Parainfluenza - Revision history

Rossdonaldson1: /* References */

2022-08-31T20:20:50Z

References

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	==References==		==References==
	<references/>		<references/>

			[[Category:ID]]

Rossdonaldson1 at 22:37, 10 August 2022

2022-08-10T22:37:14Z

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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	Chest X-~~Ray is often~~ helpful in confirming diagnosis of a viral syndrome, ~~the~~ canonic "steeple sign" is not a unique finding to ~~HPIV~~ infection.		*[[Chest X-ray]]
	In the absence of signs of dehydration or other concurrent conditions (immunocompromised, COPD exacerbation, asthma exacerbation, CHF exacerbation), additional workup is not typically needed.		**Often helpful in confirming diagnosis of a viral syndrome,
			**The canonic "steeple sign" is not a unique finding to parainfluenza infection.
			*In the absence of signs of dehydration or other concurrent conditions (immunocompromised, COPD exacerbation, asthma exacerbation, CHF exacerbation), additional workup is not typically needed.

	~~The presentation of HPIV~~ shares many characteristics with other viruses including RSV and influenza virus. It must also be distinguished from bacterial causes of upper and lower respiratory infections. ~~The following is a non-exhaustive list for conditions that may share characteristics with HPIV~~		===Diagnosis===
			*Presentation shares many characteristics with other viruses, including [[RSV]] and [[influenza]] virus. It must also be distinguished from bacterial causes of upper and lower respiratory infections. In general, in the absence of warning signs it is not especially important to specifically diagnose a parainfluenza virus infection.
	~~Initial evaluation of~~ the ~~patient with HPIV infection centers around assuring the stability~~ of ~~the airway. Any~~ signs ~~of airway compromise should be addressed aggressively up~~ to ~~and including intubation. While wheezing is often~~ a ~~hallmark of HPIV~~ infection~~, as with other airway conditions the absence of wheezing may suggest significant airway obstruction and should not necessarily be viewed as a reassuring sign~~.		*In the emergency department context, PCR assays are the most likely confirmatory testing to yield results in a reasonable timeframe.

	~~Once emergent airway concerns are addressed,~~ the ~~patient should be examined for signs of mechanical airway obstruction rather than infection~~, ~~as this will change management. In~~ the ~~absence of known ingestion/aspiration, these signs may include diminished breath sounds on one side or unilateral wheezing~~.

