Life-threatening respiratory syncytial virus disease in children

Respiratory syncytial virus (RSV) is the most common viral cause of seasonal acute respiratory tract illness in very young children worldwide. In addition, life-threatening RSV disease accounts for the most frequent cause of non- elective pediatric intensive care unit admission for mechanical ventilatory support in infants during the winter season. This review article discusses factors associated with a life-threatening course of RSV disease as well as available therapeutic options and mortality rates. Pre-existing medical conditions, direct virus-induced cytopathology and host immunopathology, as well as co-factors such as bacterial and/or viral co-infection, apnea and the syndrome of inappropriate antidiuretic hormone are important features associated with turning a trivial community acquired upper respiratory tract illness into life-threatening disease. Although numerous medical therapies for life-threatening RSV have been suggested, the mainstay of therapy is still primarily supportive. Mortality rates of previously healthy children requiring mechanical ventilation for RSV-associated disease are almost zero, whereas mortality rates in infants with a pre-existent medical condition are up to 10%. © 2011 Bentham Science Publishers Ltd.