Is clinical recognition of respiratory syncytial virus infection in hospitalized elderly and high-risk adults possible?

J Infect Dis. 2007 Apr 1;195(7):1046-51. doi: 10.1086/511986. Epub 2007 Feb 15.


Background: The clinical and radiographic features of respiratory syncytial virus (RSV) infection in elderly hospitalized persons have not been described in detail, to our knowledge, despite its relative frequent occurrence.

Methods: Clinical characteristics of 132 RSV infections were compared with 144 influenza A virus infections and with all non-RSV infections in elderly and high-risk persons admitted to the hospital with acute respiratory illness. Radiographic findings were categorized for RSV-infected persons.

Results: RSV was more commonly associated with nasal congestion (68% vs. 55%; P=.03), wheezing by history (73% vs. 53%; P=.002) and on examination (82% vs. 68%; P=.02), and lower temperature (P=.004) than influenza A virus. Compared with all non-RSV-infected subjects, nasal congestion (odds ratio [OR], 2.0 [95% confidence interval {CI}, 1.3-2.9]), wheezing on examination (OR, 1.8 [95% CI, 1.2-2.8]), and temperature >37.9 degrees C (OR, 1.6 [95% CI, 1.1-2.4]) were independent predictors of RSV infection, although their sensitivity and specificity were poor. New radiographic infiltrates were seen in approximately half of RSV-infected persons, and pneumonic opacities were typically small and unilateral.

Conclusions: Although RSV causes a different clinical syndrome than influenza A virus, it is not readily differentiated on clinical grounds from influenza A nor from all non-RSV illnesses in elderly patients.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Health Services for the Aged
  • Hospitalization / statistics & numerical data
  • Humans
  • Influenza A virus
  • Influenza, Human / diagnosis
  • Male
  • Middle Aged
  • New York / epidemiology
  • Predictive Value of Tests
  • Radiography
  • Respiratory Syncytial Virus Infections / diagnosis*
  • Respiratory Syncytial Virus Infections / diagnostic imaging
  • Respiratory Syncytial Virus Infections / epidemiology
  • Respiratory Syncytial Virus Infections / etiology
  • Respiratory Syncytial Virus Infections / pathology
  • Respiratory Syncytial Viruses / isolation & purification*
  • Sensitivity and Specificity
  • Severity of Illness Index