Cold Weather Viruses

Asif Noor; Theresa Fiorito; Leonard R. Krilov

doi:10.1542/pir.2018-0237

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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.

Abbreviations:

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?