	~~===Diagnosis===~~
	In general, in the absence of warning signs in the unhospitalized patient it is not especially important to specifically diagnose a parainfluenza virus infection. In the emergency department context, PCR assays are the most likely confirmatory testing to yield results in a reasonable timeframe.
	==Management==		==Management==
	~~There are not currently any antiviral agents for the treatment~~ of ~~HPIV~~. ~~Therefore~~, ~~management of the patient~~ with ~~HPIV infection is largely symptomatic. In~~ the ~~case~~ of ~~croup, racemic epi~~ may ~~provide symptomatic relief while early corticosteroids may reduce the need for intubation~~.		*Assure airway stability
	~~~8-15%~~ of ~~children with croup require hospitalization while 1-3% may require intubation<ref> Sofer S, Dagan R, Tal A. The need~~ for ~~intubation in serious upper respiratory tract infection in pediatric patients (a retrospective study) Infection. 1991;19(3):131–134.</ref>.~~		**Any signs of airway compromise should be addressed aggressively up to and including intubation.
			**While wheezing is often a hallmark, as with other airway conditions the absence of wheezing may suggest significant airway obstruction and should not necessarily be viewed as a reassuring sign.
			*Symptomatic management
			**See [[croup]] for treatment of that entity
			*There are not currently any antiviral agents available for treatment

	==Disposition==		==Disposition==
	Generally, pediatric patients without signs of respiratory distress may be discharged and managed symptomatically in the outpatient setting.		*Generally, pediatric patients without signs of respiratory distress may be discharged and managed symptomatically in the outpatient setting.
	Immunocompromised adults and those with concurrent COPD exacerbation, asthma exacerbation, or CHF exacerbation typically require admission for monitoring and management of symptoms.		*Immunocompromised adults and those with concurrent [[COPD exacerbation]], [[asthma exacerbation]], or [[CHF]] exacerbation typically require admission for monitoring and management of symptoms.

	==See Also==		==See Also==

Rossdonaldson1 at 21:08, 10 August 2022

2022-08-10T21:08:37Z

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	==Background==		==Background==
	*~~Human parainfluenza virus (HPIV) is an~~ enveloped, negative-sense, single-stranded RNA virus<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>		*An enveloped, negative-sense, single-stranded RNA virus<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>
	**Related to but of a different family classification as the [[influenza]] virus.		**Related to but of a different family classification as the [[influenza]] virus.
	**There are 4 known serotypes.<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>		**There are 4 known serotypes.<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>
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	==Differential Diagnosis==		==Differential Diagnosis==
			===Pediatric Patients===
	The presentation of HPIV shares many characteristics with other viruses including RSV and influenza virus. It must also be distinguished from bacterial causes of upper and lower respiratory infections. The following is a non-exhaustive list for conditions that may share characteristics with HPIV: <br>
	~~<br>~~
	Pediatric Patients
	* Foreign object airway obstruction		* Foreign object airway obstruction
	* Other viral infection (including RSV, influenza virus, adenovirus, rhinovirus, COVID)		* Other viral infection (including RSV, influenza virus, adenovirus, rhinovirus, COVID)
	* Bacterial respiratory infection		* Bacterial respiratory infection
	~~<br>~~
	Adult Patients		===Adult Patients===
	* COPD exacerbation		* COPD exacerbation
	* Asthma exacerbation		* Asthma exacerbation
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	==Evaluation==		==Evaluation==
			===Workup===
			Chest X-Ray is often helpful in confirming diagnosis of a viral syndrome, the canonic "steeple sign" is not a unique finding to HPIV infection.
			In the absence of signs of dehydration or other concurrent conditions (immunocompromised, COPD exacerbation, asthma exacerbation, CHF exacerbation), additional workup is not typically needed.

			The presentation of HPIV shares many characteristics with other viruses including RSV and influenza virus. It must also be distinguished from bacterial causes of upper and lower respiratory infections. The following is a non-exhaustive list for conditions that may share characteristics with HPIV

	Initial evaluation of the patient with HPIV infection centers around assuring the stability of the airway. Any signs of airway compromise should be addressed aggressively up to and including intubation. While wheezing is often a hallmark of HPIV infection, as with other airway conditions the absence of wheezing may suggest significant airway obstruction and should not necessarily be viewed as a reassuring sign.		Initial evaluation of the patient with HPIV infection centers around assuring the stability of the airway. Any signs of airway compromise should be addressed aggressively up to and including intubation. While wheezing is often a hallmark of HPIV infection, as with other airway conditions the absence of wheezing may suggest significant airway obstruction and should not necessarily be viewed as a reassuring sign.

	Once emergent airway concerns are addressed, the patient should be examined for signs of mechanical airway obstruction rather than infection, as this will change management. In the absence of known ingestion/aspiration, these signs may include diminished breath sounds on one side or unilateral wheezing.		Once emergent airway concerns are addressed, the patient should be examined for signs of mechanical airway obstruction rather than infection, as this will change management. In the absence of known ingestion/aspiration, these signs may include diminished breath sounds on one side or unilateral wheezing.

	~~===Workup===~~
	~~Chest X-Ray is often helpful in confirming diagnosis of a viral syndrome, the canonic "steeple sign" is not a unique finding to HPIV infection.~~
	~~In the absence of signs of dehydration or other concurrent conditions (immunocompromised, COPD exacerbation, asthma exacerbation, CHF exacerbation), additional workup is not typically needed.~~

	===Diagnosis===		===Diagnosis===

Rossdonaldson1: /* Clinical Features */

2022-08-10T20:40:31Z

Clinical Features

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	''Up to half of the above are complicated by concurrent [[otitis media]]''		''Up to half of the above are complicated by concurrent [[otitis media]]''

	===~~Immunocompetent~~ Adult Patients===		===Adult Patients (Immunocompetent)===
	* Generally mild [[URI]] cold symptoms, though can also initiate exacerbation of [[COPD]], [[asthma]], or [[CHF]]		* Generally mild [[URI]] cold symptoms, though can also initiate exacerbation of [[COPD]], [[asthma]], or [[CHF]]

	===~~Immunocompromised~~ Adult Patients===		===Adult Patients (Immunocompromised)===
	* Often initially [[URI]] cold symptoms but high risk to progress to [[pneumonia]]		* Often initially [[URI]] cold symptoms but high risk to progress to [[pneumonia]]

Rossdonaldson1: /* See Also */

2022-08-10T19:12:17Z

Rossdonaldson1: /* Clinical Features */

2022-08-10T19:11:22Z

Clinical Features

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	* '''[[Pneumonia]]''': Indistinct from other presentations of viral pneumonia with a similar overall disease course as bronchiolitis.		* '''[[Pneumonia]]''': Indistinct from other presentations of viral pneumonia with a similar overall disease course as bronchiolitis.
