Published Date: 1997-09-03 23:50:00
Subject: PRO> Respiratory syncytial virus, adults
Archive Number: 19970903.1887

RESPIRATORY SYNCYTIAL VIRUS, ADULTS
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A ProMED-mail post
Date: Mon, 01 Sep 1997 13:34:41 -0400
From: Jonathan Trouern-Trend <jtrend@erols.com>
(Press release from Ohio State University)
Researchers have found that a respiratory virus common in children under the
age of two also afflicts previously healthy adults. The Ohio State
University research suggests that because doctors and hospitals do not
routinely test adults for [human] respiratory syncytial virus (RSV), [which
can cause] a form of viral pneumonia, they sometimes misdiagnose it as
bacterial pneumonia, which requires different treatment.
"Antibiotics for bacterial pneumonia don't work against RSV, so if we think
somebody has pneumonia and they really have RSV, we don't help them by giving
them standard antibiotics," said Andrew R. Murry, an Ohio State clinical
instructor of internal medicine.
When researchers scoured the medical records and blood tests of 1,195
pneumonia patients hospitalized between December 1990 and May 1992 in two
Ohio counties, they found that 57 of the patients (4.8%) actually had RSV.
"RSV has never been recognized as a serious problem for adults," said Murry.
"There is a great deal of information about adult RSV in medical literature,
but nobody has gone through it all and looked at it quite this way until now."
For a paper which appeared in a recent issue of the journal Hospital
Practice, Murry and Scott F. Dowell, a medical epidemiologist for the
Centers for Disease Control, pored over these medical records as well as the
results of other studies dating back to the 1960s. Murry and Dowell then
pieced together a set of symptoms that doctors can look for when examining a
patient for RSV.
Murry said the typical patient had experienced severe cold symptoms for a
week or two, then, despite taking antibiotics, developed a worse fever,
shortness of breath, or wheezing before entering the hospital. Some had
underlying medical problems such as heart disease or lung disease that were
exacerbated by the illness, but 8 of the 57 RSV-positive people were
previously healthy and less than 40 years old.
While 135 patients tested positive for RSV antibodies, only the 57 whose
level of antibodies quadrupled over the course of a month were considered
true cases of RSV for the study. In some patients, researchers noticed the
effects of bacterial infection, which indicates they might have acquired a
bacterial pneumonia along with or after RSV infection.
"Doctors used to think that adults who acquire RSV may get cold symptoms, not
pneumonia", said Murry. "But in fact, a third of the 57 RSV patients in this
study had changes in their lung X-rays which were probably RSV-related."
The RSV virus attacks the epithelial cells that line the airways in the
lungs. It spreads as people cough up infected epithelial cells, so hand
washing is the best way to limit the spread of RSV.
RSV is the leading cause of severe lower respiratory tract infection in
infants and young children. According to Murry, nearly every child in the
United States acquires RSV before the age of two, as their immune systems are
developing. Adults most vulnerable to infection are those who have undergone
chemotherapy or organ transplants, as well as those with HIV.
If a patient has a severe enough case of RSV to need the help of a breathing
machine, doctors can treat the infection with ribavarin, an anti-viral drug.
Doctors dissolve the drug in saline, and patients inhale it through a mist.
Symptoms of RSV persist even after the patient is discharged from the
hospital. "When people go home, it may be a while before they feel
completely better, because the damage to their airways will take at least 8
weeks to heal," said Murry. So they'll remain kind of wheezy and a little
short of breath for that time. Most people can go back to work as soon as
they go home from the hospital.
Murry said a normal person couldn't easily tell whether they have RSV or
just a nasty cold. One clue is the time of infection -- cases of RSV explode
across the United States only in winter. In summer, cases of RSV are
practically nonexistent.
In Ohio, most people catch RSV between November and April. In the
Southeastern United States, most people catch it in November or December. In
the Pacific Northwest, the peak infection time occurs in February. Doctors
aren't sure why the peak time varies by location.
Doctors may suspect a wheezing patient has RSV if the patient's white blood
cell count is normal. In the case of bacterial pneumonia, patients' white
blood cell counts increase to fight the infection. Patients with RSV
demonstrate a normal or only slightly elevated white blood cell count.
Murry said that once doctors and hospitals begin wider testing for RSV,
they can begin to prevent the disease from spreading to their
immunocompromised patients and people in the surrounding community.
"Anybody who is sick enough to be admitted to the hospital should be
routinely tested for RSV," said Murry. Patients feel reassured when they can
know what they have and that they're going to get better, and we can decrease
unnecessary antibiotic use.
---
Andrew R. Murry
TEL: (614) 293-8745
e-mail: <Murry.1@osu.edu>
[This virus is a member of the family Paramyxoviridae, subfamily
_Pneumovirinae_, genus _Pneumovirus_. Excellent antigen and antibody
detection ELISAs are available for RSV and might easily be made part of a
routine battery of assays. However, I wonder why adult respiratory disease
caused by RSV had not been detected previously. Even if only about 5% of
hospitalized adult pneumonia patients have RSV infection, at least those
could be treated with antivirals. I have a warm spot for RSV; I learned the
ins and outs of ELISA with RSV in the Virology Laboratory of the University
of Turku, Finland, under the expert tutelage of Dr. Pekka E. Halonen.
The message obviously was written for a nonscientific audience but I think
the points are made. --Mod CHC]
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