Children with severe disease are at risk for complications including apnea and respiratory failure requiring mechanical ventilation. Pneumonia : Pneumonia in children classically presents with fever, cough, and rales with infiltrates or consolidation on chest radiographs. Pneumonic infiltrates are usually described as bilateral interstitial infiltrates, though alveolar infiltrates can be seen. Chest radiograph and chest computed tomography CT of a 5-year-old child with HPIV3-associated necrotizing community-acquired pneumonia.
Blood culture was positive for methicillin-resistant Staphylococcus aureus. Chest radiograph A reveals bilateral, multifocal infiltrates and a small left pleural effusion.
B CT confirms dense consolidation in the left lower lobe, right upper, and right lower lobes; numerous satellite nodules in the left lower and upper lobe bronchiectasis; and multifocal cystic lesions bilaterally. Reproduced with permission from Derek J. Williams, and Samir S. Shah J Pediatr Infect Dis ;—5.
Tracheobronchitis : Tracheobronchitis is a term used to describe disease that does not fit well into other classical syndromes but generally involves inflammation of the large airways, that is, trachea and bronchi, in the absence of symptoms of croup and radiologic findings of pneumonia.
In addition to upper respiratory tract symptoms and fever, patients may have a productive cough, wheezing, and rhonchi. It is generally a clinical syndrome seen in older children and associated with HPIV viral infection in a fourth of all cases. Adult disease in immunocompetent hosts : HPIV infections in healthy adults are generally mild, self-limited URTIs with typical cold symptoms rhinorrhea, cough, and sore throat with or without fever.
Immunocompromised hosts : Parainfluenza viruses cause severe infections in immunocompromised children and adults and have been associated with significant morbidity and mortality. Patterns found on high-resolution chest computed tomography CT in hematopoietic stem cell transplant recipients with HPIV3 pneumonia. A Peribronchial nodules. B Nodules and associated consolidation. C Very small peribronchial nodules in the left upper lobe.
D Multiple small peribronchial nodules and ground-glass consolidation. Reproduced with permission from Ferguson PE, et al. Clin Infect Dis ;— Limited studies have demonstrated a more modest impact of HPIV infections in solid-organ transplants recipients. Anecdotal reports have described isolated cases of HPIV infection associated with acute rejection in renal and liver transplant patients.
Finally, increased risk of infection and persistent or severe disease has also been demonstrated in other special populations including children with other immunodeficiency syndromes such as severe combined immunodeficiency syndrome SCIDS who may have atypical presentations like parotitis or rapidly fatal giant cell pneumonia. Other syndromes : Although HPIV infection is generally associated with respiratory tract illnesses, nonrespiratory complications of HPIV infection have been described in both adults and children.
Neurologic disease : Reports have described both acute and chronic neurological disease in children and adults associated with HPIV infections. Laboratory diagnosis : Although the clinical syndrome of croup is commonly associated with HPIV1, most other presentations of HPIV infection do not have unique features which allow viral infection to be diagnosed on clinical grounds alone.
Thus, if the specific viral diagnosis is desired, laboratory testing is needed and can be accomplished by viral detection or host antibody response to infection. Sample collection : Detection of virus whether by culture, fluorescent antibody assays, or molecular testing depends on the collection of an adequate sample. Several sample types are acceptable for testing and include nasopharyngeal swabs NPS , combined nose and throat swabs NTS , nasal washes, sputum, and bronchoalveolar lavage BAL.
The sample type will in part depend on the age and immune status of the patient and the severity and stage of the illness. Nasal washes which are commonly used in children are poorly tolerated by acutely ill older adults and NTSs are reasonable alternate specimens to collect. Viral culture : For many years, viral culture has been considered the gold standard for diagnosis. Viral isolation on cell culture depends on the development of cytopathic effect CPE or detection of hemadsorption HAD to the monolayers.
Traditional viral culture demands an experienced clinical laboratory, and time to diagnosis limits clinical utility 5—14 days. Fluorescent antibody assays : Detection of viral antigens performed directly on clinical samples has been used since the s as a rapid method for viral diagnosis.
