eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Parainfluenza Virus Infections

Author: Roy M Vega, MD, Assistant Professor of Pediatrics, Albert Einstein College of Medicine; Director, Pediatric Emergency Services, Department of Emergency Medicine, Bronx Lebanon Hospital Center, Bronx, NY
Contributor Information and Disclosures

Updated: Aug 28, 2009

Introduction

Background

Human parainfluenza viruses (PIVs) account for a large percentage of pediatric respiratory infections, including upper respiratory tract infections (URTIs), laryngotracheobronchitis (croup), bronchiolitis, and pneumonia. Human parainfluenza viruses is the major cause of croup (type 1 is most frequent, followed by type 3 and type 2). Human parainfluenza viruses are divided into 4 types, all of which are classified as paramyxoviruses. Infections from types 1 and 3 account for most disease. 

Transmission electron micrograph of parainfluenza...

Transmission electron micrograph of parainfluenza virus. Transmission electron micrograph of parainfluenza virus. Two intact particles and free filamentous nucleocapsid.

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Transmission electron micrograph of parainfluenza...

Transmission electron micrograph of parainfluenza virus. Transmission electron micrograph of parainfluenza virus. Two intact particles and free filamentous nucleocapsid.



In 2005, a previously unidentified human parvovirus was identified.1 The virus was named human bocavirus. It resembles 2 other parvoviruses that belong to the Bocavirus genus. Human bocavirus resembles respiratory syncytial virus (RSV) in its clinical manifestations. Similar age profiles were noted in a study evaluating the epidemiological profile of human bocavirus, with infections predominantly limited to infants and young children.2 Clinical manifestations of human bocavirus include bronchiolitis, pneumonia, bronchitis, and exacerbations of asthma.

Pathophysiology

The virus colonizes the nose and the nasopharynx; then, it invades the epithelium, resulting in cell damage, edema, and loss of cilia. A fibrinous exudate develops with downward spread of cell damage and edema. The resulting airway obstruction and laryngeal muscle spasm account for the typical symptoms of croup. The incubation period is 1-7 days.

Frequency

United States

Outbreaks of parainfluenza disease occur regularly throughout fall and mid winter. Parainfluenza virus type 1 causes biennial epidemics in the United States.

Mortality/Morbidity

Most children with croup have mild infections that are usually managed on an outpatient basis. Approximately 41,000 individuals per year are admitted to the hospital for parainfluenza virus infections. Precautions are necessary within hospitals to prevent further spread.3 Only 1-5% of patients admitted to the hospital need artificial airway support.

Age

Parainfluenza-related laryngotracheobronchitis commonly affects children aged 3 months to 3 years. Parainfluenza virus infection can also account for bronchiolitis in infants and children younger than 2 years.

Clinical

History

  • Patients with parainfluenza virus (PIV) infection typically present with a history of coryza and low-grade fever. They then develop the classic barking cough associated with croup.
  • Symptoms of croup include the following:
    • Fever
    • Barking cough
    • Coryza
    • Stridor
    • Retractions
    • Tachypnea (when lower airways become involved)
    • Irritability
  • Children with croup are usually more symptomatic at night. Coughing often awakens them from sleep. The reasons for worsening of symptoms at night are unknown.
  • Parainfluenza infections can also present as bronchiolitis. The typical presentation includes fever, coryza, tachypnea, coughing, and wheezing.4

Physical

  • Croup scoring systems have been developed to aid in grading the severity of infection.
  • Factors in such scoring systems include stridor, retractions, air entry, color, and level of consciousness.
  • Croup scoring systems were developed prior to the advent of pulse oximetry. Pulse oximetry may be beneficial in grading severity of illness, response to management, and disposition.

More on Parainfluenza Virus Infections

Overview: Parainfluenza Virus Infections
Differential Diagnoses & Workup: Parainfluenza Virus Infections
Treatment & Medication: Parainfluenza Virus Infections
Follow-up: Parainfluenza Virus Infections
Multimedia: Parainfluenza Virus Infections
References
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References

  1. Kesebir D, Vazquez M, Weibel C, et al. Human bocavirus infection in young children in the United States: molecular epidemiological profile and clinical characteristics of a newly emerging respiratory virus. J Infect Dis. Nov 1 2006;194(9):1276-82. [Medline].

