We often think of RSV as primarily a pediatric disease. For those of us who practice pediatrics alongside internists in a rural hospital, we find a curious mindset about infection control, where nursing believes RSV infection control has no meaning for adult care on the floor.
Last year, we experienced the worst RSV season since we have had pediatrics in our facility (about six years). This was associated with a high rate of HIB coinfection, among other pathogens, that precipitated a brief collapse of our county's pediatric inhouse care capacity due to the need to tranfer multiple children to an ICU that was hundreds of miles away.
Last week after conferring with adult critical care intensivists in a nearby small city, we discovered that during the same time, they admitted three (!) adult patients who presented with RSV pneumonia that degenerated to ARDS / full ventilatory support. It is crucial to note that RSV ARDS in adults is associated with an astounding 40-60% mortality.
So, this post is to offer up what little is in PubMed regarding this important diagnostic consideration:
Am J Med Sci. 1988 Mar;295(3):218-22.Respiratory syncytial virus infection: a cause of respiratory distress syndrome and pneumonia in adults.Zaroukian MH, Kashyap GH, Wentworth BB.Source
Department of Medicine, College of Human Medicine, Michigan State University, East Lansing 48824-1315.
Respiratory syncytial virus (RSV) infection, an important and sometimes lethal disease of infants and children, generally causes a milder and self-limited syndrome of cough, nasal congestion and fever in adults. While some evidence suggests that RSV may be responsible for more serious respiratory illness in the elderly and chronically ill, it has not been shown to cause life-threatening respiratory tract disease in previously healthy adults. This report describes a previously healthy woman who experienced the acute onset of right lower lobe pneumonia which rapidly progressed to the adult respiratory distress syndrome (ARDS). Acute and convalescent serology showed RSV was the cause of the respiratory tract illness. Michigan Department of Public Health records revealed six additional cases of adult bilateral pneumonia with diagnostic antibody titers to RSV, with or without coinfection with a second organism. These data suggest that RSV may be an under-recognized cause of lower respiratory tract disease in adults.
PMID:3354594 [PubMed - indexed for MEDLINE]
Arch Bronconeumol. 2011 Jun;47(6):315-7. doi: 10.1016/j.arbres.2010.12.002. Epub 2011 Mar 21.Inhaled ribavirin therapy in adult respiratory syncytial virus-induced acute respiratory distress syndrome. [Article in English, Spanish]Luo YH, Huang CY, Yang KY, Lee YC.Source
Department of Chest Medicine, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taiwán.
Respiratory syncytial virus (RSV) infection-induced acute respiratory distress syndrome (ARDS) in previously healthy adults is rare, but the overall mortality rate is 40-60%. Inhaled ribavirin is approved for the treatment of hospitalized infants and young children with severe lower respiratory tract infections due to RSV. We present the case of an adult female with RSV pneumonia-induced ARDS who was successfully treated with inhaled ribavirin and whose pulmonary function was restored to near normal. The role of inhaled ribavirin in adults is controversial, but it might have a therapeutic potential for severe RSV infection-induced ARDS in adults.
James M. Wilson V, M.D.
Delta County Memorial Hospital
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