Abstract
Background
Respiratory Syncytial Virus (RSV) has been recognized for over half a century as a
cause of morbidity in infants and children. Over the past 20 years, data has emerged linking RSV as a cause of illness in adults resulting in 177,000
annual hospitalizations and up to 14,000 deaths among older adults.
Objective
Characterize clinical variables in a cohort of adult RSV patients. We hypothesize
that emergency physicians do not routinely consider RSV in the differential diagnosis
(DDx) of influenza like illness.
Methods
Observational study of all adult inpatients, age ≥ 19, with a positive RSV swab ordered within 48 h of their hospital visit, including their emergency department (ED) visit, and who
initially presented to a university affiliated urban 100,000 annual visit emergency
department from 2007 to 2014. A data collection form was created, and a single trained
clinical research assistant abstracted demographic, clinical variables. ED providers
were given credit for RSV DDx if an RSV swab was ordered as part of the diagnostic
ED workup. Results: 295 consecutive inpatients (mean age = 66.5 years, range, 19–97, 53% male) were RSV positive during the 7-year study period. 207
cases (70%) were age ≥ 60. 76 (26%) had fever, 86 (29%) had O2sat <92% and 145 (49%) had wheezing. 279 patients required admission, 30 needed ICU stay
and overall mortality was 12 patients (4%). Age ≥ 60 was associated with overall mortality (p = 0.09). There were 106 (36%) immunocompromised patients (23% transplant, 40% cancer,
33% steroid use) in the cohort. A diagnosis of RSV was considered in the ED in 105
(36%) of patients. Being immunocompromised, having COPD/asthma, O2sat <92, or wheezing did not alert the ED provider to order an RSV test.
Conclusion
Adults can harbor RSV as this can lead to significant mobility and mortality, especially
in individuals who are over the age of 60. RSV is not being considered in the DDx
diagnosis, and this was especially surprising in the transplant/immunocompromised
subgroups. Given antiviral treatment options, educational efforts should be undertaken
to raise awareness of RSV in adults.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- An overview of respiratory syncytial virus.PLoS Pathog. 2014; e1004016https://doi.org/10.1371/journal.ppat.100
- Respiratory syncytial virus—United States, July 2012–June 2014.MMWR. 2014; 63: 1133-1136
- The burden of respiratory syncytial virus infection in young children.NEJM. 2009; 360: 588-598
- Respiratory syncytial virus-associated mortality in hospitalized infants in young children.Pediatrics. 2015; 135: e24-e31
- Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis.Lancet. 2010; 375: 1545-1555
- Respiratory syncytial virus (RSV) infection in elderly mice results in altered antiviral gene expression and enhanced pathology.PLoS One. 2014; 9e88764
- Impaired immune response to vaccination against infection with human respiratory syncytial virus at advanced age.J Virol. 2014; 88: 9744-9750
- Respiratory syncytial virus infection in elderly and high-risk adults.NEJM. 2005; 352: 1749-1759
- Respiratory syncytial virus and influenza a infections in the hospitalized elderly.J Infect Dis. 1995; 172: 389-394
- Respiratory syncytial virus infection in adults.Curr Opin Pulm Med. 2008; 14: 235-240
- Medically attended respiratory syncytial virus infections in adults aged greater than 50 years.Clin Infect Dis. 2014; 58: 342-349
- Influenza and RSV associated hospitalizations among adults.Vaccine. 2007; 25: 846-855
- Respiratory syncytial virus infection in elderly adults.Drugs Aging. 2005; 22: 577-587
- High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections.Clin Infect Dis. 2013; 57: 1069-1077
- Viral infection in adults hospitalized with community-acquired pneumonia: prevalence, pathogens, and presentation.Chest. 2008; 134: 1141-1148
- Mortality attributable to 9 common infections: significant effect of influenza a, respiratory syncytial virus, influenza B, norovirus and parainfluenza in elderly persons.J Infect Dis. 2012; 206: 628-639
- Estimates of Mortality Attributable to Influenza and RSV in the United States during 1997–2009 by Influenza Type or Subtype, Age, Cause of Death, and Risk Status. Influenza and Other Respiratory Viruses.8. 2014: 507-515
- Respiratory syncytial virus-and human metapneumovirus-associated emergency department and hospital burden in adults.Influenza Other Respi Viruses. 2014; 8: 347-352
- Viral pathogens in acute exacerbations of chronic obstructive pulmonary disease.Intern Emerg Med. 2008; 3: 355-359
- Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review.Influenza Other Respi Viruses. 2016; 10: 268-290
- Respiratory syncytial virus lower respiratory disease in hematopoietic cell transplant recipients: viral RNA detection in blood, antiviral treatment, and clinical outcomes.Clin Infect Dis. 2013; 57: 1731-1741
- Oral ribavirin therapy for respiratory syncytial virus infections in moderately to severely immunocompromised patients.Transpl Infect Dis. 2014; 16: 242-250
- Challenges and opportunities in developing respiratory syncytial virus therapeutics.J Infect Dis. 2015; 211: S1-20
Article Info
Publication History
Published online: June 11, 2017
Accepted:
June 10,
2017
Received in revised form:
June 8,
2017
Received:
July 27,
2016
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