  2. Manning A, Russell V, Eastick K, et al. Epidemiological profile and clinical associations of human bocavirus and other human parvoviruses. J Infect Dis. Nov 1 2006;194(9):1283-90. [Medline].

  3. [Guideline] Standard precautions in hospitals. In: Betsy Lehman Center for Patient Safety and Medical Error Reduction, JSI Research and Training Institute, Inc. Prevention and control of healthcare-associated infections in Mass. Part 1: final recommendations of the Expert Panel. Massachusetts Department of Public Health; 2008 Jan 31. p. 42-9. [Full Text].

  4. Lopez Perez G, Morfín Maciel BM, Navarrete N, Aguirre A. Identification of influenza, parainfluenza, adenovirus and respiratory syncytial virus during rhinopharyngitis in a group of Mexican children with asthma and wheezing. Rev Alerg Mex. May-Jun 2009;56(3):86-91. [Medline].

  5. Stankova J, Carret AS, Moore D, et al. Long-term therapy with aerosolized ribavirin for parainfluenza 3 virus respiratory tract infection in an infant with severe combined immunodeficiency. Pediatr Transplant. Mar 2007;11(2):209-13. [Medline].

  6. Barkin RM. Respiratory disorders. In: Pediatric Emergency Medicine Concepts Clinical Practice. 1993.

  7. Cressman WR, Myer CM 3rd. Diagnosis and management of croup and epiglottitis. Pediatr Clin North Am. Apr 1994;41(2):265-76. [Medline].

  8. Cruz MN, Stewart G, Rosenberg N. Use of dexamethasone in the outpatient management of acute laryngotracheitis. Pediatrics. Aug 1995;96(2 Pt 1):220-3. [Medline].

  9. Custer JR. Croup and related disorders. Pediatr Rev. Jan 1993;14(1):19-29. [Medline].

  10. Donaldson D, Poleski D, Knipple E, et al. Intramuscular versus oral dexamethasone for the treatment of moderate-to-severe croup: a randomized, double-blind trial. Acad Emerg Med. Jan 2003;10(1):16-21. [Medline].

  11. Kairys SW, Olmstead EM, O'Connor GT. Steroid treatment of laryngotracheitis: a meta-analysis of the evidence from randomized trials. Pediatrics. May 1989;83(5):683-93. [Medline].

  12. Klassen TP, Watters LK, Feldman ME, et al. The efficacy of nebulized budesonide in dexamethasone-treated outpatients with croup. Pediatrics. Apr 1996;97(4):463-6. [Medline].

  13. Prendergast M, Jones JS, Hartman D. Racemic epinephrine in the treatment of laryngotracheitis: can we identify children for outpatient therapy?. Am J Emerg Med. Nov 1994;12(6):613-6. [Medline].

  14. Rittichier KK, Ledwith CA. Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing. Pediatrics. Dec 2000;106(6):1344-8. [Medline].

  15. Rudy. Croup: Has management changed?. Contemp Pediatr. 1993;10:21-32.

  16. Vega R. Rapid viral testing in the evaluation of the febrile infant and child. Curr Opin Pediatr. Jun 2005;17(3):363-7. [Medline].

  17. Wendt CH, Weisdorf DJ, Jordan MC, Balfour HH Jr, Hertz MI. Parainfluenza virus respiratory infection after bone marrow transplantation. N Engl J Med. Apr 2 1992;326(14):921-6. [Medline].

  18. Williams JV. The clinical presentation and outcomes of children infected with newly identified respiratory tract viruses. Infect Dis Clin North Am. Sep 2005;19(3):569-84. [Medline].

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Further Reading

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Keywords

parainfluenza virus infection, PVI, croup, upper respiratory tract infection, laryngotracheobronchitis, URTI, severe acute respiratory syndrome, SARS, pneumonia, parainfluenza virus, coryza, cough, bronchiolitis, paramyxovirus, human bocavirus, treatment, diagnosis

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Contributor Information and Disclosures

Author

Roy M Vega, MD, Assistant Professor of Pediatrics, Albert Einstein College of Medicine; Director, Pediatric Emergency Services, Department of Emergency Medicine, Bronx Lebanon Hospital Center, Bronx, NY
Roy M Vega, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital
Ashir Kumar, MBBS, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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