Respiratory Syncytial Virus (RSV) is a virus that causes respiratory illnesses, most commonly in infants and young children. It can be highly contagious and is spread easily through respiratory droplets (sneezing and coughing especially). It typically is worse during the winter months, and like other viruses will “surge” in specific locations over a matter of 1-3 months.
RSV is the leading cause of respiratory illnesses in infants and children under the age of five. RSV can cause mild to severe symptoms, and can even require hospitalization in some cases. In fact, RSV is also the leading cause of hospitalization in the United States for all infants.
Common symptoms of RSV include a runny nose, coughing, wheezing, and difficulty breathing. In some cases, fever, sore throat, and reduced appetite may also be present. Some of these symptoms can also be signs of other illnesses, so it is important for the provider to assess the patient carefully and consider any other medical history or risk factors before making a final diagnosis.
The first step in evaluating and diagnosing RSV is to assess the patient’s age. Children most at risk for severe symptoms of RSV are infants less than 6 months of age. Specifically, for neonatal patients, there is a risk of hypoxia (low oxygen levels) or even sudden death. That is why viral testing for RSV when a neonate is displaying symptoms can be critical.
For children above the age of 5, RSV may cause symptoms consistent with a common cold, but almost never causes life threatening symptoms of shortness of breath, wheezing or hypoxia (unless the child has a medical issue that predisposes them to severe lung infections. For this reason, viral testing for RSV is not typically performed for children 5 years and up or for adults.
At ContinuEM, we use a rapid nasal swab to see if a patient has RSV. Often, we check for a variety of viruses at the same time, including Influenza and COVID as the symptoms of these different viruses can be very similar. This will help us risk stratify the patient and assist with treatment. Blood tests can also be used to look for antibodies that indicate a previous exposure to the virus, however, the nasopharyngeal swab is much faster and much more helpful in diagnosing active infection.
Once the diagnosis of RSV has been confirmed, treatment can begin. For mild cases of RSV, the main focus of treatment is symptom management. This can include over-the-counter medications to reduce fever and pain, as well as cough and cold medicines to reduce congestion. It is important to note that antibiotics should not be used to treat RSV, as they are not effective against the virus.
For more severe cases of RSV, and especially for the youngest patients, hospitalization may be necessary. In these cases, the patient may need to be monitored closely and provided with supplemental oxygen. Intravenous fluids and medications to reduce inflammation and improve breathing may be used, though this is typically reserved for the inpatient setting.
Finally, it is imperative that families and close contacts of a patient with RSV follow good hand-washing and try to not share utensils or glasses as the virus can be highly communicable, especially for pediatric patients.
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