Respiratory Syncytial Virus (RSV) Infection
Respiratory syncytial virus (RSV) is a medium-sized, membrane-bound RNA virus that causes acute respiratory tract illness in patients of all ages.
- In adults, RSV causes upper respiratory tract infection (URTI).
- In infants and children, RSV commonly presents as lower respiratory tract infection (LRTI) that manifests as bronchiolitis and rarely pneumonia, respiratory failure, and death.
- 90–95% of children are infected by 24 months.
- Leading cause of pediatric bronchiolitis (50–90%)
- Premature infants and infants under the age of 6 months are at increased risk.
- Outbreaks of RSV disease occur each winter (October to late January).
- Morbidity and mortality:
- RSV infection leads to >100,000 annual hospitalizations.
- In the United States, 2.1 million outpatient visits for RSV in children <5 years.
- Worldwide, RSV is responsible for approximately 33 million LRTI/year and up to 199,000 childhood deaths.
- RSV is the most common etiology of pneumonia in children (29%).
- 177,000 hospitalizations, 14,000 annual deaths are attributable to RSV in the elderly.
- The COVID-19 pandemic significantly impacted RSV presentations to clinical care.
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Etiology and Pathophysiology
- RSV is a single-stranded, negative-sense RNA virus belonging to the Paramyxoviridae family.
- Two subtypes, A and B, are simultaneously present in most outbreaks with A subtypes causing more severe disease.
- RSV is spread via direct contact or droplet aerosols. Incubation period ranges from 2 to 8 days, mean 4 to 6.
- Natural RSV infections result in incomplete immunity; recurrent infections are common.
- RSV causes a neutrophil-intensive inflammation of the airway.
- RSV develops in the cytoplasm of infected cells and matures by budding from the plasma membrane.
- RSV is a major cause of exacerbation of asthma and chronic obstructive pulmonary disease (COPD).
- Severe RSV infections may be associated with polymorphisms in cytokine-related genes, including CCR5; IL4; IL8, IL10, and IL13.
- RSV replicates in apical ciliated bronchial epithelial cells. The airway epithelium produces chemokines, which recruit neutrophils.
- Significant association with RSV-associated acute LRTI
- Infants born before the 35 weeks’ gestation
- Low birth weight, male gender
- Underlying cardiopulmonary disease
- Down syndrome
- Any age group with persistent asthma
- Children <5 years with socioeconomic vulnerability
- Siblings with asymptomatic RSV infection
- Secondhand smoke
- History of atopy, no breastfeeding
- Adult patients with COPD or functional disability
- Other risk factors
- Daycare center attendance
- Exposure to indoor and environmental air pollutants
- Multiple births, malnutrition, higher altitude
- Isolate patients with proven or suspected RSV.
- Palivizumab is a humanized monoclonal antibody for the prevention of severe RSV in high-risk children (2)[A]:
- Preterm infants born ≤28 weeks, 6 days of gestation, or who are <12 months at start of RSV season
- Infants with bronchopulmonary dysplasia who are <1 year or <23 months and requiring treatment
- Infants ≤12 months of age who are being medically treated for acyanotic heart disease or have moderate to severe pulmonary hypertension
- Prophylactic use is indicated for infants and children <24 months of age with:
- Chronic lung disease (CLD) of prematurity
- Hemodynamically significant congenital heart disease
- Congenital abnormalities of the airway or neuromuscular disease
- Preterm infants born <29 weeks’ gestational age (wGA) and <1 year at the RSV season start date
- Infants in the 1st year of life with CLD of prematurity
- Infants with HS-CHD <1 year at the season start date
- Dosage: maximum of 5 monthly doses beginning in November or December at 15 mg/kg per dose IM
Commonly Associated Conditions
In hospitalized infants:
- Pulmonary infiltrates/atelectasis (42.8%)
- Otitis media (25.3%)
- Hyperinflation (20.8%); respiratory failure (14%)
- Hyperkalemia (10.1%, defined as K+ >6.0)
- Apnea (8.8%); bacterial pneumonia (7.6%)
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Domino, Frank J., et al., editors. "Respiratory Syncytial Virus (RSV) Infection." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688919/all/Respiratory_Syncytial_Virus__RSV__Infection.
Respiratory Syncytial Virus (RSV) Infection. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688919/all/Respiratory_Syncytial_Virus__RSV__Infection. Accessed May 29, 2023.
Respiratory Syncytial Virus (RSV) Infection. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688919/all/Respiratory_Syncytial_Virus__RSV__Infection
Respiratory Syncytial Virus (RSV) Infection [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 29]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688919/all/Respiratory_Syncytial_Virus__RSV__Infection.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Respiratory Syncytial Virus (RSV) Infection ID - 1688919 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688919/all/Respiratory_Syncytial_Virus__RSV__Infection PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -