Respiratory Syncytial Virus Infection

Respiratory syncytial virus infection occurs almost exclusively in infants and young children. It's the leading of lower respiratory tract infections, pneumonia, tracheobronchitis, and bronchiolitis in this age group. It's also a suspected cause of the fatal respiratory diseases of infancy.

Rates of illness are highest among infants age 1 to 6 month; incidence peaks between 2 and 3 months. Those day-care settings are especially susceptible. The virus creates annual epidemics during winter and spring.

Causes

RSV infection is caused by a virus that attacks the respiratory tract—the nose, eyes, throat, and lungs. Infection spreads from person to person through everyday contact. The virus is most often spread by sharing food or drink with an infected person or by getting droplets containing the virus on your hands and then touching your eyes, nose, or mouth. The incubation period—the time from exposure to RSV until you develop symptoms—ranges from 2 to 8 days, but usually is 4 to 6 days.

Symptoms and Signs

• Cough
• Rapid breathing
• Breathing difficulty
• Shortness of breath
• Cyanosis
• Nasal congestion
• Nasal flaring
• Wheezing
• Fever

Diagnostic tests

Cultures of nasal and pharyngeal secretions may show respiratory syncytial virus; however, the virus is very labile, so cultures aren't always reliable.

Serum antibody titers may be elevated, but in infants under age 4 months, maternal antibodies may impair test results.

Two serologic techniques that give rapid results are indirect immunofluorescence and the enzyme­linked immunosorbent assay (ELISA). However, these tests are an impractical diagnostic tool because serum specimens aren't obtained until 4 weeks after the onset of illness. They're mainly used for epidemiologic studies.

Treatment

Appropriate treatment aims to support respiratory function, maintain fluid balance, and relieve symptoms. Ribavirin, a broad-spectrum antiviral agent, is being used successfully to treat infants with severe lower respiratory tract infection caused by the respiratory syncytial virus. The aerosol form of the drug is given by way of tent, oxygen hood, mask, or ventilator for 2 to 5 days, 12 to 18 hours a day. With this drug therapy, patients show less severe symptoms and improvements in arterial oxygen saturation.

Prevention

• Insist that others wash their hands with warm water and soap before touching your baby.
• Try to keep young children away from your baby. RSV is very common among young children and is easily spread from child to child.
• Have others avoid contact with the baby if they have a cold or fever.
• Be aware that kissing the baby can spread RSV infection.

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