- respiratory syncytial virus infection
The respiratory syncytial virus, commonly known as RSV, can cause lung infections. These infections are usually mild in healthy adults but can be serious in infants, young children or in people with weak immune systems.
What is going on in the body?
RSV can cause infections in the nose, throat, windpipe, smaller airways called bronchioles, and the lungs. RSV infection typically causes mild, common cold-like symptoms in adults and older children.
In infants younger than 1 year, RSV can cause pneumonia or a lower airway infection called bronchiolitis.
RSV can also cause pneumonia in people with weak immune systems, such as those receiving chemotherapy for cancer.
What are the causes and risks of the infection?
RSV is highly contagious and is spread from person to person. RSV is spread through contact with infected secretions from the eyes, nose, and mouth. These secretions are usually spread to the hands and then to objects that the contaminated hands touch. When a person touches these objects, he or she may acquire the infection.
Children younger than 1 year are not only more susceptible to the virus, but are also more likely to be exposed because they often place objects in their mouths. Premature infants are at especially high risk.
Children in day care centers are at a higher risk of infection than other children. RSV tends to occur in large outbreaks between late fall and early spring, with most cases in the winter.
If infected, those at high risk of complications include:
children with serious heart disorders such as congenital heart disease
children with lung problems, such as cystic fibrosis, an inherited disorder causing the secretion of thick mucus in the airways
anyone with a weak immune system, or immunodeficiency disorder
- adults with chronic lung problems, such as a chronic lung disorder called emphysema
What can be done to prevent the infection?
Though it makes sense to keep infants away from those with respiratory symptoms, there is no practical way to prevent most cases of RSV. Frequent hand washing, especially by staff of newborn nurseries and day care centers, may help prevent some cases.
Children who have chronic disease, immune disorders, or a history of prematurity may have a monthly shot of palivizumab (i.e., Synagis) during RSV season to help prevent serious infection. This medication is made up of proteins that can prevent infection for a limited period of time. It is used only in children who are at high risk of having severe problems if they do get infected with RSV..
How is the infection diagnosed?
Diagnosis starts with the history and physical exam. This may be all that is needed to make the diagnosis if the child has typical symptoms, is younger than 1 year, if it is winter, and if there is a current outbreak of RSV in the community.
A chest X-ray may help with the diagnosis and rule out other causes for the symptoms. If needed, a special test called an immune assay can be done on nose or lung secretions to detect RSV. This is commonly done when children are admitted to a hospital so that outbreaks within the hospital can be limited.
Long Term Effects
What are the long-term effects of the infection?
RSV accounts for as many as 125,000 hospitalizations of children under the age of one every year. Up to 2% of these children may die from the infection or its complications. If a person requires a ventilator to help with breathing, the severe infection as well as the ventilator can cause permanent damage to the lungs.
Most people, however, recover completely from RSV and have no long-term effects. Children who develop breathing problems because of RSV may have a slightly increased likelihood of developing asthma later in life.
What are the risks to others?
RSV is highly contagious. When an outbreak of RSV occurs, up to 50% of the infants in a community may be affected.
What are the treatments for the infection?
Adults and older children with RSV usually do not need treatment. Over-the-counter medications to relieve symptoms can be used as needed.
Infants with RSV or those with weak immune systems may be admitted to the hospital for monitoring and treatment. Treatment for RSV often involves the use of humidified or moistened oxygen. Special medications, such as albuterol, can be mixed with the oxygen to help open the airways.
Fluids can be given through an intravenous line (IV), a thin tube connected to a vein in the arm.
In severe cases, an antiviral agent known as ribavarin (i.e., Copegus, Rebetol, Ribasphere) may be given. In rare cases, a person may need to be connected to a ventilator.
What are the side effects of the treatments?
Most treatments for RSV have few side effects. Ribavarin is not given routinely for RSV infections, because it is often ineffective and sometimes makes breathing worse. Rarely, an infant can contract a new infection or suffer lung damage from a ventilator.
What happens after treatment for the infection?
Most people recover completely and return to normal activities as soon as they feel able. A person may still have the virus in his or her secretions for 1-2 weeks after symptoms go away. This is important to remember in terms of spreading the infection. Children in day care may be asked to stay home for a few days to prevent an outbreak.
How is the infection monitored?
Those with severe breathing difficulty need close monitoring in a hospital until the condition improves. For those at home with RSV, any new or worsening symptoms should be reported immediately to the healthcare provider.
Rudolph's Fundamentals of Pediatrics, 1998, Rudolph et al.
Harrison's Principles of Internal Medicine, 1998, Fauci et al.