VIROLOGY DIAGNOSIS AND TREATMENT OF RESPI RATORY SYNCYTIAL VIRUS-INFECTIONS

Respiratory syncytial virus infections occur frequently in children, o ften localized in the upper respiratory tract. Outcome is usually quit e satisfactory, but in nearly one half of the infants lower tract invo lvement may cause severe respiratory insufficiency leading to hospital ization in about 1% of the cases. Its frequency has been estimated at 20 to 30% of the viral infections in hospitalized infants, 10 times th e frequency of the other respiratory virus. Respiratory syncytial epid emias last about 4 to 5 months with a seasonal peak in december and ja nuary. The direct detection of respiratory syncytial antigens in nasal specimens by immunofluorescence or enzymatic immunoassay is the key t o rapid diagnosis. They appear as performant and more convenient than specific IgM antibodies or nucleic acid detections, and than virus iso lation on cell culture, which is justified to evaluate strain sensitiv ity to ribavirin. Immunofluorescence has also been used to identify th e subgroups A and B from 1981 to 1993, and respiratory syncytial subgr oup A seems to signify more severe disease. Symptomatic assistance may require hydratation, oxygenotherapy and respiratory physical therapy. Antibiotics should not be given as a routine treatment since bacteria l superinfection is infrequent, but may be indicated in cases with ass ociated signs of complications. Indications for bronchodilators and co rticosteroids are still under debate. Significant results have been ob tained with ribavirin and specific anti respiratory syncytial immunogl obulins but further evaluations are still required to precise their us e in clinical practice.