Child and Chest Health Care Delhi NCR

RSV(Respiratory syncytial virus) is the most common cause of bronchiolitis in children.

Bronchiolitis is usually mild but in infants between 3-6 months,it may become serious and sometimes life threatening.

It usually becomes serious in preterm infants and infants already having cardiac disease with significant shunt,infants having CLD(Chronic lung disease,previously known as BPD) and infants with primary immune deficiency.

There is no specific treatment other than Rivaverin which may or may not work.

So, the mainstay of treatment is only supportive and it has high morbidity and mortality.

In such situations,a new drug Sisunatovir may be life saving for many infants.

In a research ,66 adults were inoculated with RSV,then they were given treatment with this new drug Sisunatovir.It resulted in significant reduction in clinical symptoms with significant reduction in viral load,with no significant adverse effects.The new drug was well tolerated and there was no resistane to this new drug.It was Phase 2a study.

Sisunatovir binds to the surface protein F, of RSV and inhibits its replication.It is a fusion inhibitor which is administered orally.

REFERENCES:ReViral announces FDA Fast Track designation granted to sisunatovir for the treatment of serious respiratory syncytial virus infection. https://www.businesswire.com/news/home/20200804005065/en/ReViral-Announces-FDA-Fast-Track-Designation-Granted. Accessed August 4, 2020

Computed tomography of chest(Chest CT) has become an essential imaging modality to diagnose many chest conditions including some complicated Pneumonia.

As CT chest is time consuming,so children below 3 years should better be sedated for proper examination of chest by CT.

Ground glass opacity (GGO) may be seen in different chest conditions and its location may give some clue to the diagnosis.

In the time of widespread occurance of COVID 19 ,CT chest may be useful to point towards diagnosis when the serological tests are negative.

In COVID 19 Pneumonia typical findings on chest CT is bilateral ground glass opacity located peripherally in the subpleural regions and at lower lobes of lung.Later on there may be crazy pavy changes with architectural damage ,perilobular opacities superimposed upon ground glass lesions.

There may be consolidation in the lower lobes of the lung located in subpleural regions suggestive of COVID19 Pneumonia.

Atypical findings in COVID19Pneumonia may be ground glass opacity on the upper lobes of lung,peribronchovascular regions and,there may be cavitation,lymphadenopathy and pleural thickening.

Ground glass opacities are also seen in other viral pneumonia.It is seen in upto 75%cases of Adenovirus Pneumonia and more than 75%cases of cytomegalovirus(CMV) Pneumonia.It is also seen in approximately 25% cases of Herpes simplex Pneumonia.

It is also seen in Pneumonia due to Pneumocystis carini but in this case it is mainly located on the upper lobes.

GGO may be observed in interstitial lung diseases(ILD) but the pattern of distribution may differentiate it from infective origin.

GGO may be seen in lung injury caused by electronic cigarrette smokes,eosinophilic pneumonia,hypersensitivity Pneumonia,Pulmonary alveolar proteinosis,diffuse alveolar hemorrhage,and pulmonary edema.

Bacterial Pneumonia can be differentiated by the distribution of opacities in the focal ,segmental and lobar regions not predominantly in the lower lobes.Other findings also differentiate it from viral pneumonia, like cavitation,lymphadenopathy and lung abscess

REFERENCES;Cite this: Broad Differential Diagnosis of Chest CT Ground-Glass Opacities – Medscape – Jul 16, 2020.