Infectious Disease Compendium

Respiratory Syncytial Virus

Microbiology

A virus.

Epidemiologic Risks

Winter/spring outbreaks in children under 5. They get it from their parents and older siblings (PubMed).

Adults is usually reinfection with pre-existing immunity so disease is milder than kids but still nasty as URI's go with a 9 day illness, lower shedding and often is exacerbating underlying disease.

Often shows up when testing for influenza; sputum and nasal are both good specimen.

Syndromes

Pneumonia, bronchiolitis, tracheobronchitis, or upper respiratory tract with fever and otitis media. In adults it has a high mortality (PubMed).

Incubation time is around 5 days, it is spread by direct contact.

Can cause nursing home outbreaks with 90% attack rates and may kill 11,000 elderly a year. Bacterial superinfection occurs a third of the time.

In the transplant patient it often progresses and patient often dies. Cold symptoms and sinusitis are hints.

The risk of MI goes up with acute viral pneumonias: Influenza > RSV > other viri (PubMed), especially during the first week of infection.

Treatment

Aerosolized ribavirin. VERY expensive. But does decrease mortality in the transplant patient. Giving aerosolized is also a real pain, but could always try po or iv in no inhaled option.

Oral ribavirin has been tried in a variety of hosts like lung transplant with maybe efficacy (PubMed)(PubMed).

There is also IVIG and a monoclonal RSV antibody, Palivizumab, used in kids.

Notes

On the bright side, this disease is disappearing thanks to global warming (PubMed). Always look on the bright side of life.

Curious Cases

Relevant links to my Medscape blog

Ra's al Ghul was not so far off

See it while you still can

Now what?

Last Update: 04/07/18.