Respiratory Syncytial Virus Infection Clinical Presentation

Updated: Oct 17, 2017
  • 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. As many as 40% of children have an associated otitis media, which may be viral, bacterial, or both. Additionally, assessment of the infant’s hydration status (eg, by evaluating skin turgor, capillary refill, and mucous membranes) is an important part of the physical examination of the infant with bronchiolitis.



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]