Respiratory Syncytial Virus (RSV) infections Linked To Respiratory Failure In Adults

Dr. Nelson Lee MBBS(HK),MD(CUHK),FRCP(Lond),FRCP(Edin),FHKCP,FHKAM(Med) Daniel Yu Professor of Infectious Diseases Head, Division of Infectious Diseases, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong. Hon. Consultant, Prince of Wales Hospital, Hong KongMedicalResearch.com Interview with:
Dr. Nelson Lee
BBS(HK),MD(CUHK),FRCP(Lond),FRCP(Edin),FHKCP,FHKAM(Med)
Daniel Yu Professor of Infectious Diseases
Head, Division of Infectious Diseases,
Department of Medicine and Therapeutics,
Faculty of Medicine, The Chinese University of Hong Kong.
Hon. Consultant, Prince of Wales Hospital, Hong Kong

Medical Research: What is the background for this study? What are the main findings?

Dr. Lee: Respiratory syncytial virus (RSV) is increasingly recognized as an important cause of severe respiratory-tract infections in older adults, resulting in excessive hospitalizations and deaths annually. At present, no established antiviral treatment is available. The slow progress in therapeutics development is limited by the poor understanding of the clinical manifestations, severity, virologic changes, and pathophysiology in adult RSV diseases. To address the knowledge gap, we conducted a prospective study to look at the lower-respiratory complications, progression to respiratory failure, and their relationships to genomic viral loads in adults hospitalized for confirmed RSV infections.

We found that among 123 RSV patients, nearly 90% had lower respiratory tract complications (acute bronchitis/bronchiolitis, radiographic pneumonia, exacerbation of underlying airway diseases, or their combinations), 53% developed respiratory insufficiency requiring bronchodilators and supplemental oxygen, 16% required assisted ventilation, and 12% were admitted to ICU or died. High viral RNA concentration was detected in their respiratory samples, including in patients who had onset longer than 2 days (>7 log10copies/mL). Viral load was associated with disease severity and development of respiratory insufficiency (about 40% increase in risk per log RNA increase).

Medical Research: What should clinicians and patients take away from your report? What recommendations do you have for future research as a result of this study?

Dr. Lee: RSV can cause serious diseases in the older adults, leading to respiratory failure and deaths. Viral load is likely one of the key driving forces for severe manifestations. These results strongly indicate the need and provide important basis for clinical research on potential antiviral therapies in the high-risk adult population. These may include novel fusion inhibitors, polymerase inhibitors, small interfering RNA, and antibody-based interventions. As viral replication may continue for several days, a therapeutic time window of more than 48 hours seems possible and warrant study.

Citation:

Nelson Lee, Martin C.W. Chan, Grace C.Y. Lui, Ran Li, Rity Y.K. Wong, Irene M.H. Yung, Catherine S.K. Cheung, Eugenia C.Y. Chan, David S.C. Hui, and Paul K.S. Chan

High Viral Load and Respiratory Failure in Adults Hospitalized for Respiratory Syncytial Virus (RSV) infections J Infect Dis. first published online April 22, 2015 doi:10.1093/infdis/jiv248

 

MedicalResearch.com Interview with: Dr. Nelson LeeBBS(HK),MD(CUHK),FRCP(Lond),FRCP(Edin),FHKCP,FHKAM(Med), Daniel Yu Professor of Infectious Diseases, Head, Division of Infectious Diseases,, Department of Medicine and Therapeutics,Faculty of Medicine, The Chinese University of Hong Kong. (2015). Respiratory Syncytial Virus (RSV) infections Linked To Respiratory Failure In Adults