RSV, or respiratory syncytial virus, is a very common respiratory virus that most children will have by the age of 2. It is the most common cause of bronchiolitis and pneumonia in children under 1 year of age in the United States. RSV infects the lungs and breathing passages, causing symptoms like runny nose, cough, fever, wheezing and decrease in appetite. For most children, RSV leads to mild, cold-like symptoms. But for some, especially infants and older adults, RSV can lead to severe infection requiring hospitalization and even be life-threatening. So what happens if you don’t treat RSV?
What is RSV?
RSV is a virus that infects the respiratory tract. The respiratory tract includes the nose, throat, larynx (voice box), trachea (windpipe), and bronchi (airways going to the lungs). RSV is very contagious and spreads when an infected person coughs or sneezes near you. It can also spread through direct contact with contaminated surfaces.
Almost all children will have had RSV by age 2, but then immunity develops and continues into adulthood. However, RSV continues to circulate and re-infect throughout life. For most healthy adults it causes mild cold-like symptoms. But infants, especially those born prematurely, and older adults are at higher risk for severe disease from RSV.
What are the symptoms of RSV?
RSV symptoms usually show up 2-8 days after getting infected. The common signs and symptoms include:
- Runny nose
- Decreased appetite
- Coughing
- Sneezing
- Fever
- Wheezing
These symptoms usually last about 1-2 weeks. Most RSV infections go away on their own within that time. However, some people can experience more severe symptoms and complications, especially infants, older adults, and those with weakened immune systems or heart/lung disease. Severe symptoms and complications can include:
- Difficulty breathing/rapid or shallow breathing
- Flaring of nostrils
- Cyanosis – a bluish tinge to the skin, lips, fingernails due to lack of oxygen
- Dehydration
- Difficulty feeding (infants)
- Lethargy, extreme sleepiness
- Apnea – slowed or stopped breathing (infants)
- Pneumonia
- Bronchiolitis – inflammation of the small airways in the lungs
- Respiratory failure
Infants under 6 months old are at highest risk for severe RSV infection, with about 2-3% of them needing hospitalization. Premature infants and those under 6 weeks old are at even greater risk. Adults over age 65 also have increased risk of RSV complications. Underlying heart/lung conditions and weakened immune systems increase severity for all ages.
What complications can occur with RSV?
Most healthy children and adults infected with RSV will recover fully within 1-2 weeks without any complications or long term effects. However, RSV can sometimes lead to complications, especially in high risk groups like infants, older adults, and those with chronic medical conditions. Potential complications include:
Bronchiolitis
Inflammation and congestion in the small airways of the lungs. This can make breathing difficult and reduce oxygen levels. Bronchiolitis is the most common complication of RSV in infants. About 2-3% of U.S. infants are hospitalized for bronchiolitis each year.
Pneumonia
Infection of the lung tissue itself that causes inflammation and fluid buildup. RSV pneumonia often occurs together with bronchiolitis.
Respiratory failure
When the respiratory system fails, it cannot provide enough oxygen to the body or remove carbon dioxide waste. Respiratory support with a ventilator may be required.
Ear infections
Middle ear infection (otitis media) can sometimes occur as a secondary bacterial infection after RSV.
Dehydration
Infants with RSV often have trouble feeding and drinking due to congestion and poor appetite. Dehydration can occur if fluid intake is inadequate.
Worsening of chronic lung disease
In patients with underlying chronic lung diseases like asthma, COPD, cystic fibrosis, RSV can worsen inflammation and airway obstruction.
Heart complications
RSV may rarely affect heart rhythm or function, especially in those with underlying heart disease.
When should you call the doctor for RSV?
Most mild cases of RSV can be managed at home without seeing a doctor. However, you should contact your child’s doctor if they have signs of RSV and:
- Are younger than 3 months old
- Born prematurely
- Have underlying heart/lung conditions
- Have a weakened immune system
- Show symptoms of dehydration – dry mouth, lack of tears, less frequent urination
- Have a persistent high fever above 102°F (39°C)
- Have difficulty breathing – rapid, wheezing, flaring nostrils
- Have bluish skin, lips, or fingernails
- Are getting better but then seem to get worse
Infants who are dehydrated or struggling to breathe need to be evaluated by a doctor right away. Call 911 or go to the ER if a child is having emergency signs like:
- Trouble breathing/gasping for air
- Unconsciousness
- Blue skin, lips, fingernails
- Ribs pulling in with each breath
- Severe dehydration with little or no urine output
Adults should contact their doctor if they have risk factors like age over 65, heart/lung conditions, or weakened immunity and have difficulty breathing, persistent fever, chest pain, confusion, or worsening of chronic medical conditions.
How is RSV diagnosed?
A doctor can often diagnose RSV based on symptoms and medical history. However, diagnostic testing can help confirm RSV infection. Some common diagnostic tests include:
Rapid antigen testing
Nasal or throat swabs are used to detect RSV antigens. Results are fast, in about 15-30 minutes, but not as accurate as molecular tests.
Molecular testing – PCR
Nasal/throat swabs are used and results take 1-2 days. Molecular tests like PCR are very accurate in detecting RSV.
