Respiratory syncytial virus is the most common cause of bronchiolitis; nearly every child has been infected by 2 years of age.
Seasonal outbreaks occur worldwide during winter months.
Characterised by cough, wheeze, respiratory distress, and hypoxia.
Most episodes are mild and self-limiting.
Treatment is mostly supportive: supplemental oxygen, nasal and pulmonary toilet, respiratory support, nutritional support.
RSV disease in adults is often overlooked but is well associated with lower respiratory tract infection especially in the elderly and those with underlying lung comorbidities.
High-risk groups for severe illness include infants with a history of prematurity, chronic lung disease, complex congenital heart disease, and immunocompromise.
Immunoprophylaxis with palivizumab is available for high-risk groups.
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. RSV can also cause pneumonia in children and, rarely, in immunocompetent adults.
History and exam
- 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)
Frank Esper, MD
Center for Pediatric Infectious Diseases
Cleveland Clinic Children’s Hospital
FE declares that he has is on an advisory board for Procter & Gamble.
Giovanni Piedimonte, MD, FAAP, FCCP
Vice President for Research
Professor of medicine in the School of Medicine Department of Pediatrics.
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.
MLW declares that he has no competing interests.
Leonard R. Krilov, MD
Pediatric Infectious Disease
Department of Pediatrics
Children's Medical Center
Winthrop University Medical Center
Professor of Pediatrics
School of Medicine
Stony Brook University Medical Center
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.
Robert Welliver, MD
Professor of Pediatrics
Women and Children's Hospital
RW declares that he has no competing interests.
Jennifer Handforth, MB ChB, MRCPCH, DTM&H
Croydon University Hospital
JH declares that she has no competing interests.
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