-rural areas of the Littoral region of Cameroon

BMC Infectious Diseases ◽

10.1186/s12879-021-05838-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Henshaw Mandi ◽

Bekolo Cavin Epie ◽

Agnes Eyoh ◽

Sindhiya Jan ◽

Sue Ann Costa Clemens ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Syncytial Virus ◽

Odds Ratio ◽

Respiratory Infections ◽

Enzyme Linked Immunosorbent Assay ◽

Acute Respiratory Infections ◽

Littoral Region ◽

Health Centres ◽

Rsv Infection ◽

Syncytial Virus

Abstract Background The respiratory syncytial virus (RSV) has been established as a leading cause of acute lower respiratory illness (ALRI) in infants and children. In 2015, the global disease burden (GBD) study estimated that the overall RSV-ALRI mortality could be as high as 118,200, with most death occurring in low- and middle-incomes countries (LMIC). This study aimed to assess the burden of RSV infection among children less than 2 years with acute respiratory infections (ARI) in the Littoral region of Cameroon. Methods We carried out a cross-sectional study in seven health centres in the Littoral region of Cameroon. Venous blood was collected using serum separation tubes from eligible children who visited these health centres with acute respiratory infections. ELISA (Enzyme-linked immunosorbent assay) testing was used to assess the seroprevalence of anti-IgM RSV for the total population and by selected demographic and health parameters and potential risk factors. Results The overall RSV-associated ARI seroprevalence was 33% (95%CI:23.6–42.3; 33/100 children). The only demographic factor significantly associated with RSV acquisition was age of 6 months and below (odds ratio: 7.54 (2.62, 23.36); p = 0.000). Children who were clinically diagnosed to be concomitantly infected with malaria had a lower risk of RSV infection (odds ratio: 0.38 (0.14, 0.95; P = 0.03). Conclusions The RSV burden is high among children less than 2 years with ARI in the Littoral region of Cameroon. There is a need for an effective public health RSV surveillance system with standard laboratory techniques and equipment to better understand the RSV disease age-specific incidence, seasonality, risk factors and RSV burden among patients in communities in Cameroon.

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Seroepidemiology of Respiratory Syncytial Virus infection in rural and semi-rural areas of the Littoral Region of Cameroon

10.21203/rs.3.rs-18010/v2 ◽

2020 ◽

Author(s):

Henshaw Eyambe Mandi ◽

Solomon Abebe Yimer ◽

Cavin Epie Bekolo ◽

Agnes Eyoh ◽

Sindhiya Jan ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Syncytial Virus ◽

Rural Areas ◽

Odds Ratio ◽

Respiratory Infections ◽

Acute Respiratory Infections ◽

Littoral Region ◽

Elisa Testing ◽

Rsv Infection ◽

Syncytial Virus

Abstract Background: The respiratory syncytial virus (RSV) has been established as a leading cause of acute lower respiratory illness (ALRI) in infants and children. In 2015, the global disease burden (GBD) study estimated that the overall RSV-ALRI mortality could be as high as 118200, with most death occurring in low- and middle-incomes countries (LMICs). This study aimed to assess the burden of RSV infection among children less than two years with acute respiratory infections (ARI) in the littoral region of Cameroon.Methods: We carried out a cross-sectional study in seven health in the littoral region of Cameroon. Venous blood was collected using serum separation tubes from eligible children who visited these healthcare facilities with acute respiratory infections. ELISA testing was used to assess the seroprevalence of anti-IgM RSV for the total population and by selected demographic and health parameters and potential risk factors. Results: The overall RSV-associated ARI seroprevalence was 33% (95%CI:23.6-42.3; 33/100 children). The only demographic factor significantly associated with RSV acquisition was age of six months and below (odds ratio: 7.54 (2.62, 23.36); p=0.000). Children who were concomitantly infected with malaria had a lower risk of RSV infection (odds ratio: 0.38 (0.14, 0.95; P = 0.03). Conclusions: The RSV burden is high among children less than two years with ARI in the littoral region of Cameroon. There is a need for an effective public health RSV surveillance system with standard laboratory techniques and equipment to better understand the RSV disease age-specific incidence, seasonality, risk factors and RSV burden among patients in communities in Cameroon.

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