Pediatric Parainfluenza Virus Infections

Author: Roy M Vega, MD; Chief Editor: Russell W Steele, MD more...

Updated: Aug 24, 2011

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Background
Pathophysiology
Epidemiology
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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. See the image below.

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.

Proceed to Clinical Presentation

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.

Specialty Editor Board

Ashir Kumar, MD, MBBS, FAAP Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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.

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; Novartis 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: Nothing to disclose.

References

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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].
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American Academy of Pediatrics. Red Book: 2009 Report of the Committee on Infectious Diseases. 28^th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009.
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