RS virus

RS virus: description

The term RS virus (or RSV) stands for the English term respiratory syncytial virus: It is a virus that leads in the respiratory tract (respiratory tract) to the fusion of cells (syncytia). The pathogen is similar to the flu virus and occurs worldwide. There is a seasonal accumulation of outbreaks: in Europe, most people fall ill with RS virus between November and April, most often in January and February.

RS virus: baby and toddler often affected

In principle, people of any age can get sick by the RS virus. But it is more common for toddlers. Infection with the RS virus is the leading cause of hospital treatment for respiratory disease in infants and toddlers. Especially in premature babies and infants, the disease can take a difficult course. In premature babies with lung damage or children with heart defects, RSV infection is even fatal in any of 100 cases.

About 50 to 70 percent of all children develop at least once during their first year of life from an RS virus infection. After the second year of life, almost all children have already undergone an RS virus infection. Girls and boys are equally affected. However, the risk of a severe course is twice as high for boys than for girls.

RS virus: highly infectious

The RS virus is considered highly infectious. This means that it is very easy to be infected with patients. When the RS virus enters the hospital, the risk of infection for patients and staff at the ward is high. Therefore, patients with RS virus should be isolated to prevent the spread of the disease. The RS virus is considered to be the most common child-borne infection in the hospital.

RS virus: symptoms

The symptoms of RSV infection can vary widely from patient to patient. Adults who are otherwise healthy often have no complaints. Then doctors speak of asymptomatic or clinically silent RSV infection. In addition, RS virus disease can be mild. Then patients have cold-like symptoms like

• sniff
• dry cough
• Sneeze
• Sore throat

RSV bronchiolitis

Especially in infants, RSV infection may affect the upper respiratory tract (nose, mouth, throat) as well as the lower respiratory tract (bronchi and lungs). This is called RSV bronchiolitis. Often, their symptoms appear one to three days after the onset of the disease: In addition to fever, it comes to breathing difficulties, which can be expressed as follows:

• accelerated breathing
• Rattle sounds and wheezing while breathing audible
• Cough with expectoration
• heavy breathing with the use of respiratory muscles (supporting the arms)

The clinical picture may remind of whooping cough. In addition, there is a high fluid loss. He expresses himself by:

• dry, cold and pale skin
• sunken fontanelle in children under 18 months

In addition, general signs of illness can be observed such as weakness, malaise, lack of appetite and refusal to drink. The symptoms of RSV infection can get worse in a few hours. In premature babies, respiratory arrest (apnea) may occur repeatedly.

RS virus: causes and risk factors

The RS virus consists of a protein envelope that encloses the genetic information (RNA). It multiplies in the superficial cells of the mucous membranes lining the respiratory tract. In the virus envelope is anchored a special protein, the fusion (F -) protein. It causes a fusion of cells (syncytium formation) in the affected mucous membranes. These syncytia and invading immune cells damage the mucous membranes. The dead cells then move the airways.

RS virus: transmission

The RS virus occurs only in humans. It is transmitted via droplet infection, for example by sneezing or coughing, when the virus enters the nasal or conjunctival membranes. Even a smear infection, for example, over contaminated toys or clothing is possible. The time between infection and the onset of the disease (incubation period) is two to eight days, on average five days. A patient is contagious (infectious) for about three to eight days from the first day after the RSV infection.

RS virus: risk factors

In some cases, infection with RS viruses is difficult. This affects above all people belonging to the following risk groups:

• Premature babies (have no nest protection by antibodies of the mother)
• Children with cystic fibrosis, pulmonary disease (bronchopulmonary dysplasia) or congenital heart disease
• Adults who suffer from heart or lung disease
• People whose immune system is weakened by illness or medication (such as AIDS patients, donor organ recipients, patients with malignant blood diseases)
• People with trisomy 21 (“Down syndrome”)

RS virus: examinations and diagnosis

If your child has flu-like symptoms, shortness of breath or high fever, visit the pediatrician with him. This first asks you in detail about the history of the disease (anamnesis). He will ask you the following questions:

• Since when does your child have a fever?
• Did your child have respiratory problems since being ill?
• Is your child drinking and eating enough?
• Is your child suffering from an underlying condition, such as heart disease or cystic fibrosis?

