INTERVIEW: ‘Adenoviruses can cause bronchiolitis in babies and children’, says Prof Sidhartha Das
This is consequent to involvement of small bronchi in the lungs (viral pneumonia). Supportive treatment and use of bronchodilators are likely to have remission.
Common cold, fever and cough may be common during the monsoon and winter. The severity of flu this time has been extreme with many suffering from high fever and prolonged cough, lasting for several days. Hemant Kumar Rout speaks to Prof Sidhartha Das, medicine specialist and diabetologist and advisory board member of CSIR, India, to understand the reasons and remedies available.
Post Covid, a ‘long fever’ epidemic has hit the country with people across states down with high temperatures and cough persisting for two to three weeks. Why is the flu season more severe this time?
It is mainly because of two issues. Medically, it is now well appreciated that many people who had suffered from Covid-19 are having features of bronchitis and symptoms of lower respiratory involvements presenting as breathlessness, throat clearing and cough with minimal expectoration. This is consequent to the involvement of small bronchi in the lungs (viral pneumonia). Supportive treatment and the use of bronchodilators are likely to cause remission.
The other is seasonal respiratory virus infections that are seen in winter, mostly in north India. This year, we are observing these cases a little earlier. Besides the changes in weather, environmental pollution is one of the important precipitating causes for the same.
Is it respiratory syncytial virus (RSV) or Covid-19 or seasonal influenza? Symptoms vary from person to person with some suffering from fever for a week or so and some from long-lasting cough.
The prevalence of respiratory infections is unlikely due to Covid-19. Besides, vaccination against COVID-19 in India has shown very successful results in preventing its recurrence in the country. We are seeing people down with common flu viruses, H3N2 and H1N1 viruses. RSV usually affects babies and children, although it can also infect immunocompromised adults and elderly people.
Further, there are many other viruses that can cause respiratory infections viz adenoviruses. They are usually infections of the upper respiratory tract i.e. nose and throat to produce sneezing, coughing and running nose-like symptoms with fever. But in many patients, these viruses can infect the lower respiratory tract like the bronchi and lungs to produce severe bronchitis and pneumonia. In babies and children, they can cause bronchiolitis, often requiring intensive care management.
Children are developing more severe symptoms than ever. How can they be protected and what are the preventive measures?
Babies and small children may develop serious complications like bronchiolitis where oxygen diffusion from lungs to blood circulation may be badly impeded. Children may develop cyanosis (blue coloration of the body) with rapid respiratory rate and it is a serious situation. Primarily, children or adults should be protected from exposure to known sources of viral infections. Maintaining personal hygiene like hand washing is very important for prevention. Exposing children and compromised persons to crowded areas should be avoided. Vaccines against RSV are available. Similarly, drugs like Palivizumab (monoclonal antibodies) are available for prophylactic use in high risk babies but they are very expensive.
Even in the post-viral phase, people have prolonged fatigue, weakness, tiredness, mental fogging, and inability to work and concentrate. How can they deal with it?
Viral infections stimulate systemic inflammatory response through activation of the body's immune system. Activation of the immune system produces many substances that lead to inflammatory processes. Thus, viral infections can affect organs/systems of the body other than the respiratory tract. Therefore, in certain viral infections, patients develop symptoms pertaining to other organs.
Fatigue, generalised weakness, tiredness etc are manifestations of generalised inflammatory response involving the musculoskeletal system and metabolic changes in the blood like accumulation of lactate etc. In certain types of viral infections, the brain can also get infected and the patient may present with confusion, and convulsions to the unconscious. Apart from medication, people should avoid exposure to cold air and get adequate rest, good nutrition and adequate hydration as well as good sleep to improve their immune response against the viral infection.
Viral fever is getting prolonged nowadays and cases of relapse in a short span are on the rise. Is it because Covid immunity is on the wane?
Usually, viral fevers are short except when complications like coagulation abnormalities, pneumonia, brain involvement with encephalitis, heart involvement with myocarditis etc develop and prolong the illness to have a protracted course requiring specialised medical attention. Repeated infections in compromised patients may be possible due to the same virus or infection due to other viruses within a short gap. It is too early to comment on waning of Covid-19 immunity as it requires longitudinal and periodic evaluation of Covid-19 antibody levels at the community level.