Responsible for more than 100,000 pediatric hospitalizations in the United States every year, respiratory syncytial virus (RSV) is considered to be the major cause of respiratory infections in infants and young children [1] [2]. In fact, it is estimated that virtually all children up to age 3 will become infected with RSV, almost universally in a symptomatic fashion [3]. However, several reports have emphasized its role as a respiratory pathogen across all age groups, including adults and the elderly, and approximately 11,000-17,000 deaths in the United States are attributed to RSV every year [4] [5]. In milder cases, the clinical presentation is comprised of a cough, wheezing, fever, croup, and nasal congestion, with bronchiolitis being the most common type of infection [2] [6]. In some patients, otitis media may be the initial manifestation of RSV infection [3]. More severe forms, however, such as pneumonia, have been encountered more commonly in patients who exhibit any of the following risk factors: immunosuppression (B or T-cell inherited immunodeficiencies, human immunodeficiency virus infection, immunosuppressive therapy after marrow transplantation), premature birth, cyanotic congenital heart disease, chronic obstructive pulmonary disease (COPD), and older age [1] [3] [6] [7]. Severe pneumonia can be life-threatening, both in infants and in adults, suggesting that an early diagnosis is pivotal.

• Fever

  KEYWORDS: fever; fever duration; fever responses; pediatrics; respiratory syncytial virus [Indexed for MEDLINE] Free full text [ncbi.nlm.nih.gov]

  Other symptoms to look for include difficult breathing, fever in a baby who is younger than 2 months, a fever that lasts for 3 days or longer, or fever that doesn’t respond to fever-fighting medication. [infectioncontroltoday.com]

  They may also have a fever above hundred and one degrees Fahrenheit. In case of severe RSV infection, the infant may need to be hospitalized for treatment. [news-medical.net]

• Hypoxemia

  Because of the severe hypoxemia, three doses of surfactant were administered and prone positioning was implemented for nine days. [ncbi.nlm.nih.gov]

  Transient episodes of hypoxemia may resolve with positioning and suctioning. [clinicaladvisor.com]

  Physical exam: wheezing and other abnormal sounds in the chest Chest X-rays to check for typical bilateral perihilar fullness of bronchiolitis induced by the virus Skin monitoring to check for hypoxemia, a lower than usual level of oxygen in the bloodstream [en.wikipedia.org]

• Malaise

  Common symptoms of RSV infection for both adults and children include: fever congestion cough Less common symptoms include: wheezing difficult, short, or fast breathing bluish skin irritability, malaise, or trouble breathing in infants Usually, these [healthline.com]

  Signs and Symptoms of RSV The first symptoms of RSV infection typically include runny nose and decreased appetite—followed by fever, cough, wheezing and other cold symptoms (headache, sneezing, sore throat, fatigue, malaise). [healthcommunities.com]

• Fatigue

  Signs and Symptoms of RSV The first symptoms of RSV infection typically include runny nose and decreased appetite—followed by fever, cough, wheezing and other cold symptoms (headache, sneezing, sore throat, fatigue, malaise). [healthcommunities.com]

• Cough

  Among individual signs and symptoms, cough alone had the highest sensitivity to detect laboratory-confirmed RSV [96 %, 95 % CI (95-98)]. [ncbi.nlm.nih.gov]

  Signs and symptoms The first symptoms are usually: fever runny nose cough wheezing. Ear infections are common. Pneumonia and bronchiolitis often follow, especially in infants. [sahealth.sa.gov.au]

  RSV spreads from person to person through The air by coughing and sneezing Direct contact, such as kissing the face of a child who has RSV Touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your [medlineplus.gov]

  It spreads through the air—when an infected person coughs or sneezes—and through contact with infected nasal or oral secretions. [healthcommunities.com]

• Common Cold

  Most children’s RSV appears as a common cold, but a few infant’s RSV can cause serious problems such as an infection in the small airway of the lungs (Bronchiolitis) or pneumonia. [breathepa.org]

  Some facts about common colds are as follows: Although colds have been with humans likely for eons, the first common cold virus was identified in 1956 in England, so the history of the cause of colds is relatively recent. [emedicinehealth.com]

  Respiratory syncytial virus (RSV) is a common respiratory virus that can affect people of all ages. Most people (including infants) usually develop only mild disease similar to that of a common cold, with congestion, runny nose, and cough. [lung.org]

  Protective measures are similar to those that help stop the spread of other respiratory infections like the common cold—such as frequent hand washing. [healthcommunities.com]

  The virus is most common between late fall and early spring. RSV spreads the same way as a common cold: By touching the hands of someone who has the infection. [caringforkids.cps.ca]

• Rhinorrhea

  Clinical symptoms included low-grade fever, nonproductive cough, rhinorrhea or nasal congestion, and radiographic evidence of interstitial infiltrates and sinusitis. [ncbi.nlm.nih.gov]

