Case Study – Bronchiolitis and Respiratory Syncytial Virus (RSV)

Case Study – Bronchiolitis and Respiratory Syncytial Virus (RSV)

Most Likely Diagnosis and Pathogen

Based on the symptoms and clinical presentation provided, Jamie likely has bronchiolitis, a common respiratory condition in infants, predominantly caused by the Respiratory Syncytial Virus (RSV). Her symptoms, including coughing, rhinorrhea with yellowish discharge, fever, lethargy, and signs of respiratory distress like expiratory wheezing and intercostal retractions, align closely with this diagnosis (Schweitzer & Justice, 2023). This condition is particularly concerning in young children who have small airways that are easily obstructed by inflammation and mucus.

Pathogen and Transmission

RSV is a virus that often occurs in children and is spread through droplets via air by a cough or sneeze from an infected child. It can also spread through contact with surfaces previously in contact with the virus, followed by touching the face. Furthermore, taking into account the attendance at the daycare and having a sibling who caught a cold recently, Jamie’s exposure to RSV or similar viruses is possible. This makes it extremely easy for such nasty diseases to spread among young children in the daycare setting because they come into close contact and share facilities.

Supporting Data

Research has indicated that RSV is the prime cause of bronchiolitis in children below two years old (Erickson & Mendez, 2023). The clinical manifestations of bronchiolitis include wheezing, coughing, and different levels of respiratory deterioration and distress, as evident in Jamie’s case. The CDC indicates that the RSV has distinct seasonal trends that spike during the colder parts of the year due to the closeness of people indoors (Justice & Le, 2023). This seasonal pattern should help increase awareness of these months and, more specifically, for children in group care.

Diagnostic Tests

Given the clinical presentation and the need to confirm the diagnosis, the following diagnostic tests are recommended.

RSV Antigen Detection Test

A rapid antigen detection test via a nasal swab can confirm RSV infection, providing clarity on the specific pathogen responsible.

Chest X-ray

This imaging test can rule out pneumonia and evaluate the severity of bronchial inflammation or other complications.

Pulse Oximetry

Continuous monitoring of Jamie’s oxygen saturation is crucial, especially given her current reading of 92%. This will help in assessing the need for supplemental oxygen.

Complete Blood Count (CBC)

While not specific, a CBC can help identify secondary bacterial infections, indicated by elevated white blood cell counts (Surie et al., 2024).

Treatment Plan

Supportive Care

• Hydration and Nutrition: Ensure Jamie is well-hydrated, which helps maintain mucosal linings and supports immune function. Difficulty breathing can interfere with feeding, so small, frequent meals may be necessary.
• Fever Management: Use acetaminophen to manage her fever and provide comfort.
• Nasal Suctioning: Regular suctioning can help relieve nasal congestion, allowing for better breathing and feeding.

Respiratory Support

• Monitor Respiratory Status: Closely monitor for any signs of respiratory difficulty. Watch for persistent coughing, wheezing, or increased work of breathing.
• Humidified Oxygen: If her oxygen saturation remains below 90% or she shows signs of respiratory distress, provide humidified supplemental oxygen.
• Hospitalization: Consider hospitalization if Jamie exhibits severe symptoms such as significant lethargy and persistent high fever or if there is no improvement with outpatient management.

Preventive Measures and Education

• Infection Control: Put in practice measures that can reduce the viral circulation within the home, such as washing hands and keeping Jamie and her sibling or any other family members who cannot work from home isolated once she develops symptoms.
• Parental Guidance: Inform Jamie’s parents of certain symptoms she exhibits and other signs indicating that she needs medical attention. Be specific on how they should handle fever and respiratory complaints at home.

Follow-Up

A follow-up appointment should be scheduled within 48 to 72 hours, depending on the increase and worsening of symptoms in Jamie. If there is no change or if it becomes worse, then she may require a more detailed evaluation in an effort to re-evaluate the treatment plan or to further evaluate her condition. This proactive approach ensures that any complication is detected early and tackled before it gets out of hand. Thus, continuous parental education and supervision remain crucial to monitor her symptoms occasionally in the house to prevent the deterioration of the condition and help her recover soon.

References

Erickson, E. N., & Mendez, M. D. (2023). Pediatric bronchiolitis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519506/

Justice, N. A., & Le, J. K. (2023, June 26). Bronchiolitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441959/

Schweitzer, J. W., & Justice, N. A. (2023, June 20). Respiratory syncytial virus infection (RSV). National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459215/

Surie, D., Yuengling, K. A., DeCuir, J., Zhu, Y., Lauring, A. S., Gaglani, M., Ghamande, S., Peltan, I. D., Brown, S. M., Ginde, A. A., Martinez, A., Mohr, N. M., Gibbs, K. W., Hager, D. N., Ali, H., Prekker, M. E., Gong, M. N., Mohamed, A., Johnson, N. J., . . . Self, W. H. (2024). Severity of respiratory syncytial virus vs COVID-19 and influenza among hospitalized US adults. JAMA Network Open, 7(4), e244954. https://doi.org/10.1001/jamanetworkopen.2024.4954

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Case 3
Jamie is a 1-year-old girl who is coughing and has had rhinorrhea with yellowish discharge for the past day. Her father says today he felt like she had a fever and has not been eating or playing; she has been mostly sleeping. Her 5-year- old sibling has had a cold for a week.

Case Study – Bronchiolitis and Respiratory Syncytial Virus (RSV)

• Medications: none.
•
Allergies: no known drug allergies.
• Vaccinations: up to date for age.
• Social history: in day care; lives with mother, father, and 5-year-old sibling.
Physical examination: vital signs – temperature 101.5°F; pulse 120 beats per minute; respirations 34 per
minute; blood pressure 100/60 mmHg; pulse oximeter 92%.
• General: sitting in father’s lap; ill, lethargic appearance, and coughing.
• HEENT: nasal flaring, nasal mucus yellowish bilaterally; oropharynx with mild erythema.
• Neck: small anterior and posterior cervical nodes.
• CV: unremarkable.
• Lungs: intercostal retractions, expiratory wheezing. • Abdomen: unremarkable.

Answer the following questions or provide responses based on this scenario.
1. What is the most likely diagnosis and pathogen causing this disorder? Discuss the mode of transmission and discuss data that supports your decision.
2. What diagnostic test, if any, should be done?
3. Develop a treatment plan for this patient.