Microbiology
A virus.
Epidemiologic Risks
Winter/spring outbreaks in children under 5. They get it from their parents and older siblings (PubMed).
Adults are usually reinfection with pre-existing immunity to the disease is milder than kids but still nasty as URIs go with a 9-day illness, lower shedding and often is exacerbating underlying disease.
Often shows up when testing for influenza; sputum and nasal are both good specimens.
Syndromes
Pneumonia, bronchiolitis, tracheobronchitis, or upper respiratory tract with fever and otitis media. In adults, it has a high mortality (PubMed).
In the elderly may be worse than influenza (Pubmed).
Incubation time is around 5 days, it is spread by direct contact.
It can cause nursing home outbreaks with 90% attack rates and may kill 11,000 elderly a year. Bacterial superinfection occurs a third of the time.
In the transplant patient, it often progresses and the patient often dies. Cold symptoms and sinusitis are hints.
The risk of MI goes up with acute viral pneumonias: Influenza > RSV > other viri (PubMed), especially during the first week of infection.
Treatment
Aerosolized ribavirin is the traditional treatment and is VERY expensive, over $20,000 a vial, thank you very much Valeant Pharmaceuticals. But does decrease mortality in the transplant patient. Giving aerosolized is also a real pain, but could give po or iv.
And most of the data suggests the po ribavirin is just as good (PubMed) as iv, even in bone marrow transplant patients at a fraction of the cost (PubMed).
Oral ribavirin has been tried in a variety of hosts like lung transplant with maybe efficacy (PubMed)(PubMed).
There is also IVIG and a monoclonal RSV antibody, Palivizumab, used in kids.
Notes
On the bright side, this disease is disappearing thanks to global warming (PubMed). Always look on the bright side of life (Reference).
Curious Cases
Relevant links to my Medscape blog
Ra's al Ghul was not so far off
Last Update: 07/20/19.