No commercial rapid antigen test for HPIV is available. Molecular assays : If available, molecular assays such as polymerase chain reaction PCR assays are the diagnostic test of choice for HPIV infection on the basis of optimal sensitivity, specificity, and rapidity of diagnosis.
Low viral loads can also be detected with PCR assays which may be important for early therapy and infection control in transplant populations. Sputum has been rarely used in molecular assays due to the viscous nature of the specimen, but new techniques have been described which allow the use of sputum samples for fully automated molecular assays. Serologic diagnosis : Serologic diagnosis is rarely used in clinical practice and is primarily a research tool.
Complement fixation and EIA assays are available but require collection of convalescent sera to show fourfold or more rise in antibody titer and confirm acute infection. Cross-reactive immune responses to HPIV1 and 3 antigens make serotype-specific diagnosis of these infections by antibody response alone difficult. Currently, there are no antiviral agents with proven efficacy for parainfluenza virus infection. Treatment of HPIV infection is generally symptomatic in healthy children and adults.
Croup : Croup, commonly caused by HPIV1 and HPIV2 infection, presents with symptoms of a barking cough and stridor due to swelling and obstruction in the subglottic area of the trachea. The use of nebulized epinephrine is associated with short-term relief of symptoms at 30 minutes, but treatment effects generally disappear after 2 hours. Racemic and L-epinephrine are felt to have equivalent efficacy.
Heliox, which is a mixture of helium and oxygen has been proposed as a treatment for croup but is difficult to administer and does not offer significant benefits over conventional treatments. Antiviral agents : Presently there are no licensed antiviral agents for the treatment of HPIV infection.
Data on the use of antiviral agents is primarily derived from animal studies, case reports, and small uncontrolled series in immunocompromised children and adults. However, active research for new effective antiviral agents for HPIV is ongoing and several new agents show promise in vitro and in vivo. Ribavirin : Ribavirin is a synthetic nucleoside analogue which has broad-spectrum in vitro and in vivo activity against many RNA and DNA viruses.
Nichols et al reported the treatment and outcomes of HSCT patients with HPIV infection who were administered ribavirin within 48 hours of diagnosis and found no effect on day mortality and the highest risk of death in patients with bacterial and fungal copathogens. Although the efficacy of ribavirin for the treatment of LRTI appears poor, early treatment to prevent progression to pneumonia remains an unanswered question with failures clearly documented.
DAS : A novel approach which appears promising is a drug initially developed to treat influenza which acts on the host cell receptor for HPIV to prevent binding rather than exerting a direct effect on the virus. Finally, four immunocompromised children infected with HPIV demonstrated clinical and radiographic improvement along with decreased viral load after treatment with DAS Other antiviral agents : Several other small molecules with in vitro activity against HPIV are in development.
Immunoglobulins : Immunoglobulin preparations contain neutralizing antibody to HPIV and may have anti-inflammatory effects. Case reports claim dramatic results with the use of IVIG, while larger observational studies find no benefit.
Vaccines : Currently, there is no licensed vaccine for the prevention of parainfluenza infection. Antibody to the two surface glycoproteins, F and HN are neutralizing and serum and nasal antibody to either protein protects against HPIV infection and ameliorates disease. Currently, most vaccine efforts are focused on HPIV3 which is the primary cause of severe disease and pneumonia in infants and in older adults.
In young children, maternal antibody and the immature immune system are impediments to active immunization. Because of the disastrous results of the formalin-inactivated RSV vaccine trials performed in the s during which enhanced disease with natural infection was observed, most HPIV vaccine research has avoided subunit vaccines.
Infection control : Transmission of HPIV is thought to be via large particle aerosols and fomites with self-inoculation.
Interestingly, two HPIV outbreaks occurred in healthy young adults 10 and 29 weeks after complete social isolation at the South Pole and were likely due to persistent low level shedding in some individuals.
HPIVs cause a significant burden of disease in children and adults. A wide spectrum of illness including colds, croup, bronchiolitis, and pneumonia are attributed to these ubiquitous pathogens. The most severe disease is found among immunocompromised patients and treatment at present remains largely supportive. Several promising antiviral drugs are in development and are in early-stage clinical trials.
