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Parainfluenza virus infection
Other Resources UpToDate PubMed

Parainfluenza virus infection

Contributors: James J. Douglas MD, FRCPC, Sagar A. Vaidya MD, PhD, Ricardo M. La Hoz MD
Other Resources UpToDate PubMed

Synopsis

Parainfluenza viruses are a family of single-stranded enveloped RNA viruses that are a common cause of upper and lower respiratory illnesses, most often seen in children. The family is divided into 5 subtypes; type 3 is the most common. By the age of 5 most children have experienced parainfluenza infection. Parainfluenza can be spread via direct person-to-person contact or large droplet inhalation and has an incubation period ranging from 2 to 6 days. In healthy children, parainfluenza is responsible for mild upper respiratory tract illnesses, otitis media, bronchiolitis, croup, and occasionally interstitial pneumonitis and pneumonia. In immunocompetent adults, clinically it usually appears as a mild, self-limited upper respiratory tract infection, although it can also lead to community-acquired pneumonia. Parainfluenza is also linked to asthma and chronic obstructive pulmonary disease exacerbations and rarely with aseptic meningitis and Guillain-Barré syndrome.

In elderly, HIV-positive, and immunocompromised individuals, including adult and pediatric solid organ transplant (SOT) recipients, hematopoietic stem cell transplant (HSCT) recipients, and patients with primary immunodeficiency, parainfluenza can cause severe upper respiratory tract illnesses along with pneumonia and interstitial pneumonitis, which can be fatal.

Symptoms:
  • Cough, often barking
  • Hoarseness
  • Wheezing
  • Rhinorrhea
  • Sore throat
Signs:
  • Rales/rhonchi
  • Fever above 38°C (100.4°F)
  • Irritability
  • Stridor
  • Dyspnea
Risk factors for severe disease:
  • Infants
  • T-cell immune defects (SOT, HSCT, and primary immunodeficiencies)
Note: In 2022 and 2023, pediatric invasive group A streptococcal (iGAS) infections and noninvasive group A streptococcal infection cases have been associated with respiratory infections due to parainfluenza among other viruses. Concurrent or preceding viral infections, including varicella (chickenpox), may increase risk for iGAS infection. Severe outcomes of iGAS infections include necrotizing fasciitis, streptococcal toxic shock syndrome, and death.

Codes

ICD10CM:
J12.2 – Parainfluenza virus pneumonia

SNOMEDCT:
12188008 – Parainfluenza

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Respiratory syncytial virus infection – nasal congestion and cough with progression to bronchiolitis, pneumonia, and tracheobronchitis
  • Common cold – sore throat, rhinorrhea, sneezing, nasal obstruction
  • Human metapneumovirus infection
  • Influenza
  • Adenovirus infection – conjunctivitis and  pharyngitis
  • COVID-19
  • Mycoplasma pneumonia – pneumonia (slower onset), myalgias/arthralgias, erythema nodosum, encephalitis, myocarditis, rash, cold agglutination
  • Measles – cough, conjunctivitis, and coryza
  • Epiglottitis (Haemophilus influenzae infection) – leaning forward, anxious, and drooling
  • Tracheitis – high fever, stridor, dyspnea and copious sputum
  • Deep neck space abscess including Peritonsillar abscess and Retropharyngeal abscess – fever, dysphagia, and drooling
  • Respiratory diphtheria – systemic toxicity
  • Foreign body aspiration
  • Trauma
  • Vocal cord paralysis
  • Angioneurotic edema
  • Reflux laryngitis

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated:04/06/2023
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Parainfluenza virus infection
A medical illustration showing key findings of Parainfluenza virus infection (Older Child/Adult) : Fever, Hoarseness, Rhinorrhea, Pharyngitis
Copyright © 2024 VisualDx®. All rights reserved.