• Users Online: 780
  • Print this page
  • Email this page


 
 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 74-75

Human Bocavirus (HBoV) Infection: An associated Life Threatening Respiratory illness


1 Fellow in PICU, Division of Pediatric Critical care, St John's Medical college and Hospital, Banglore, India
2 Assistant Professor, Division of Pediatric Critical care, St John's Medical college and Hospital, Banglore, India
3 Associate Professor, Head, PICU,Division of Pediatric Critical care, St John's Medical college and Hospital, Banglore, India

Date of Submission06-Mar-2018
Date of Acceptance12-Apr-2018
Date of Web Publication30-Apr-2018

Correspondence Address:
S Sumithra
Assistant Professor St.John's Medical College and Hospital, Sarjapur Road, Bengaluru, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.21304/2018.0502.00378

Rights and Permissions
  Abstract 


Background: 10 month old infant presenting with fever, cough and coryza for 3 days progressed to acute respiratory failure. An initial clinical presentation of wheeze associated lower respiratory tract infection developed into an extremely severe course of disease characterized by acute respiratory failure requiring invasive mechanical ventilation. Bronchoalveolar Lavage fluid analysis revealed high titres of Bocavirus by PCR.
Case characteristics : 10 month old infant presenting with fever, cough and coryza for 3 days progressed to acute respiratory failure. Outcome: Bronchoalveolar Lavage fluid analysis revealed high titres of Bocavirus by PCR.
Message : Bocavirus infection should be suspected in case of rapidly progressing respiratory illness escalating to Type II respiratory failure

Keywords: Bocavirus (HBoV), Respiratory failure, WALRI, BAL(Bronchoalveolar Lavage)


How to cite this article:
Suryanarayana G, Sumithra S, Lalitha A V. Human Bocavirus (HBoV) Infection: An associated Life Threatening Respiratory illness. J Pediatr Crit Care 2018;5:74-5

How to cite this URL:
Suryanarayana G, Sumithra S, Lalitha A V. Human Bocavirus (HBoV) Infection: An associated Life Threatening Respiratory illness. J Pediatr Crit Care [serial online] 2018 [cited 2020 Mar 29];5:74-5. Available from: http://www.jpcc.org.in/text.asp?2018/5/2/74/281125




  Introduction Top


HBoV is a recently identified viral agent that belongs to the family Parvoviridae and contains a single linear positive-sense or negative-sense single- stranded deoxyribonucleic acid genome.[1] This virus has been detected mainly in younger children, in nasopharyngeal secretions, in sera and blood samples of patients with upper and lower respiratory tract infections and in faecal specimens of subjects with gastroenteritis.[2] The role of HBoV as a causative agent of respiratory disease is frequently questioned due to its common detection with other potential pathogens[3] and the evidence that in some studies co- infections can have a significantly greater clinical and socioeconomic impact on infected children and their households than HBoV infection alone.[4]


  Case Report Top


We report a case of 11 month old male child who presented to our Paediatric ER with cough and coryza of 3 days and respiratory distress for one day prior to admission, there was no significant past and family history. On admission, he was febrile, irritable, with HR- 140/min, RR- 88/min with subcostal and intercostal retraction. On respiratory system examination: Respiratory distress (+), air entry was bilaterally equal, normal vesicular breath and wheeze present. Other systems were within normal limits. His investigations were as follows, CBC was 11,810/ mm3; Sr.Procalcitonin 0.8αg/ml, chest X-ray showed bilateral streaky opacities [Figure 1], a possibility of bronchopneumonia was considered. Child was shifted to PICU within in 30mins and was connected to High Flow Nasal Cannula (HFNC) in view of respiratory distress. Child was started on continuous salbutamol nebulisations, steroids and received a dose of magnesium sulphate.
Figure 1: chest X-ray showing bilateral peri hilar inhomogenous opacities and right middle and lower zone pneumonitis.

Click here to view


Child was initially on HFNC for 6hrs and was later intubated and connected to mechanical ventilator in view of impending respiratory failure and poor sensorium. On ventilator, child continued to have bilateral rhonci and the ventilatory parameters were modified as per reactive airway disease strategy by reducing PEEP, low rates and increasing Te. However there was no significant clinical response to treatment, and the child continued to have fever spikes, antibiotics were escalated and child was subjected to Bronchoscopy.

Bronchoscopic Alveolar Lavage (BAL) fluid was sent for molecular diagnostic panel for Adenovirus, Human Metapneumovirus, Influenza, Rhinovirus, Parainfluenza, Parechovirus, Streptococcus pneumonia., Hemophilus influenza., Klebsiella sp., Mycoplasma pneumonia and several other organisms. The report was found to be positive for HBoV by Real time PCR assay [Figure 2]. Child required mechanical ventilation for total duration of 4 days and extubated to HFNC.
Figure 2: BAL fl uid positive for Human Bocavirus

Click here to view


Discussion: HBoV is the fourth most frequent virus detected after rhinoviruses, enteroviruses, and RSV. HBoV was found in the nasopharynx of 19% of children with bronchiolitis.[5] Human Boca virus had been isolated in nasopharyngeal and tracheal aspirates of children with respiratory illnesses. However it was as a co-infection with several other organisms like Respiratory syncytial virus, Rhinovirus, Human metapneumovirus. It was initially considered as co- infectious organisms associated with bronchiolitis and recurrent wheezing in infants. There is a case report on human bocavirus infection with complications like pneumothorax, pneuomediastinum and air leak syndrome.[5]


  Conclusion: Top


It s need of the hour to recognise these novel infections and to anticipate these complications, and act accordingly to reduce the complications. Keeping in mind of these infections and their stormy course will help the clinicians to anticipate these complications, while managing the regular respiratory infections like bronchiolitis, viral triggered wheeze.

Message: HBoV infection was usually associated as a co-infective organism with bronchiolitis. In our case HBoV was associated with severe life threatening respiratory tract infection requiring invasive mechanical ventilation.

Source of Funding - Nil

Conflict of Interest - Ni



 
  References Top

1.
Allander T, Tammi MT, Eriksson M, Bjerkner A, Tiveljung- Lindell A, Andersson B. Cloning of a human parvovirus by molecular screening of respiratory tract samples. Proc Natl Acad Sci USA 2005;102: 12891-96.  Back to cited text no. 1
    
2.
Peltola V, Söderlund-Venermo M, Jartti T. Human bocavirus infections. Pediatr Infect Dis J 2013;32: 178-9. doi: 10.1097/ INF.0b013e31827fef67  Back to cited text no. 2
    
3.
Esposito S, Daleno C, Prunotto G, Scala A, Tagliabue C, Borzani I, et al. Impact of viral infections in children with community-acquired pneumonia: results of a study of 17 respiratory viruses. Influenza Other Respir Viruses 2013;7: 18-26.  Back to cited text no. 3
    
4.
Esposito S, Bosis S, Niesters HG, Tremolati E, Sabatini C, Porta A, et al. Impact of human bocavirus on children and their families. J Clin Microbiol 2008;46: 1337-42. doi: 10.1128/ JCM.02160-07.  Back to cited text no. 4
    
5.
Edner, N., P. Castillo-Rodas, L. Falk, K. Hedman, M. Soderlund-Venermo, and T. Allander. Life-threatening respiratory tract disease with human bocavirus-1 infection in a four-year-old child. J.Clin.Microbiol 2011;50:531-2.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Conclusion:
References
Article Figures

 Article Access Statistics
    Viewed3    
    Printed0    
    Emailed0    
    PDF Downloaded2    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]