Respiratory syncytial virus infection

Case history

A 6-month-old, previously well, female infant presents in midwinter with a 3-day history of rhinorrhoea, cough, and malaise. Several other school-age children in the home also have respiratory symptoms. The infant has a temperature of 38.5°C (101.2°F), respiratory rate of 70 breaths per minute, and oxygen saturation of 85% on room air. She has nasal flaring, head bobbing, and suprasternal and intercostal retractions. Auscultation reveals bilateral wheeze with prolonged expiration. The infant's work of breathing improves mildly with nasal suctioning, and her oxygenation improves with warm, humidified oxygen through nasal cannula, but there is no improvement with nebulised salbutamol.

Other presentations

Respiratory syncytial virus (RSV) bronchiolitis or pneumonia may produce severe respiratory distress as well as low-grade fever, persistent cough, and malaise. High-risk infants, such as those with prematurity, chronic lung disease, complex congenital heart disease, or immune deficiency, are more likely to present with severe disease.

Apnoea is a common complication, especially in very young infants, and may be the presenting sign. Laryngotracheobronchitis, commonly called croup, is another possible presentation of RSV and should be managed as any other viral cause of croup would be.