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- Asif Noor, MD*
- Theresa Fiorito, MD*
- Leonard R. Krilov, MD*,†
- *Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola, NY
- †Department of Pediatrics, State University of New York, Stony Brook School of Medicine, Stony Brook, NY
AUTHOR DISCLOSURE
Drs Noor and Fiorito have disclosed no financial relationships relevant to this article. Dr Krilov has disclosed that he has clinical research grants paid to NYU Winthrop Hospital from AstraZeneca (Medimmune) and Regeneron. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. In addition to the above-mentioned affiliations, the current affiliation of Drs Noor, Fiorito, and Krilov is Department of Pediatrics, New York University, Long Island School of Medicine, New York, NY.
- AAP:
- American Academy of Pediatrics
- Adv:
- adenovirus
- CDC:
- Centers for Disease Control and Prevention
- FDA:
- Food and Drug Administration
- hMPV:
- human metapneumovirus
- PCR:
- polymerase chain reaction
- PIV:
- parainfluenza virus
- RSV:
- respiratory syncytial virus
- RV:
- rhinovirus
Education Gap
Clinicians must learn to identify viral infections in children during the winter months and must practice caution with the use of unnecessary medications in such cases. Recognition of the clinical pattern of viral infection (eg, bronchiolitis) in conjunction with judicious use of viral tests (either office-based immunoassays or newer molecular tests) may assist in epidemiological monitoring, cohorting patients in the hospital, withholding unnecessary therapies, and providing a definitive diagnosis.
Objectives
After completing this article, readers should be able to:
Review the epidemiological aspects and clinical signs and symptoms of common cold weather viruses.
Recognize situations in which viral testing is indicated.
Recognize situations in which treatment is indicated.
Case
In early November you are evaluating a 9-month-old boy born at 33 weeks of gestation. The infant presents with 2 days of fevers (101°F–102°F [38.3°C–38.8°C]), copious rhinorrhea, and 1 day of coughing with difficulty breathing. He is otherwise feeding well and has had adequate urination. His 4-year-older sister has an upper respiratory tract infection.
On physical examination, the infant has a respiratory rate of 45 breaths/min without chest wall retractions. On auscultation there is good air entry with scattered rhonchi bilaterally. What is the most appropriate next step in management?
Obtain respiratory syncytial virus (RSV) and influenza antigen testing.
Obtain a chest radiograph to look for focal infiltrate.
Provide supportive care with nasal …
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