Summary
Definition
Respiratory syncytial virus (RSV) was historically placed in the Paramyxovirus family. It has been recategorised to the order Mononegavirales as a member of the Pneumoviridae family. It is the most common cause of bronchiolitis. Symptoms include rhinorrhoea, cough, wheeze, respiratory distress, and hypoxaemia.[1] RSV can also cause pneumonia in children and, rarely, in immunocompetent adults.
[Figure caption and citation for the preceding image starts]: Electron micrograph revealing the morphological traits of the RSVCDC/Palmer EL; used with permission [Citation ends].
History and exam
Key diagnostic factors
- presence of risk factors
- rhinorrhoea/congestion
- tachypnoea
- increased work of breathing
- cough
- wheeze
- poor feeding
- cyanosis
- rales
- apnoea
Risk factors
- exposure to RSV
- complex congenital heart disease
- history of prematurity
- immunocompromise
- chronic lung disease
- high-risk infants with no recent immunoprophylaxis against RSV
- infants aged <6 months
- winter season
- older adult age
- smoke exposure
- family history of asthma
- Down's syndrome
Diagnostic investigations
Investigations to consider
- chest x-ray
- direct fluorescent antibody staining of respiratory specimen (e.g., nasopharyngeal aspirate)
- reverse transcriptase polymerase chain reaction of respiratory specimen (e.g., nasopharyngeal aspirate)
- enzyme-linked immunosorbent assay of respiratory specimen (e.g., nasopharyngeal aspirate)
- viral culture of respiratory specimen (e.g., nasopharyngeal aspirate)
Treatment algorithm
Contributors
Authors
Center for Pediatric Infectious Diseases
Cleveland Clinic Children’s Hospital
Cleveland
OH
Disclosures
FE declares that he has no competing interests.
The Steven and Nancy Calabrese Endowed Chair for Excellence in Pediatric Care, Research, and Education
Professor & Chair of Pediatrics
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
Chief
Global Pediatric Research Operations
Cleveland Clinic Foundation
Director
Center for Pediatric Research
Lerner Research Institute
Cleveland
OH
Disclosures
GP declares that he has no competing interests.
Dr Frank Esper and Dr Giovanni Piedimonte would like to gratefully acknowledge Dr Melvin L. Wright, a previous contributor to this topic.
Peer reviewers
Chief
Pediatric Infectious Disease
Vice Chairman
Department of Pediatrics
Children's Medical Center
Winthrop University Medical Center
Mineola
Professor of Pediatrics
School of Medicine
Stony Brook University Medical Center
Stony Brook
NY
Disclosures
LRK has participated as an investigator in multiple clinical research trials supported by grants from MedImmune. LRK has also served as a consultant to MedImmune on medical advisory boards and is a member of their speakers' bureau.
Professor of Pediatrics
Women and Children's Hospital
Buffalo
NY
Disclosures
RW declares that he has no competing interests.
Consultant Paediatrician
Croydon University Hospital
Croydon
UK
Disclosures
JH declares that she has no competing interests.
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