|Year : 2018 | Volume
| Issue : 2 | Page : 74-75
Human Bocavirus (HBoV) Infection: An associated Life Threatening Respiratory illness
G Suryanarayana1, S Sumithra2, AV Lalitha3
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 Submission||06-Mar-2018|
|Date of Acceptance||12-Apr-2018|
|Date of Web Publication||30-Apr-2018|
Assistant Professor St.John's Medical College and Hospital, Sarjapur Road, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
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|| |
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. 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. The role of HBoV as a causative agent of respiratory disease is frequently questioned due to its common detection with other potential pathogens 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.
| Case Report|| |
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.|
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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.
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. 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.
| Conclusion:|| |
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
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[Figure 1], [Figure 2]