Mrs. Clay, a young mom of a cute but tired looking 3-year-old boy, was relating the recent chain of events that had landed her son, Tommy, in our office after five days of symptoms.
“He’s really just been moving a little slower than usual and not eating or drinking as much … and he’s kept a fever for a few days. Oh, and I noticed he seems to be breathing a bit quicker than usual, and just seems tired. Other than that just cold symptoms with a runny nose and a cough. Finally I decided to bring him in to be checked.”
Tommy looked deceptively OK. He just sat rather placidly on the exam table waiting for me to check him over. He didn’t look like he was in any particular distress. When I listened to his lungs there were no crackles or wheezes, just normal breath sounds. But those breath sounds were at a rate of almost 60 breaths per minute — two to three times the normal rate for him. And his oxygen level from the pulse oximeter was an even 90 percent when a healthy 3-year-old should be in the high 90s. It was all enough to convince me he needed a chest X-ray. Sure enough, the X-ray showed pneumonia on both sides. That made my next decision easier — next stop, Children’s Hospital in Knoxville for what ended up being a two-day hospital stay for supportive treatment.
The cause of Tommy’s pneumonia was respiratory syncytial virus (RSV). During these days when we are seeing schools close due to illnesses, we are seeing flu, strep, flu-like viruses, and yes, RSV. RSV is the leading cause of lower respiratory tract infections (think pneumonia, and a wheezing condition called bronchiolitis) in infants and young children. In the U.S. each year, 4-5 million children younger than 4 years old acquire an RSV infection, and more than 125,000 are hospitalized.
Symptoms of RSV infection may include fever, cough, rapid breathing, shortness of breath, fatigue, wheezing and other abnormal lung sounds. In young infants, apnea and cyanosis (turning bluish) may occur. Of course with any of these symptoms at a significant level it would be wise to have a child examined, their lungs listened to, and their oxygen level checked. When appropriate, there is a fairly easy in-office test that can be done to confirm or rule out RSV.
When it comes to treatment, it is mainly supportive — keeping them hydrated, making sure they are not getting exhausted with their breathing, being sure they are maintaining a good oxygen level. Those who have more severe cases are the ones who end up in the hospital on IV fluids and oxygen. There are also some rather rarely-used meds and preventives used primarily on the very young or those with congenital heart and lung conditions. Otherwise, bronchodilators help only a few and most of the other treatments such as steroids haven’t really proven themselves in studies. So all-in-all, treatment is mostly to support the patient while their body fights off this rather miserable virus.
Infants hospitalized for RSV are at higher risk for subsequent wheezing and abnormal pulmonary function and this increased risk may persist for up to 10 years or longer. RSV’s role in causing subsequent reactive airway disease (asthma) remains controversial. By age 3 almost all children have had at least one episode of RSV. It is primarily in those well under a year of age that the illness can, rarely, be life-threatening.
Unfortunately recurrent infection can occur and usually produces illness lasting seven-10 days rather than the typical three-four day illness caused by most colds. Even the elderly can get severe RSV infections and November through February tends to be peak RSV season in Tennessee. So if those respiratory symptoms seem a bit worse or are dragging on longer than expected, best to get them checked out and see if those three letters, RSV, have gotten you.