Respiratory syncytial virus infection in adults: Differences with influenza

Abstract

Introduction

Respiratory syncytial virus (RSV) causes an acute respiratory illness similar to influenza, although there are few data comparing both of them in adults. The existence of clinical differences between these two infections could have implications for their management.

Materials and methods

Retrospective observational cohort study including 63 adults with positive PCR for RSV and 221 for influenza during winter 2018–2019. Epidemiological, clinical characteristics and outcomes were contrasted between both groups.

Results

Compared to influenza, RSV-positive patients presented a higher association with active neoplasia (OR = 2.9; 95% CI: 1.2–6.9), dependence for basic activities of daily living (OR = 3.4; 95% CI: 1.4–8.2) and immunosuppression due to chronic glucocorticoid administration (OR = 7.6; 95% CI: 1.6–36.1). At diagnosis, fever was less common (OR = 0.3; 95% CI: 0.2–0.7), and C-reactive protein level ≥100 mg/l was more frequent (OR = 2.1; 95% CI: 1.0–4.5). They developed bacterial co-infection by Staphylococcus aureus in a higher proportion (OR = 8.3; 95% CI: 1.5–46.9) and presented a greater need for admission to the intensive care unit (OR = 5.4; 95% CI: 1.4–19.2).

Conclusion

RSV is an important cause of respiratory illness in adults during the influenza season. It especially affects vulnerable patients with chronic underlying diseases, and has a higher morbidity than influenza. For all these reasons, specific detection, prevention and treatment of RSV is necessary in order to reduce the consumption of health care resources due to RSV disease in adults.

Resumen

Introducción

El virus respiratorio sincitial (VRS) produce una enfermedad respiratoria aguda parecida a la gripe, aunque en adultos existen pocos datos que las comparen. La existencia de diferencias clínicas entre ambas infecciones podría conllevar implicaciones en su manejo.

Materiales y métodos

Estudio observacional de cohortes retrospectivo incluyendo 63 adultos con PCR positiva para VRS y 221 para gripe durante el invierno 2018–2019. Se contrastaron las características epidemiológicas, clínicas y desenlaces entre ambos grupos.

Resultados

En comparación con la gripe los pacientes VRS positivos asociaron mayor relación con neoplasia activa (OR = 2,9; IC 95%: 1,2–6,9), dependencia para las actividades básicas de la vida diaria (OR = 3,4; IC 95%: 1,4–8,2) e inmunosupresión por administración crónica de glucocorticoides (OR = 7,6; IC 95%: 1,6–36,1). Al diagnóstico era menos común la presencia de fiebre (OR = 0,3; IC 95%: 0,2–0,7) y más frecuente un nivel de proteína C reactiva ≥ 100 mg/l (OR = 2,1; IC 95%: 1,0–4,5). Desarrollaron coinfección bacteriana por Staphylococcus aureus en mayor proporción (OR = 8,3; IC 95%: 1,5–46,9) y presentaron una mayor necesidad de ingreso en la unidad de cuidados intensivos (OR = 5,4; IC 95%: 1,4–19,2).

Conclusión

El VRS es una causa importante de enfermedad respiratoria en adultos durante la época de gripe. Afecta especialmente a pacientes vulnerables con enfermedades crónicas de base, y presenta una morbilidad superior a la gripe. Por todo ello es necesaria la detección, prevención y tratamiento específicos del VRS con el objetivo de reducir el consumo de recursos sanitarios que supone la enfermedad por VRS en adultos.