Abstract
BackgroundOnce considered primarily a pediatric concern, respiratory syncytial virus (RSV) infection is gaining recognition as a cause of significant morbidity and mortality in adults. A better understanding of RSV epidemiology and disease in adults is needed to guide patient management and to assess the need for prophylaxis, vaccines, and treatments.MethodsWe conducted a retrospective cohort study of adults admitted to four hospitals in Toronto, Canada, between September 2012 and June 2013 with RSV identified by a qualitative real-time reverse-transcriptase polymerase chain reaction assay in nasopharyngeal swab or bronchoscopy specimens. Main outcomes were hospital length of stay, need for intensive care unit (ICU) or mechanical ventilation, and all-cause mortality.ResultsEighty-six patients were identified as requiring hospitalization for RSV infection (56% female). Median age was 74 (range 19–102) years; 29 (34%) were < 65 years. Eighty-three (97%) had underlying chronic medical conditions; 27 (31%) were immunosuppressed, and 10 (12%) known smokers. The most common symptoms and signs were cough in 73 (85%), shortness of breath in 68 (79%), sputum production in 54 (63%), weakness in 43 (50%), fever in 41 (48%), and wheezing in 33 (38%). Lower respiratory tract complications occurred in 45 (52%), cardiovascular complications occurred in 19 (22%), and possible co-pathogens were identified in 11 (13%). Sixty-seven (78%) were treated with antibiotics and 31 (36%) with anti-influenza therapy. Thirteen (15%) required ICU care and 8 (9%) required mechanical ventilation. Five (6%) died during hospitalization. Need for ICU and mechanical ventilation were associated with mortality (P ≤ 0.02). Median hospital length of stay was 6 days (mean 10.8 days).ConclusionsRSV infection is associated with the need for extended hospital stay, ICU care and mortality in adults of all ages with chronic underlying conditions. Presenting signs and symptoms are nonspecific, co-infections occur, and patients often receive antibiotics and anti-influenza therapy. There is need for ongoing research and development of RSV prophylaxis, vaccines and treatments for adults.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0665-2) contains supplementary material, which is available to authorized users.
Highlights
Once considered primarily a pediatric concern, respiratory syncytial virus (RSV) infection is gaining recognition as a cause of significant morbidity and mortality in adults
Six patients met criteria for hospital-acquired infection and three patients presented with RSV infections unrelated to the reason for hospitalization (1 each admitted for reactivation of tuberculosis, pulmonary embolism, and lung cancer with hemoptysis)
Eighty-six adult patients were identified with RSV infection requiring hospitalization and are included in the analysis
Summary
Once considered primarily a pediatric concern, respiratory syncytial virus (RSV) infection is gaining recognition as a cause of significant morbidity and mortality in adults. RSV was long thought to cause primarily mild upper respiratory tract infections. A prospective study of RSV infections in previously healthy working adults aged 18–60 found that 26% had LRTI symptoms and 38% required time away from work during their illness [4]. In studies of previously healthy military recruits, 11-14% with respiratory symptoms were found to have RSV and most were unwell enough to require time away from duty [26,27]. Healthy adults have been shown to have altered airway reactivity for weeks following RSV infection [29]
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