RS virus: physical examination

The doctor then thoroughly examines his patient. He lights up with a lamp in the mouth and in the ears to determine possible redness of the throat or ears. Then he scans the lymph nodes on the neck for possible enlargements and then hears the lungs with a stethoscope. An RSV bronchiolitis can be heard in the stethoscope as crackling and wheezing. Then the doctor looks at whether the fingernails or lips of the patient are bluish discolored (cyanosis) – an indication of insufficient oxygen in the blood (hypoxemia).

RS virus: diagnosis

It is not easy to distinguish a RS virus disease from other viral diseases of the respiratory tract. In addition to the clinical examination help the doctor the exact description of the symptoms and the age of the patient. In a smear of nasopharyngeal secretions, the RS viruses can be detected in the laboratory. Antibody detection in the blood is rarely possible because the body produces few antibodies against the RS virus.

RS virus: treatment

There is no causal (causal) therapy for RSV infection. Only the symptoms can be treated (symptomatic therapy). This includes:

• adequate hydration
• expectorant measures such as steam baths
• antipyretic measures such as calf wrap or the administration of ibuprofen or acetaminophen
• Keep nasopharynx free from flushing or nose drops
• Breathing support

RS virus: respiratory support

Depending on how difficult the patient’s breathing is, various methods can be used to facilitate breathing and to ensure that the patient receives enough oxygen. If your child gets a bad breath at home, you can lift up your upper body with the help of pillows. In addition, certain medicines (bronchodilators) such as salbutamol may dilate the airways. The patient inhales through an inhaler.

At the doctor or in the hospital, the patient can be given oxygen via a breathing mask when the oxygen level in the blood drops dangerously (below 94 percent). It may also be necessary to ventilate via a CPAP mask (continuous positive airway pressure) or a tube. If respiratory arrest (apnea) occurs in babies, they must be monitored in hospital.

RS Virus: Helping Medication?

Until a few years ago, children with severe RSV infection received the antiviral drug ribavirin. However, studies have shown that it is not effective. Also considered ineffective is cortisone (glucocorticoids, steroids) when inhaled. But if it is given systemically, in the form of tablets, it can improve the acute symptoms and shorten the duration of the disease. Antibiotics are not effective against the RS virus because they only help against bacteria and not against viruses. You may be prescribed if a bacterial infection occurs in addition to the RS virus infection.

RS Virus: Prevent

The best way to prevent RS virus infection is hygiene:

• Wash your hands often.
• Sneezing and coughing in the elbow and not in the hands.
• Clean children’s toys regularly.
• Diseased people should not visit community facilities.

Breastfeeding is also beneficial for infants: Breastfeeding children are less likely to suffer from respiratory diseases than bottle children.

There is no active RSV vaccine. For children with risk factors such as preterm infants with congenital heart disease, there is a passive vaccine. During the RSV season (November to April) monthly finished antibodies (palivizumab) are injected into a muscle that is directed against the envelope of the RS virus.

RS virus: disease course and prognosis

In general, the prognosis is good for an infection with the RS virus. Duration and severity of the disease are short and mild in otherwise healthy patients. Frequently, the RS virus disease heals by itself within a few days. The mucous membranes of the respiratory tract take about four to eight weeks to regenerate.

Severe courses mainly affect toddlers. Preterm babies, in particular, have a high risk of developing severe RSV infection in the first six months of life. This ends in about one percent of cases deadly despite intensive care.

RS virus: complications

A complication of an RS virus infection is the middle ear infection (acute otitis media). About 75 percent of all middle ear infections in children under the age of three are caused by RS viruses.

In addition, the RS virus can lead to hypersensitivity (hyperreactivity) of the respiratory tract, which can cause early childhood asthma. Not least, the infection with the RS virus can worsen existing diseases such as asthma.

RS virus: re-infection possible

The endured infection with RS viruses offers no long-term protection against re-infection. This lack of immunity is due to the fact that the body hardly produces antibodies to the RS virus. Reoccurrence, which is common in adults with close contact with infants, is usually less severe than that RS virus-Erstinfektion. Often she expresses herself by coughing, which lasts for several weeks.