Respiratory Syncytial Virus Infection Clinical Presentation

Updated: Aug 23, 2023
  • 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.