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Section 3. Summaries of Infectious Diseases
Respiratory Syncytial Virus
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Respiratory syncytial virus (RSV) causes acute respiratory tract illness in patients of all ages. In infants and young children, RSV is the most important cause of bronchiolitis and pneumonia. During the first few weeks of life, particularly among preterm infants, infection with RSV may produce minimal respiratory tract signs. Lethargy, irritability, and poor feeding, sometimes accompanied by apneic episodes, may be the major manifestations. Most previously healthy infants infected with RSV do not require hospitalization, and many who are hospitalized improve with supportive care and are discharged in fewer than 5 days. Conditions that increase the risk of severe or fatal RSV infection are cyanotic or complicated congenital heart disease, especially conditions causing pulmonary hypertension; underlying pulmonary disease, especially bronchopulmonary dysplasia; prematurity; and immunodeficiency disease or therapy causing immunosuppression at any age. The association between RSV bronchiolitis early in life and subsequent reactive airway disease remains poorly understood. After RSV bronchiolitis, some children will develop long-term abnormalities in pulmonary function and experi ence recurrent wheezing. This association may reflect an underlying predisposition to reactive airway disease rather than a direct consequence of RSV infection.
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Almost all children are infected at least once by 2 years of age, and reinfection throughout life is common. Older children and adults usually develop upper respiratory tract illness but also can develop more serious lower respiratory tract infection. Exacerbation of asthma or other chronic lung conditions may occur.
ETIOLOGY: Respiratory syncytial virus is an enveloped RNA paramyxovirus that lacks neuraminidase and hemagglutinin surface glycoproteins. Two major subtypes (A and B) have been identified and often circulate concurrently. The clinical and epidemiologic significance of strain variation
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