Viral infections commonly affect the upper or lower respiratory tract. Although respiratory infections can be classified by the causative virus (eg, influenza), they are generally classified clinically according to syndrome (eg, the common cold, bronchiolitis, croup, pneumonia). Although specific pathogens commonly cause characteristic clinical manifestations (eg, rhinovirus typically causes the common cold, respiratory syncytial virus [RSV] typically causes bronchiolitis), each can cause many of the viral respiratory syndromes.
Severity of viral respiratory illness varies widely; severe disease is more likely in older patients and infants. Morbidity may result directly from viral infection or may be indirect, due to exacerbation of underlying cardiopulmonary conditions or bacterial superinfection of the lung, paranasal sinuses, or middle ear.
Causes of Common Viral Respiratory Syndromes
Syndrome | Common Causes | Less Common Causes |
|---|---|---|
Rhinoviruses | ||
Rhinoviruses Coronaviruses | Adenoviruses Human metapneumoviruses | |
Influenza-like illness | Adenoviruses | |
Adenoviruses Coronaviruses (including SARS-CoV-2) | Enteroviruses Rhinoviruses Human metapneumoviruses | |
RSV = respiratory syncytial virus. | ||
Diagnosis of Viral Respiratory Infections
Typically, clinical evaluation and local epidemiology
Sometimes diagnostic testing
Viral respiratory infections are typically diagnosed clinically based on symptoms and local epidemiology. For patient care, diagnosing the syndrome is usually sufficient; identification of a specific pathogen is rarely necessary.
Diagnostic testing should typically be reserved for the following:
Situations in which knowing the specific pathogen affects clinical management
Epidemiologic surveillance (ie, identifying and determining the cause of an outbreak)
Pathogen identification can be important in the rare instances when specific antiviral therapy is contemplated. Currently, such instances are limited to early or severe influenza, COVID-19, severe adenovirus pneumonia, or RSV infection in severely immunocompromised patients. Identifying the specific pathogen, (particularly the influenza virus or RSV in hospitalized patients or patients residing in a facility) may also be important for identifying and containing potential outbreaks.
Rapid point-of-care antigen-based diagnostic tests are readily available for influenza, RSV, and SARS-CoV-2, but have poorer sensitivity than laboratory tests. Point-of-care tests are typically reserved for cases when clinical diagnosis is uncertain and
Antiviral therapy is being considered.
Identification of the viral pathogen would prevent additional evaluation for or treatment of a bacterial infection.
Polymerase chain reaction (PCR)-based detection of viral pathogens in a multiplex panel (or individually for influenza, RSV, and SARS-CoV-2) is available in many clinical laboratories. These tests are rapid and more sensitive than point-of-care tests and, when available, are preferred for clinical purposes.
Cell culture or serologic tests are slower than PCR tests but may be useful for epidemiologic surveillance.
Treatment of Viral Respiratory Infections
Supportive
Sometimes antiviral drugs
Treatment of viral respiratory infections is usually supportive.
Antibacterial drugs are ineffective against viral pathogens, and prophylaxis against secondary bacterial infections is not recommended. Antibiotics should be given only when secondary bacterial infections develop. In patients with chronic lung disease, antibiotics may be given with less restriction.
≤ 18 years with a suspected viral respiratory tract infection, because Reye syndrome is a risk.
Some patients continue to cough for weeks after resolution of an upper respiratory infection; these symptoms may lessen with use of an inhaled bronchodilator or corticosteroids.
In some cases, antiviral drugs are useful:
prevent RSV infection in infants and young children. (Nirsevimab is preferred but may not be available to some infants; if it is not available, eligible high-risk infants and children should receive palivizumab.)
