respiratory syncytial virus (RSV)
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Etiology
- age is the single largest risk factor
- pneumonia in infants
- lower RSV-specific serum IgG & nasal IgA titers are associated with susceptibility to RSV in the elderly[9]
Epidemiology
- annual winter outbreaks (October-April)
- children & adults
- 90% of children are infected with RSV during the 1st 2 years of life[8]
- 22% of patients presenting with flu-like syndrome (vs 32% with culture &/or PCR-documented influenza)
- annual risks of 3-7% in healthy elderly vs 4-10% in high-risk elderly[2] (twice rate of influenza infection)
- 10% of elderly hospitalized for acute respiratory symptoms test positive for RSV
- 1 in 50 deaths among children < 5 years & 1 in 28 deaths in infants < 6 months of age globally.
- most people with RSV are contagious for 3-8 days[10]
- immunocompromised persons & some infants may transmit RSV for up to 4 weeks[10]
Pathology
- RSV infection is limited to the respiratory tract[10]
- inoculation of RSV occurs in upper respiratory tract epithelial cells
- spread of the virus down the respiratory tract occurs through cell-to-cell[10] transfer of the virus along syncytia from upper to lower respiratory tract[10]
- RSV viral load is correlated with the severity of disease[9]
- neutrophilic inflammation both upper tract & lower respiratory tract
- eosinophilic infiltration of the airways may occur
- rise in cytotoxic CD8 T-cells is associated with clearance of RSV
- clearance of virus from the upper resiratory tract is associated with RSV-neutralizing nasal IgA
- RSV replication continues in the airway for about 8 days
* Electron micrograph of respiratory syncytial virus[12]
Genetics
- negative single-stranded RNA virus
- enveloped, spherical virus with a diameter of approximately 150 nm
- filamentous forms also noted
- RNA-dependent replication cycle of RSV is error prone without a proofreading mechanism allowing single nucleotide polymorphisms (SNPs) & other mutations[9]
Clinical manifestations
- mean incubation period is 4-6 days with range of 2-8 days[10]
- flu-like syndrome
- rhinorrhea is common[3]
- tachypnea, intercostal & subcostal retractions[10]
- wheezing[10]
- cyanosis[10]
Laboratory
- RSV antigen in tissue
- RSV serology
- RSV RNA in nasopharyngeal swabs by RT-PCR
- RSV identified by culture
- see ARUP consult[2]
- RSV is a clinical diagnosis that does not necessarily require laboratory testing[10]
- non-specific testing
Complications
- mortality in hospitalized patients roughly equivalent to influenza (10%)[5]; however, patients who died with RSV sicker prior to infection[6]
- most common comorbidities were obesity, COPD, congestive heart failure, diabetes mellitus & immunocompromise[6]
Management
- supportive care
- aerosolized ribavirin is the only FDA-approved treatment
- palivizumab for prevention
- RSV-IgIV (RespiGam) formerly available prior to introduction of palivizumab
- investigational therapy
- a novel oral agent, GS-5806, that interferes with RSV entry by blocking viral-envelope fusion with the host-cell membrane reduces RSV viral load[7]
- Moderna introduces RSV vaccine 84% effective at preventing lower respiratory tract disease[13]
Notes
More general terms
Additional terms
- bivalent prefusion-stabilized F glycoprotein RSV vaccine; RSVpreF vaccine (Arexvy, Abrysvo)
- respiratory syncytial virus immune globulin
References
- ↑ Journal Watch 21(24):194, 2001 Zambon MC, Stockton JD, Clewley JP, Fleming DM. Contribution of influenza and respiratory syncytial virus to community cases of influenza-like illness: an observational study. Lancet. 2001 Oct 27;358(9291):1410-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11705487
- ↑ 2.0 2.1 2.2 Journal Watch 25(10):84, 2005 Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med. 2005 Apr 28;352(17):1749-59. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15858184
- ↑ 3.0 3.1 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ ARUP Consult: Respiratory Syncytial Virus - RSV The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/respiratory-syncytial-virus
- ↑ 5.0 5.1 Lee N et al. High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections. Clin Infect Dis 2013 Oct; 57:1069 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23876395 <Internet> http://cid.oxfordjournals.org/content/57/8/1069
- ↑ 6.0 6.1 6.2 6.3 McLellan JS et al. Structure-based design of a fusion glycoprotein vaccine for respiratory syncytial virus. Science 2013 Nov 1; 342:592 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24179220 <Internet> http://www.sciencemag.org/content/342/6158/546.1
- ↑ 7.0 7.1 DeVincenzo JP et al. Oral GS-5806 activity in a respiratory syncytial virus challenge study. N Engl J Med 2014 Aug 21; 371:711 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25140957 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1401184
Wright PF. Progress in the prevention and treatment of RSV infection. N Engl J Med 2014 Aug 21; 371:776 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25140965 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1407467 - ↑ 8.0 8.1 8.2 Ralston SL et al Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis Pediatrics. October 27, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25349312 <Internet> http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2014-2742.full.pdf+html
- ↑ 9.0 9.1 9.2 9.3 Griffiths C, Drews SJ, Marchant DJ Respiratory Syncytial Virus: Infection, Detection, and New Options for Prevention and Treatment. Clin Microbiol Rev. 2017 Jan;30(1):277-319. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27903593 PMCID: PMC5217795 Free PMC article
- ↑ 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 Bronze MS Fast Five Quiz: Respiratory Syncytial Virus (RSV). Medscape. Nov 8, 2022 https://reference.medscape.com/viewarticle/983643
- ↑ RSV in Adults https://www.rsvinadults.com
Older adults are at high risk for severe RSV infection. Centers for Disease Control and Prevention. Accessed June 23, 2022. https://www.cdc.gov/rsv/high-risk/older-adults.html - ↑ 12.0 12.1 Krilov LR, Steele RW Respiratory Syncytial Virus Infection. Medscape. Updated Nov 21, 2022 https://emedicine.medscape.com/article/971488-overview
- ↑ 13.0 13.1 Moderna. Jan 17, 2023 Moderna Announces mRNA-1345, an Investigational Respiratory Syncytial Virus (RSV) Vaccine, Has Met Primary Efficacy Endpoints in Phase 3 Trial in Older Adults. https://investors.modernatx.com/news/news-details/2023/Moderna-Announces-mRNA-1345-an-Investigational-Respiratory-Syncytial-Virus-RSV-Vaccine-Has-Met-Primary-Efficacy-Endpoints-in-Phase-3-Trial-in-Older-Adults/default.aspx
- ↑ Surie D, Yuengling KA, DeCuir J et al. Disease severity of respiratory syncytial virus compared with COVID-19 and influenza among hospitalized adults aged >= 60 years - IVY Network, 20 U.S. States, February 2022-May 2023. MMWR Morb Mortal Wkly Rep 2023 Oct 6; 72:1083. https://www.cdc.gov/mmwr/volumes/72/wr/mm7240a2.htm
Havers FP, Whitaker M, Melgar M, et al. Characteristics and outcomes among adults aged >= 60 years hospitalized with laboratory-confirmed respiratory syncytial virus - RSV-NET, 12 states, July 2022- June 2023. MMWR Morb Mortal Wkly Rep 2023 Oct 6; 72:1075. https://www.cdc.gov/mmwr/volumes/72/wr/mm7240a1.htm