Respiratory Syncytial Virus Infection Clinical Presentation

Updated: Feb 25, 2019
  • Author: Leonard R Krilov, MD; Chief Editor: Russell W Steele, MD  more...
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History and Physical Examination

Patients with respiratory syncytial virus (RSV) infection may present with the following symptoms:

  • Fever (typically low-grade)

  • Cough

  • Tachypnea

  • Cyanosis

  • Retractions

  • Wheezing

  • Rales

  • Sepsislike presentation or apneic episodes (in very young infants)

Physical examination of the infant with RSV lower respiratory tract infection (LRTI) reveals evidence of diffuse small airway disease. On inspection, the characteristic examination findings are the presence of rhinorrhea, tachypnea, intercostal and subcostal retractions. Nasal flaring and tracheal tugging may be present in severe cases of bronchiolitis. On auscultation, the presence of coarse or fine crackles (rales) are typical, sometimes associated with prolonged expiratory phase.

The course of bronchiolitis varies and may require serial observations to adequately assess illness acuity. The decision to hospitalize an infant with RSV infection can be challenging. Among the more consistent and reliable findings in severe RSV disease are decreased oxygen saturations; thereby hypoxia (oxygen saturation ≤ 90 %) in an infant should be considered an indication for further inpatient monitoring. Rapid fluctuations in clinical manifestations are characteristic of RSV, thereby serial assessments either in the office or the hospital settings are helpful.



Infants hospitalized for RSV LRTI in infancy are at higher risk for subsequent wheezing and abnormal pulmonary function tests than age-matched control subjects who did not have such an admission, and this increased risk may persist for up to 10 years or longer.

RSV’s role in causing subsequent reactive airway disease remains controversial. Several small studies have suggested that infants who are hospitalized with RSV infection and treated with ribavirin have better pulmonary function on follow-up than infants who are not. If this finding is confirmed, it should help elucidate the link between RSV LRTI in infancy and subsequent reactive airway disease. Analyses comparing recipients of RSV prophylaxis with nonrecipients may also help answer this clinically important question. [12, 13]

A study by Kitsantas et al that included the records of 1,542 infants reported that approximately 10% of the children developed asthma and more than 9% developed hay fever or respiratory allergy by age 6. [14]