eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Respiratory Syncytial Virus (RSV) Infection: Differential Diagnoses & Workup

Author: Leonard R Krilov, MD, Chief of Pediatric Infectious Diseases, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital
Contributor Information and Disclosures

Updated: Jul 27, 2009

Differential Diagnoses

Asthma
Human Metapneumovirus
Bronchiolitis
Influenza
Bronchitis, Acute and Chronic
Neonatal Sepsis
Croup
Pneumonia

Other Problems to Be Considered

Reactive airway disease

Workup

Laboratory Studies

  • Laboratory studies frequently are not indicated in the infant with bronchiolitis who is comfortable in room air, well hydrated, and feeding adequately.
  • Nonspecific laboratory studies may include CBC count, serum electrolytes, urinalysis, and oxygen saturation measurement. The CBC count may reveal a normal or mildly elevated WBC count and an elevated percentage of band forms. Blood cultures, although obtained frequently, are rarely positive for pathogenic bacteria.
  • An arterial blood gas may be indicated if carbon dioxide retention is a concern.
  • Specific diagnostic tests for confirmation of respiratory syncytial virus (RSV) infection are readily available. These tests can be performed on samples of secretions obtained by washing, suctioning, or swabbing the nasopharynx. Secretions can be analyzed for virus in the laboratory by culture and/or antigen revealing techniques. Newer molecular probes for revealing RSV in clinical specimens are being developed and may be more sensitive than the above assays, although they are not routinely available at this time.
  • The antigen detection methods offer the potential for diagnosis within hours and may be obtained reliably in the absence of a sophisticated virology laboratory. However, monitoring of test performance is critical in maintaining appropriate sensitivity and specificity. Specific tests for RSV may be indicated for making decisions regarding therapy (eg, withdrawal of unnecessary antibiotics), isolation of patients, and in educating parents and staff about the nature of RSV disease.

Imaging Studies

  • Chest radiography is frequently obtained in children with severe RSV infection.
  • Chest radiography typically reveals hyperinflated lung fields with a diffuse increase in interstitial markings.
  • In 20-25% of cases, focal areas of atelectasis and/or pulmonary infiltrate are also noted.
  • Generally, these findings are neither specific to RSV infection nor predictive of the course or outcome, except for the observation that infants who have the additional findings of atelectasis and/or pneumonia may have a more severe course with their illness.

Histologic Findings

  • In infants who have died from RSV bronchiolitis, lung tissue demonstrates mononuclear cell and neutrophil infiltration of the peribronchiolar areas, necrosis of the small airway epithelium, plugging of the lumens with exudate and edema, and atelectasis and hyperinflation.

More on Respiratory Syncytial Virus (RSV) Infection

Overview: Respiratory Syncytial Virus (RSV) Infection
Differential Diagnoses & Workup: Respiratory Syncytial Virus (RSV) Infection
Treatment & Medication: Respiratory Syncytial Virus (RSV) Infection
Follow-up: Respiratory Syncytial Virus (RSV) Infection
Multimedia: Respiratory Syncytial Virus (RSV) Infection
References
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References

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Further Reading

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Keywords

respiratory syncytial virus infection, RSV, bronchiolitis, viral pneumonia, lower respiratory tract infection, LRT infection, upper respiratory tract infection, URT infection, chimpanzee coryza agent, Rs virus, asthma, otitis media, bone marrow transplantation, chronic lung disease of infancy, bronchopulmonary dysplasia, congenital heart disease, reactive airway disease, prematurity, severe combined immunodeficiency, SCID, atelectasis, pneumonitis, treatment, diagnosis

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Contributor Information and Disclosures

Author

Leonard R Krilov, MD, Chief of Pediatric Infectious Diseases, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital
Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Medical Editor

Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital
Ashir Kumar, MBBS, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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