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Parainfluenza viruses in children

INTRODUCTION

Human parainfluenza viruses are important respiratory pathogens in children and adults. In infants and young children, parainfluenza viruses are the most common cause of lower respiratory tract infections after respiratory syncytial virus (RSV) and possibly human metapneumovirus (hMPV) [1,2]. Lower respiratory infections are a leading cause of morbidity and mortality in infants during the first year of life in the United States and in children younger than the age of six years in developing countries [1]. In adults, parainfluenza viruses generally cause mild upper respiratory infections (URIs) but can induce life-threatening lower respiratory tract infections in immunocompromised patients [3].

The virology, clinical manifestations, diagnosis, and treatment of parainfluenza viruses in children will be reviewed here. Infection with parainfluenza viruses in adults is discussed separately. (See "Parainfluenza viruses in adults".)

MICROBIOLOGY

Virus — Parainfluenza viruses (PIV) are single-stranded, enveloped RNA viruses belonging to the genus paramyxovirus in the Paramyxoviridae family [4]. This family also includes human mumps, measles, and respiratory syncytial viruses and metapneumoviruses, as well as avian, bovine, and murine strains of these viruses [5].

The virions are pleomorphic and range in diameter from 150 to 200 nm [6]. The single strand of negative-sense RNA is 15,462 nucleotides in length and encodes at least eight viral proteins: the nucleocapsid protein (NP), the phosphoprotein (P), the matrix protein (M), the fusion glycoprotein (F), the hemagglutinin-neuramininidase glycoprotein (HN), the polymerase (L), and two proteins of unclear function (C and D) [7].

  • The HN and F proteins project through the lipid envelope and form the major antigenic targets for neutralizing antibody [8]. Their hydrophobic tails project into the virion, where they interact with the M protein to aid in virus assembly [9].
  • The nucleocapsid core is composed of NP, P, and L proteins in association with viral RNA. NP proteins bind tightly to the viral genome, creating a template for the RNA-dependent RNA polymerase composed of the P and L proteins [10].
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