Infect > Viral > RSV

Respiratory Syncytial Virus

Clinical:

RSV is a common cause of bronchiolitis and pneumonia in children and adults [1]. It is also the most common cause of lower respiratory tract infection in infants [2]. RSV is the most common viral pathogen in children hospitalized for community-acquired pneumonia in the US [5]. Infection is common is the winter and early spring [1] and children younger than 5 are more prone to infection than older children [5]. Patients present with fever, cough, dyspnea, and otalgia [1]. In immune competent adults the infection usually produces rhinorrhea, pharyngitis, cough, bronchitis, headache, fatigue, and fever [2]. In immunocompetent patients, the course is usually self limited [1]. The infection can be more severe and life-threatening in immune compromised patients particularly in hematopoietic stem cell transplant patients and those with hematologic malignancies [2]. RSV can be an important illness in elderly adults with COPD accounting for approximately 11% of hospitalizations for pneumonia [4].

X-ray:

The majority of patients with RSV infection will have normal radiographic findings [1]. in children, findings can include central mpneumonia and peribornchitis [4]. In hospitalized adults findings include consolidations and ground glass opacity- most commonly unilateral and in a lower lung zone [4].

On CT, as RSV is known to predominantly cause the clinical syndrome of bronchiolitis the infection is typically characterized by evidence of airway inflammation with tree-in-bud opacities, bronchial wall thickening, and peribronchiolar consolidaiton [3].

In immunocompromised patients findings include diffuse ground-glass opacification, consolidation, and tree-in-bud opacities [1].

REFERENCES:

(1) AJR 2005; Miller WT, Shah RM. Isolated diffuse ground-glass opacity in thoracic CT: causes and clinical presentations. 184: 613-622

(2) Radiology 2011; Franquet T. Imaging of pulmonary viral pneumonia. 260: 18-39

(3) AJR 2011; Miller WT, et al. CT of viral lower repiratory tract infections in adults: comparison among viral organisms and between viral and bacterial infections. 197: 1088-1095

(4) AJR 2014; Wong SSm, et al. Initial radiologic features as outcome predictor of adult respiratory syncytial virus respiratory tract infection. 203: 280-286

(5) Radiographics 2018; Koo HJ, et al. Radiographic and CT features pf viral pneumonia. 38: 719-739

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