	* '''[[Tracheobronchitis]]''': Inflammation of only the large airways in the absence of evidence of croup or pneumonia.		* '''[[Tracheobronchitis]]''': Inflammation of only the large airways in the absence of evidence of croup or pneumonia.
	''Up to half of the above are complicated by concurrent otitis media''		''Up to half of the above are complicated by concurrent [[otitis media]]''

	===Immunocompetent Adult Patients===		===Immunocompetent Adult Patients===
	* Generally mild URI cold symptoms, though can also initiate exacerbation of COPD, asthma, or CHF		* Generally mild [[URI]] cold symptoms, though can also initiate exacerbation of [[COPD]], [[asthma]], or [[CHF]]

	===Immunocompromised Adult Patients===		===Immunocompromised Adult Patients===
	* Often initially URI cold symptoms but high risk to progress to pneumonia		* Often initially [[URI]] cold symptoms but high risk to progress to [[pneumonia]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Clinical Features */

2022-08-10T19:10:03Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
	Can result in a large number of varied presentations~~.<br>~~		''Can result in a large number of varied presentations''
	Pediatric Patients:		===Pediatric Patients===
	* '''Croup''': Peak age is 1-2 years, with boys slightly more likely to present than girls. Infection begins in upper airway but often lower airway signs (wheezing, air trapping)		* '''[[Croup]]''': Peak age is 1-2 years, with boys slightly more likely to present than girls. Infection begins in upper airway but often lower airway signs (wheezing, air trapping)
	* '''Bronchiolitis:''' Causative agent in 10-20% of diagnosed bronchiolitis. Initially fever and congestion for 1-3 days followed by lower airway symptoms, including cough and wheezing. Most recover within 21 days, though children with underlying pulmonary conditions are a risk of prolonged course and greater complications		* '''[[Bronchiolitis]]:''' Causative agent in 10-20% of diagnosed bronchiolitis. Initially fever and congestion for 1-3 days followed by lower airway symptoms, including cough and wheezing. Most recover within 21 days, though children with underlying pulmonary conditions are a risk of prolonged course and greater complications
	* '''Pneumonia''': Indistinct from other presentations of viral pneumonia with a similar overall disease course as bronchiolitis.		* '''[[Pneumonia]]''': Indistinct from other presentations of viral pneumonia with a similar overall disease course as bronchiolitis.
	* '''Tracheobronchitis''': Inflammation of only the large airways in the absence of evidence of croup or pneumonia.		* '''[[Tracheobronchitis]]''': Inflammation of only the large airways in the absence of evidence of croup or pneumonia.
	''Up to half of the above are complicated by concurrent otitis media''		''Up to half of the above are complicated by concurrent otitis media''
	~~<br>~~
	~~<br>~~		===Immunocompetent Adult Patients===
	Immunocompetent Adult Patients:
	* Generally mild URI cold symptoms, though can also initiate exacerbation of COPD, asthma, or CHF		* Generally mild URI cold symptoms, though can also initiate exacerbation of COPD, asthma, or CHF
	~~<br>~~
	Immunocompromised Adult Patients:		===Immunocompromised Adult Patients===
	* Often ~~intially~~ URI cold symptoms but high risk to progress to pneumonia		* Often initially URI cold symptoms but high risk to progress to pneumonia

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Background */

2022-08-10T19:08:40Z

Background

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	==Background==		==Background==
	*Human parainfluenza virus (HPIV) is an enveloped, negative-sense, single-stranded RNA virus<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>.		*Human parainfluenza virus (HPIV) is an enveloped, negative-sense, single-stranded RNA virus<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>
	**Related to but of a different family classification as the [[influenza]] virus.		**Related to but of a different family classification as the [[influenza]] virus.
	**There are 4 known serotypes.<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>		**There are 4 known serotypes.<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>
	*Capable of causing both upper and lower airway disease		*Capable of causing both upper and lower airway disease
	**Most commonly known as a causative agent of [[croup]] (laryngotracheobronchitis).<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>.		**Most commonly known as a causative agent of [[croup]] (laryngotracheobronchitis).<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>

	===High Risk Groups<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>.===		===High Risk Groups<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>===
	*Young children (<5 years old)		*Young children (<5 years old)
	**Relatively narrow airway passages		**Relatively narrow airway passages

Rossdonaldson1: /* Background */

2022-08-10T19:08:07Z

Background

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	*Human parainfluenza virus (HPIV) is an enveloped, negative-sense, single-stranded RNA virus<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>.		*Human parainfluenza virus (HPIV) is an enveloped, negative-sense, single-stranded RNA virus<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>.
	**Related to but of a different family classification as the [[influenza]] virus.		**Related to but of a different family classification as the [[influenza]] virus.
	*There are 4 known serotypes.<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>. Capable of causing both upper and lower airway disease		**There are 4 known serotypes.<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>
			*Capable of causing both upper and lower airway disease
	**Most commonly known as a causative agent of [[croup]] (laryngotracheobronchitis).<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>.		**Most commonly known as a causative agent of [[croup]] (laryngotracheobronchitis).<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>.

Rossdonaldson1: /* Background */

2022-08-10T19:07:42Z

Background

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	==Background==		==Background==
	*Human parainfluenza virus (HPIV) is an enveloped, negative-sense, single-stranded RNA virus<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>.		*Human parainfluenza virus (HPIV) is an enveloped, negative-sense, single-stranded RNA virus<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>.
	**Related to but of a different family classification as the influenza virus.		**Related to but of a different family classification as the [[influenza]] virus.
	**There are 4 known serotypes.<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>. ~~The virus itself is related to but of a different family classification as the influenza virus.~~		*There are 4 known serotypes.<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>. Capable of causing both upper and lower airway disease
	*Capable of causing both upper and lower airway disease
	**Most commonly known as a causative agent of [[croup]] (laryngotracheobronchitis).<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>.		**Most commonly known as a causative agent of [[croup]] (laryngotracheobronchitis).<ref>Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med. 2016 Aug;37(4):538-54.</ref>.

← Older revision		Revision as of 19:12, 10 August 2022
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	==See Also==		==See Also==
			*[[Croup]]

	==External Links==		==External Links==