Continued research for new vaccines and therapeutics is needed. National Center for Biotechnology Information , U. Semin Respir Crit Care Med. Angela R. Branche , MD 1 and Ann R. Falsey , MD 1, 2. Ann R. Author information Copyright and License information Disclaimer. Address for correspondence Ann R. Copyright notice. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source.
These permissions are granted for the duration of the COVID pandemic or until permissions are revoked in writing. This article has been cited by other articles in PMC.
Keywords: parainfluenza virus infection. Virology Parainfluenza viruses are single-stranded, enveloped RNA viruses of the Paramyoviridaie family. Open in a separate window. Pathogenesis Parainfluenza viruses bind and replicate in the ciliated epithelial cells of the upper and lower respiratory tract. Epidemiology HPIVs were first isolated from children with croup in and were referred to as croup-associated viruses. Clinical Manifestations Parainfluenza viruses are associated with both upper and lower respiratory tract disease in children and adults, and the spectrum of illness typically includes otitis media, pharyngitis, conjunctivitis, croup, tracheobronchitis, and pneumonia.
Table 1 Westley croup severity score. Diagnosis Laboratory diagnosis : Although the clinical syndrome of croup is commonly associated with HPIV1, most other presentations of HPIV infection do not have unique features which allow viral infection to be diagnosed on clinical grounds alone. Treatment Currently, there are no antiviral agents with proven efficacy for parainfluenza virus infection.
Prevention Vaccines : Currently, there is no licensed vaccine for the prevention of parainfluenza infection. Conclusion HPIVs cause a significant burden of disease in children and adults. References 1. Parainfluenza virus type 3: seasonality and risk of infection and reinfection in young children. J Infect Dis. Epidemiologic patterns of acute lower respiratory disease of children in a pediatric group practice. J Pediatr. Croup: an year study in a pediatric practice. Epidemiology and cost of infection with human parainfluenza virus types 1 and 2 in young children.
Clin Infect Dis. Pediatr Infect Dis J. Pediatric hospitalizations for croup laryngotracheobronchitis : biennial increases associated with human parainfluenza virus 1 epidemics. Respiratory disease due to parainfluenza virus in adult bone marrow transplant recipients. Outbreaks of infectious diseases in stem cell transplant units: a silent cause of death for patients and transplant programmes.
Bone Marrow Transplant. Parainfluenza virus respiratory infection after bone marrow transplantation. N Engl J Med.
Respiratory viral infections in adults with hematologic malignancies and human stem cell transplantation recipients: a retrospective study at a major cancer center. Medicine Baltimore ; 85 5 — Henrickson K J. Parainfluenza viruses. Clin Microbiol Rev.
Karron R A, Collins P. Parainfluenza viruses; p. Safety and Prevention. Family Life. Health Issues. Tips and Tools. Our Mission. Find a Pediatrician. Text Size. Parainfluenza Viral Infections. Page Content. Signs and Symptoms The following symptoms occur in many types of parainfluenza infections, although they may be different from child to child or one kind of infection to another: A rough, barking cough. The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician.
There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
Follow Us. Back to Top. Chronic Conditions. Parainfluenza type 1 occurred in the fall of odd numbered years; parainfluenza type 2 was less predictable; and parainfluenza type 3 appeared yearly with peak activity in spring or summer.
The parainfluenza viruses were the major cause of croup and also accounted for one-half of the cases of laryngitis and over one-third of all lower respiratory tract illness in children from whom a virus was isolated.
The major clinical manifestations of infection with parainfluenza types 1 and 2 were croup, upper respiratory infections and pharyngitis; for parainfluenza type 3 upper respiratory tract infection was predominant in all age groups. Jump to navigation Skip to main content. They are most common in infants and young children, though anyone can be infected. Four types of parainfluenza viruses cause illness.
For weekly case count updates for all respiratory viruses in Wisconsin, see the Weekly Respiratory Surveillance Report, P Respiratory viruses are primarily spread to others by respiratory droplets and aerosols that travel through the air when an infected person breathes, speaks, sings, coughs, or sneezes. They can also be spread by contact — either with the infected person like kissing or shaking hands , or by touching contaminated surfaces and then touching your mouth, nose, or eyes.
These viruses can survive on surfaces for many hours. After you are infected with parainfluenza, it takes about two to seven days before you develop symptoms.
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