Respiratory syncytial virus infections--an underdiagnosed entity?

Abstract

In this issue of INFECTION we publish two papers which report interesting clinical and epidemiological features of respiratory syncytial virus (RSV) infection in children [1, 2]. Among children admitted to the hospital with symptoms of respiratory tract infection, nasopharyngeal aspirates yielded the diagnosis of RSV infection in 16.2% [2]. Approximately 70% of the cases were identified in children younger than 1 year. Infections were most frequently diagnosed during the winter months with some variations of peak prevalences. In some seasons the majority of cases were observed early (fall season), whereas in other seasons, the number of cases was higher towards spring. Resch et al. [1] also report a relatively high prevalence (21%) of RSV infection in hospitalized children below the age of 2 years with a peak in March during one season. RSV infection resulted in significant morbidity and prolongation of hospital stay, mainly in preterm-born children and children with congenital heart disease [1]. While these studies emphasize the frequency and importance of RSV infection especially among young children, they only deal with one part of the spectrum of RSV infections. Recently published studies provide additional interesting insight into the role of RSV in the pathogenesis of acute and chronic respiratory tract infections.Among patients of all ages presenting with influenza-like illnesses, RSV was identified from 480 and influenza virus from 709 swabs of a total of 2,226 nasopharyngeal swabs [3]. RSV was therefore found to be the causative agent in 20% of influenza-like illnesses [3]. As Simoes [4] points out in his comment on this study, this viral infection requires increased attention and additional efforts are needed to develop standardized methods for the rapid detection of low concentrations of virus in clinical specimens. The results of two studies addressing the role of RSV in patients with chronic lung disease lend further support to the argument that RSV should be considered an important pathogen in all age-groups. Seemungal et al. [5] report an association of RSV detection and higher inflammatory marker levels, raising the question of a role of RSV infection in acute exacerbations of chronic obstructive pulmonary disease.This hypothesis gains increased importance by the finding that RSV infection was associated with an increased number of deaths in persons older than 65 years with chronic lung disease [5]. These studies and several others shed new light on the role of RSV in health and disease. There are still many issues which require further study. Publication of the two articles by Resch and Weigl, respectively, in our journal aims to raise awareness of this important virus among readers and might stimulate further research in this field.