Diagnosis and clinical significance of parainfluenza virus infections in children

Abstract

. Diagnosis and clinical significance of parainfluenza virus infections in children. The diagnosis and clinical features of parainfluenza virus infections are described in 151 children admitted to hospital over a 2-year period. Immunofluorescence was the most sensitive method of laboratory diagnosis, while virus isolation in tissue culture was more often achieved from nasopharyngeal secretions than from cough/nasal swabs. Parainfluenza viruses were responsible for approximately 9% of 1603 acute respiratory admissions. Croup was the commonest of the wide range of respiratory illnesses associated with these infections; in a series of 132 children with croup, a parainfluenza virus was identified in 42 %. 24 of the 151 children presented with febrile convulsions, and in a series of 209 children admitted with febrile convulsions, parainfluenza viruses were responsible for 11 %. 3 of the children died in hospital with their parainfluenza virus infections, and in addition there was one instance of a close association between parainfluenza virus type 3 infection and the sudden unexpected death of an infant at home. Parainfluenza virus types 4a and 4b, which have so far rarely been identified, were isolated from 16 children.The age distribution and seasonal patterns of the infections are described. Attention is drawn to the risks of cross-infection by parainfluenza viruses in children's wards, and the finding that virus is commonly excreted for at least a week after the onset of the illness.

Parainfluenza Viruses

“…Children infected with HPIV-3 will transmit this virus to a minimum of 20% of uninfected control children residing on the same ward (258). About one-third of these will develop mild respiratory symptoms, but some will experience serious LRI and even death (75,258). Serious sequelae are most common in patients with underlying medical problems.…”

“…Children hospitalized with HPIV have had significant problems with febrile seizures. HPIV-4B appears to have the greatest association (up to 62%), followed by HPIV-3 (17%) and HPIV-1 (7%) (75). HPIV-1 strains were isolated from two patients with multiple sclerosis (213,242), but evidence of antibody to HPIV-1 in the serum or CSF of MS patients has been lacking (31,211).…”

“…HPIV-2 has been reported to cause infections biennially with HPIV-1 or alternate years with HPIV-1 or to cause yearly outbreaks (20,75,259). We see some HPIV-2 activity every year in Milwaukee, Wis.…”

Clinical and Molecular Epidemiology of Human Parainfluenza Virus 4 Infections in Hong Kong: Subtype 4B as Common as Subtype 4A

“…Description of the clinical manifestations of HPIV4 infection has relied on a small number of reported cases, some with only limited clinical information (2,4,6,13,14,16,17). Here, a significant proportion of the patients, especially those with underlying diseases, had pneumonia and complications such as asthma and seizures.…”

Introduction of a cross-infection rate in children's wards and its application to respiratory virus infections

“…This age distribution is in contrast to that for R.S. virus, which most often results in hospital admission during the first year of life (Public Health Laboratory Reports, 1972; and this is also the case, although to a lesser extent, for the other two most commonly identified respiratory viruses, parainfluenza virus types 1 and 3 (Downham, McQuillin & Gardner, 1973). No information is yet available about the age distribution of children with influenza A infection who are not admitted to hospital.…”