Pediatric Parainfluenza Virus Infections Treatment & Management

  • Author: Roy M Vega, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Aug 24, 2011
 

Medical Care

Management of croup caused by parainfluenza virus (PIV) infection depends on the severity of disease.

Prehospital care

Prehospital care includes fever control and attempts to alleviate respiratory symptoms and patient anxiety.

Respiratory symptoms commonly improve with benign measures such as sitting in a bathroom with a steaming shower and allowing vapor droplets to soothe inflamed airways. Another option includes exposing the child to the cool night air. Often, the patient's symptoms resolve en route to the hospital. Attempts at calming or distracting the child can be beneficial.

Antipyretics may assist with fever control. Moderate or severe croup requires medical evaluation in the office or emergency department.

Emergency department care

Mild croup

Management of mild croup consists of cool blow-by oxygen mist, fever control, and observation to determine whether the airway appears compromised.

Moderate croup

Cool oxygen mist and steroids are common therapies. Controlled trials for the palliation of croup symptoms have yielded conflicting results, and routine use of dexamethasone in this disease remains controversial. Dexamethasone was traditionally intramuscularly administered; however, recent studies have documented the use of oral steroids.

In patients who fail to improve, administration of racemic epinephrine with a nebulizer has been beneficial. If racemic epinephrine alleviates symptoms, observe the patient for a minimum of 3 hours to ensure the patient's condition does not worsen (eg, due to possible rebound laryngospasm as the racemic epinephrine dose wears off). If asymptomatic at this time, the patient can be discharged with proper follow-up care.

In patients with moderate croup, oral intake may be lacking; therefore, evaluate the patient's hydration status. Intravenous fluids may be required.

Severe croup

Perform the same measures as in moderate croup. Observe for signs of impending respiratory failure.

Repeat racemic epinephrine nebulization may be needed, in addition to intensive care monitoring. Racemic epinephrine nebulizations can be repeated at 1-hour to 2-hour intervals as needed. Fortunately, fewer than 5% of patients who are admitted require artificial airway support (endotracheal intubation).

Proceed to Medication
 
 
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

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

  5. 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].

  6. Karron RA, Belshe RB, Wright PF, Thumar B, Burns B, Newman F. A live human parainfluenza type 3 virus vaccine is attenuated and immunogenic in young infants. Pediatr Infect Dis J. May 2003;22(5):394-405. [Medline].

  7. 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].

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

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

  10. 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].

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

  12. 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].

  13. 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].

  14. 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].

  15. 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].

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

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

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

  19. 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].

  20. 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].

 
Previous
Next
 
Transmission electron micrograph of parainfluenza virus. Transmission electron micrograph of parainfluenza virus. Two intact particles and free filamentous nucleocapsid.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.