Is clinical recognition of respiratory syncytial virus infection in hospitalized elderly and high-risk adults possible?
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.
Walsh
Edward E
EE
Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14621, USA. edward.walsh@viahealth.org
Peterson
Derick R
DR
Falsey
Ann R
AR
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006299:Health Services for the Aged; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D009980:Influenza A virus; D007251:Influenza, Human / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011237:Predictive Value of Tests; D011859:Radiography; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index