  When to Get Medical Help While most cases of RSV infection are not life threatening, it is a good idea to get the infant to a doctor when rhinorrhea (runny nose) and pharyngitis (sore throat) are combined with constant fever after three days. [news-medical.net]

  Day 1 New onset of at least 1 of the following respiratory symptoms for ≤ 7 days prior to Day 1: nasal congestion, runny nose, cough, or sore throat, or worsening of one of these chronic (associated with a previously existing diagnosis, eg, chronic rhinorrhea [clinicaltrials.gov]

• Tachypnea

  Infants under age 1 may have more severe symptoms and often have the most trouble breathing: Bluish skin color due to a lack of oxygen ( cyanosis ) in more severe cases Breathing difficulty or labored breathing Nasal flaring Rapid breathing (tachypnea [medlineplus.gov]

  […] patients, especially those with risk factors for severe disease who are under the age of 2 years, RSV will progress to lower respiratory tract involvement with various permutations of the classic findings of bronchiolitis: rhonchorous breath sounds, tachypnea [ncbi.nlm.nih.gov]

  Signs and symptoms Patients with RSV infection may present with the following symptoms: Upper respiratory tract infection (URTI) Cough Tachypnea Cyanosis Retractions Wheezing Rales Fever (typically low-grade) Sepsislike presentation or apneic episodes [emedicine.medscape.com]

• Nasal Flaring

  Hypoxia, wheezing, stridor, nasal flaring and chest wall in-drawing had sensitivities ranging from 8 to 31 %, but had specificities >75 %. [ncbi.nlm.nih.gov]

  The symptoms may include: Coughing with yellow, green or grey mucus Sneezing Wheezing Nasal flaring Fever Runny nose with thick nasal discharge Difficulty in breathing Blue tinged lips and skin Reduced appetite Dehydration Possible complications Inflammation [news-medical.net]

  Infants under age 1 may have more severe symptoms and often have the most trouble breathing: Bluish skin color due to a lack of oxygen ( cyanosis ) in more severe cases Breathing difficulty or labored breathing Nasal flaring Rapid breathing (tachypnea [medlineplus.gov]

• Pierre Robin Syndrome

  Robin syndrome, and for conditions requiring a tracheostomy or noninvasive mechanical ventilation. [cps.ca]

• Headache

  Patients develop fever and other symptoms such as runny nose, cough, headache, decreased appetite, body ache or weakness, and occasionally otitis media. [chp.gov.hk]

  If needed, you can also give a pain reliever (not aspirin) for fever and headache. RSV easily spreads from person to person. [fpnotebook.com]

  Kids with RSV might have cold symptoms, such as: a stuffy or runny nose sore throat mild headache cough fever a general ill feeling RSV infections in premature babies, infants, and kids with diseases that affect the lungs, heart, or immune system, can [kidshealth.org]

  Signs and Symptoms of RSV The first symptoms of RSV infection typically include runny nose and decreased appetite—followed by fever, cough, wheezing and other cold symptoms (headache, sneezing, sore throat, fatigue, malaise). [healthcommunities.com]

Having in mind the rather common occurrence of RSV infection in clinical practice, particularly in young children, the physician must include this viral pathogen in the differential diagnosis of respiratory infections. The first step during workup is a thorough patient (or parent) interview that will assess the presence and course of symptoms, as well as the existence of any of the mentioned risk factors that could predispose to a more severe form of infection. The physical examination, particularly lung auscultation, is equally important, after which laboratory studies should be conducted. Microbiological testing is the cornerstone for the diagnosis of RSV infection, as the clinical presentation is nonspecific [7], and several methods have been described in the literature. Initially, viral cell cultivation was considered as the optimal procedure for isolation of RSV but the introduction of more rapid and also more reliable tests has removed it from regular use [5] [6] [8]. Direct antigen detection through immunofluorescent or enzyme immunoassays (IFA and EIA) has shown to be an efficient test to recognize RSV, but even better results are obtained through molecular studies that evaluate the presence of viral genetic material, such as polymerase chain reaction (PCR) and reverse-transcriptase PCR (RT-PCR) [4] [6] [8]. Unfortunately, their cost still is a major limiting factor [5].

• Pulmonary Infiltrate

  RSV infection is probably less severe in the late post-BMT period, but needs to be considered early in the differential diagnosis of pulmonary infiltrates in this patient population. [ncbi.nlm.nih.gov]

  Respiratory syncytial virus disease must be considered in the differential diagnosis of fever and pulmonary infiltrates in immunocompromised adults. FULL TEXT [annals.org]

• Lymphopenia

  An initial systemic T-cell lymphopenia is followed by a pulmonary CD8 + T-cell response, mediating viral clearance. Humoral immunity to reinfection is incomplete, but RSV IgG and IgA are protective. [ncbi.nlm.nih.gov]

  Risk factors for severe respiratory syncytial virus disease in children with cancer: The importance of lymphopenia and young age. Pediatrics 2008;121(2):235-43. Robinson JL, Grenier D, MacLusky I, Allen UD. [cps.ca]