Chest X-ray
Can identify pneumonia or bronchiolitis complications. X-rays may show areas of white opacity or hyperinflation.
Blood tests
Complete blood count (CBC) can detect infection. Blood cultures can help diagnose secondary bacterial infections.
Pulse oximetry
A pulse oximeter is a non-invasive device that monitors oxygen saturation levels. Low oxygen levels may indicate respiratory distress.
Diagnostic testing is especially important for high risk groups like infants to determine severity of illness and need for hospital care.
How is RSV treated?
For otherwise healthy children and adults with mild RSV infection, the virus usually resolves on its own within 1-2 weeks. Symptoms can be treated with over-the-counter medications and home care:
- Fever reducers like acetaminophen or ibuprofen
- Saline nasal drops and spray to relieve congestion
- Cough medicine (over age 6), cough drops
- Plenty of fluids and rest
- Hand washing and sanitizing to avoid spread
However, corticosteroids like inhaled budesonide may be prescribed in the first few days for infants at high risk of severe RSV to help reduce inflammation. Antibiotics are only helpful if there is a secondary bacterial infection like pneumonia or ear infection.
Ribavirin is an antiviral medication that can be given to infants and sometimes older children with severe RSV requiring hospitalization. It is administered through inhalation or IV as small particle aerosol.
For those with significant breathing difficulty from RSV, oxygen support may be needed. Other more aggressive treatments include:
- High flow nasal cannula – heated, humidified oxygen delivered via nasal prongs at higher flow rate than standard oxygen.
- CPAP – continuous positive airway pressure delivered through prongs or a face mask helps open airways.
- Ventilator – critical cases may require attachment to a breathing machine to mechanically assist with breathing.
Treating any underlying conditions, providing good nutrition, and preventing dehydration are key in management. Most cases improve within 5-7 days with supportive medical care.
Can RSV be prevented?
There is currently no vaccine available to prevent RSV, although research is ongoing. The best prevention is avoiding exposure through:
- Hand washing, especially before touching infants
- Avoiding close contact with sick people
- Cleaning contaminated surfaces like toys, cribs, countertops
- Not smoking around infants and children
Infants at high risk may benefit from RSV immune globulin (RSV-IGIV), an injected antibody treatment that provides short term protection against severe RSV.
Palivizumab (Synagis) is a monoclonal antibody given by injection that can prevent RSV in certain high-risk infants like those born very prematurely or with chronic lung disease. It is given monthly during RSV season.
The best way to prevent complications of RSV is seeking early medical treatment when symptoms first arise in infants and high risk groups. RSV progresses quickly in young infants so prompt evaluation and treatment is key.
What happens if you don’t treat RSV?
For otherwise healthy adults and older children, not treating mild RSV may have no long term effects. The infection will usually run its course in 1-2 weeks with supportive self-care at home. Cough may linger for up to 4 weeks.
However, the risks are much higher if RSV is not properly treated in vulnerable populations like infants, especially those under 3 months old. RSV can rapidly progress to serious, even life-threatening complications if left untreated in infants.
Consequences of untreated RSV in infants may include:
- Progression to severe breathing problems, respiratory failure, and oxygen deprivation due to pneumonia or bronchiolitis
- Need for hospitalization in ICU and possibly mechanical ventilation
- Increased risk of long term effects like asthma or wheezing with subsequent infections
- Secondary bacterial infections like pneumonia, sinus infections, or ear infections
- Dehydration, electrolyte imbalances
- More severe and prolonged illness
- In rare cases, death from respiratory failure – estimated to be 1 death per 100,000 cases
A case-control study found that 43% of infant deaths from RSV might have been prevented with better outpatient medical care in the early stages.
For older adults, untreated RSV can increase the risk of respiratory failure, pneumonia and COPD exacerbations requiring hospitalization. Those with heart disease are also at risk of arrhythmias and heart failure due to lack of oxygen. Overall mortality rates in older adults hospitalized for RSV range from 2-17%, reaching up to 50% in those with chronic heart/lung conditions.
Early diagnosis and treatment is key, especially for infants and other high risk groups. Care may range from outpatient monitoring and supportive care to hospital admission for oxygen, fluids, antiviral treatment, and management of complications in severe cases. Most infants with RSV recover within 1-2 weeks when treated appropriately. However, the consequences of leaving RSV untreated can be extremely serious. That is why prompt medical care is so important, ideally at the earliest signs of respiratory distress.
Conclusion
RSV is a very common respiratory virus that infects nearly all children by age 2. For healthy children and adults, RSV usually causes mild cold-like symptoms that resolve on their own within a week or two. However, RSV poses a much greater risk to vulnerable populations like infants and older adults, especially those with certain underlying medical conditions. Without proper treatment, RSV can quickly progress to potentially serious complications like pneumonia, bronchiolitis, respiratory failure, dehydration, and secondary infections in these high risk groups. That’s why prompt diagnosis and early medical intervention is so critical. With appropriate supportive care and monitoring, most cases improve within 5-7 days. But leaving RSV untreated can lead to respiratory distress, hospitalization, long term effects on the lungs, and even death in some cases. That’s why awareness, preventative steps, and timely treatment of RSV is lifesaving, particularly for infants at greatest risk of severe disease.