Clinical Presentation

RSV typically begins with rhinorrhea and sometimes cough in infants. Within 1-3 days, cough often worsens and wheezing develops as lower airways become involved.

• Physical findings in bronchiolitis include:
  • Tachypnea
  • Wheezing
  • Retractions
  • Nasal flaring
  • Hypoxemia

Cough is usually persistent. Wheezing may initially be episodic but often becomes continuous as illness progresses. Hypoxemia is common and may not correlate with physical exam findings.

Fever is variable in RSV infection. A chest x-ray is often normal but may show hyperinflation and peribronchial thickening.

• Risk factors:
  • Prematurity
  • Chronic lung disease of prematurity
  • Congenital heart disease
  • Immunodeficiency
  • Age <6 months
  • Male gender
  • Tobacco smoke exposure
  • Daycare attendance
  • School-aged siblings
  • Low socioeconomic status
  • Crowded living conditions

The clinical presentation of RSV infection can range from a mild upper respiratory infection to severe bronchiolitis and respiratory failure.