- In more temperate climates, the epidemics come in the ‘wet’ season
- Prognosis is good, but it does carry a mortality (~1%)
- Highly Infectious
- A single-stranded RNA virus
- In adults, and older children, RSV only causes coryzal, and sometimes, flu-like symptoms.
- Almost all children will have been infected at some stage by the age of 2
- Often, infants catch the virus from older siblings, who bring it home from school, or they catch it directly themselves in environments with lots of children present.
- Spread trough viral shedding, via coughing and sneezing. It can also live on surfaces and clothes outside the body for up to 5 hours.
- Other causes include parainfluenza, virus, influenza virus and adenoviruses
- Annual incidence is about 11% of those <12months
- Usually occurs between Nov and April, with peak in Jan and Feb
- Dry cough
- Increasing breathlessness (often RR >50), may include Rib recession
- Cough may continue for 1-2 weeks
- Wheezing may/may not be present
- Difficulty feeding – due to dyspnoea – is the main reason for admission
- Symptoms often worse at night
- Symptoms tend to be worse the younger the child. Children >” are rarely seriously ill, whilst those <^ months are at the greatest risk.
Signs and Symptoms of severe disease
- Sharp, dry cough
- Chest hyperinflation
- Liver displaced downwards
- Prominent sternum
- Subcostal recession
- Intercostal Recession
- Prolonged expiration
- End-respiratory crackles on auscultation
- RSV – can be easily tested for with nasopharyngeal mucous secretions.
- X-ray – usually shows hyperinflation
- Blood gases – low O2, raised CO2.
There is no specific treatment. The management is essentially supportive, and in many cases, will not require hospitalisation.
- Signs that suggest severe disease: lethargy, cyanosis, co-existing illness (e.g. immunodefiency, congenital heart defects)
- Oxygen – Delivered by nasal specs, head box, or in the smallest infants, tent. The amount of O2 is determined by pulse oximetry and blood gas results.
- Steroids and antibiotics should not be given! (no evidence) – although they often are used
- Bronchodilators via nebuliser are often used, but are not of proven benefit.
- Mist is not of proven benefit and should not be administered
- Fluids – can be given IV or by NG tube.
- Mechanical ventilation – is needed in about 2% of cases.
- Very low FEV1 (<21% of normal)
- Dry cough
- There is very little treatment. Some cases may improve with a lung transplant.
- There are many causes, not just RSV infection in childhood, often including occupational lung disease.
- Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
- Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
- Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy