When should you suspect Respiratory Syncytial Virus (RSV) infection in a patient?

When to Suspect Respiratory Syncytial Virus (RSV) Infection

RSV infection should be suspected when a patient presents with new onset of respiratory symptoms including cough, sore throat, shortness of breath, or coryza, particularly during the cold season (typically December through March), with consideration of epidemiological factors such as community outbreaks or contact with infected individuals. 1

Clinical Presentation

Common Symptoms

• Cough (present in 93% of cases) 1
• Nasal discharge/congestion (coryza) 1, 2
• Shortness of breath or dyspnea 1, 2
• Sore throat 1
• Fever (may not be present in all cases) 1, 2

Age-Specific Presentations

• Infants and young children:

  • Bronchiolitis (inflammation of small airways) 1, 3
  • Pneumonia 1, 3
  • Feeding difficulties 2
  • Apnea (particularly in premature infants) 1
  • May present as a Brief Resolved Unexplained Event (BRUE) 1

• Adults:

  • Often presents as upper respiratory tract illness 4
  • More severe presentations in elderly patients 1, 5
  • Sputum production 2
  • Wheezing 1

Seasonal and Epidemiological Considerations

• Suspect RSV during seasonal outbreaks, typically December through March in the Northern Hemisphere 1
• Consider RSV when there are known outbreaks in the community 1
• Higher suspicion warranted when there is epidemiological link to human-to-human transmission (contact with visitor, another patient, or healthcare worker) 1
• RSV follows community activity patterns with increased risk of community-acquired, household, and nosocomial transmission 1

High-Risk Populations

Maintain a higher index of suspicion in these vulnerable groups:

• Infants, especially those under 1 year of age 3, 6
• Premature infants 1, 6
• Elderly patients (≥65 years, particularly ≥75 years) 7, 8, 5
• Patients with chronic cardiac or pulmonary disease 1, 7, 8
• Immunocompromised individuals 1, 4
• Patients with hematological malignancies or post-HSCT (hematopoietic stem cell transplantation) 1
• Residents of nursing homes or long-term care facilities 7, 8

Diagnostic Approach

• Laboratory confirmation is recommended during RSV season for high-risk patients presenting with respiratory symptoms 1
• Consider testing when a patient meets the clinical criteria (new onset of symptoms with at least one respiratory symptom) and has an epidemiological link 1
• Nucleic acid amplification testing (NAT) is preferred due to higher sensitivity 1
• Direct virus antigen detection provides rapid results but has lower sensitivity (80-95%) 1
• Virus isolation by cell culture is considered standard but has longer turnaround time 1

Common Pitfalls to Avoid

• Not considering RSV in adults, especially elderly patients with respiratory symptoms during RSV season 5, 4
• Failing to test for RSV in immunocompromised patients with respiratory symptoms 1
• Assuming that absence of fever rules out RSV infection 1, 2
• Not implementing appropriate infection control measures when RSV is suspected, as it is highly contagious 1
• Overlooking RSV as a potential cause of apnea in infants, especially premature ones 1

Infection Control Considerations

• Implement contact isolation precautions when RSV is suspected 1
• Use gloves and gowns when entering the room of patients with suspected RSV 1
• Proper hand hygiene is essential to prevent transmission 1
• Restrict visitors with respiratory symptoms from accessing patients 1