  […] exacerbations of chronic obstructive pulmonary disease (COPD) or asthma.93 LRTI can further result in respiratory failure (8-13%) or death (2-5%).81 The rate of progression has also been associated with certain risk factors, such as tobacco use and lymphopenia [bmj.com]

• Neutrophilia

  In vivo, poly(I·C)-induced neutrophilia and mucosal chemokine production are blocked by a small-molecule BRD4 bromodomain inhibitor. [ncbi.nlm.nih.gov]

Treatment options for severe RSV disease remain limited and the development of therapeutic treatment strategies remains a priority. [ncbi.nlm.nih.gov]

Palivizumab (monoclonal antibody to RSV) is not effective for treatment. [msdmanuals.com]

The presence of lower respiratory tract infection and infection in the pre-engraftment phase of BMT is believed to confer a poor prognosis. [ncbi.nlm.nih.gov]

What Is the Prognosis of Respiratory Syncytial Virus (RSV)? The prognosis for respiratory syncytial virus (RSV) is good. [emedicinehealth.com]

The prognosis is generally very good post treatment. [news-medical.net]

Prognosis RSV infection usually runs its course in seven to 14 days. The cough may linger for weeks. There are no medications that can speed the body's production of antibodies against the virus. [healthofchildren.com]

The type of sequelae, however, depend on the etiology, including infection due to viral agents such as the influenza virus. Respiratory syncytial virus (RSV) infection in childhood may also contribute to this. [ncbi.nlm.nih.gov]

In addition, defining the etiologic agent for bronchiolitis may have therapeutic implications. [jped.elsevier.es]

Complication (LRTC) was defined as one of the below as determined by the adjudication committee: Primary RSV lower respiratory tract infection (LRTI) Secondary bacterial LRTI LRTI due to unusual pathogens Lower respiratory tract complication of unknown etiology [clinicaltrials.gov]

[…] an epidemiological study from 2004 to 2012; recurrent wheezing rates associated to RSV infection from SPRING study were adjusted by the evidence on the palivizumab effect from clinical trials. [ncbi.nlm.nih.gov]

Epidemiological and clinical study of viral respiratory tract infections in children from Italy. J Med Virol. 2009; 81(4):750-756. 4- Cane PA. Molecular epidemiology of respiratory syncytial virus. [scla.org.sy]

Abstract Cytotoxic and neuroinflammatory effects of TiO 2 nanoparticles (TiO 2 -NP) in human airways are mediated by nerve growth factor (NGF), which is also implicated in the pathophysiology of respiratory syncytial virus (RSV) infection. [ncbi.nlm.nih.gov]

Pathophysiology RSV infection is limited to the respiratory tract. Initial infection in young infants or children frequently involves the lower respiratory tract and most often manifests as the clinical entity of bronchiolitis. [emedicine.medscape.com]

Although multiple studies have been done to further understand the pathophysiology behind enhanced respiratory disease, the exact mechanism behind the phenomenon is still not fully understood. [bmj.com]

This analysis of the preventive effect of vaccines on RSV infection has direct applications for the prevention of RSV infections. KEYWORDS: meta-analysis; respiratory syncytial virus (RSV); vaccine prophylaxis [ncbi.nlm.nih.gov]

Experts in the USA and Europe have set guidelinesfor the use of hyperimmune globulin and monoclonal antibodies for prevention of RSV infection in high-risk groups. [libcat.calacademy.org]

1. Walsh EE. Respiratory syncytial virus infection in adults. Semin Respir Crit Care Med. 2011;32(4):423-432.
2. Lanari M, Giovannini M, Giuffré L, et al. Prevalence of respiratory syncytial virus infection in Italian infants hospitalized for acute lower respiratory tract infections, and association between respiratory syncytial virus infection risk factors and disease severity. Pediatr Pulmonol. 2002;33(6):458-465.
3. Ogra PL. Respiratory syncytial virus: the virus, the disease and the immune response. Paediatr Respir Rev. 2004;5 Suppl A: S119-126.
4. Walsh EE, Falsey AR. Respiratory syncytial virus infection in adult populations. Infect Disord Drug Targets. 2012;12(2):98-102.
5. Popow-Kraupp T, Aberle JH. Diagnosis of Respiratory Syncytial Virus Infection. Open Microbiol J. 2011;5:128-134.
6. Falsey AR, Walsh EE. Respiratory Syncytial Virus Infection in Adults. Clin Microbiol Rev. 2000;13(3):371-384.
7. Falsey AR. Respiratory syncytial virus infection in adults. Semin Respir Crit Care Med. 2007;28(2):171-181.
8. Falsey AR, Formica MA, Walsh EE. Diagnosis of Respiratory Syncytial Virus Infection: Comparison of Reverse Transcription-PCR to Viral Culture and Serology in Adults with Respiratory Illness. J Clin Microbiol. 2002;40(3):817-820.