Respiratory Syncytial Virus - RSV

  • Diagnosis
  • Background
  • Lab Tests
  • References
  • Related Topics

Indications for Testing

  • Differentiate moderate lower respiratory tract infection from other viral illnesses during RSV season and allow initiation of ribavirin

Laboratory Testing

  • Laboratory testing recommendations (CDC)
  • Testing not routinely recommended by the American Academy of Pediatrics
    • Does not change management of disease
    • If testing appears necessary and patient is not at obvious risk for RSV, consider panel testing for influenza, parainfluenza, RSV, and adenovirus
  • Point-of-care testing (POCT) is available (Binax NOW RSV) – accuracy comparable to POCT for influenza
  • DFA testing – rapid testing; frequently performed as a panel
    • Requires nasopharyngeal swab or aspirate
  • PCR testing
    • Requires nasopharyngeal swab or aspirate
    • Less rapid than DFA
    • More expensive
  • Antibody testing – may need both acute and convalescent serum testing
    • More sensitive than viral culture in adults
    • Not usually helpful in acute setting

Differential Diagnosis

Respiratory syncytial virus (RSV) is one of the most common agents of lower respiratory illnesses (including bronchiolitis and pneumonia) in infants and young children worldwide.


  • Prevalence – epidemics occur in late fall and winter and account for 5-15% of community-acquired pneumonias  
  • Age
    • 50% of children ≤1year are infected
    • 100% are infected by 3 years
    • Immunity wanes with age; disease may reoccur in patients >65 years
  • Transmission – via respiratory droplet


  • RSV, an enveloped RNA virus, is a member of the Paramyxoviridae family
    • Two subtypes – A, B

Risk Factors for Severe Disease

  • Premature birth (<35 weeks gestation)
  • Compromised immune system
  • Advanced age (>65 years)
  • Chronic lung/heart disease (eg, bronchopulmonary dysplasia, cyanotic congenital heart disease)
  • Low socioeconomic status

Clinical Presentation

  • Symptoms
    • Children
      • Infection varies from nasal congestion and upper respiratory tract infection to bronchiolitis, pneumonia, severe respiratory distress, and respiratory failure
        • Grunting, nasal flaring, and retractions reflect severe disease
      • RSV can be fatal – often believed to be the cause of sudden death in infants with respiratory disease
    • Adults
      • Infection generally mild – may cause severe pneumonitis in immunocompromised patients and the elderly
      • In older children and adults, RSV can also cause influenza-like syndromes, bronchopneumonia, or exacerbation of chronic bronchitis


  • Supportive
  • Antivirals frequently used in immunocompromised patients and children <2 years


  • RSV prophylaxis with immunoglobulin for children <2 years and for at-risk populations (preterm infants, immunosuppressed patients, and those with congenital heart disease)
Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Respiratory Syncytial Virus DFA 0060288
Method: Direct Fluorescent Antibody Stain

Respiratory Viruses DFA with Reflex to Viral Culture, Respiratory 0060281
Method: Direct Fluorescent Antibody Stain/Cell Culture


Adequacy of the direct specimen significantly influences the sensitivity of DFA

Inadequate specimen collection or too few cells on the slide may lead to failure of direct smears

Other viruses (eg,  HSV, CMV) will not be routinely detected in this culture; decreased sensitivity for adenovirus using rapid culture

Sputum and nasal swabs are best specimens

Respiratory Virus Mini Panel by PCR 0060764
Method: Qualitative Reverse Transcription Polymerase Chain Reaction

Explify Respiratory Pathogens by Next Generation Sequencing 2013694
Method: Massively Parallel Sequencing

General References

Charles PG. Early diagnosis of lower respiratory tract infections (point-of-care tests). Curr Opin Pulm Med. 2008; 14(3): 176-82. PubMed

Dawson-Caswell M, Muncie HL. Respiratory syncytial virus infection in children. Am Fam Physician. 2011; 83(2): 141-6. PubMed

Henrickson KJ, Hall CB. Diagnostic assays for respiratory syncytial virus disease. Pediatr Infect Dis J. 2007; 26(11 Suppl): S36-40. PubMed

Murata Y. Respiratory syncytial virus infection in adults. Curr Opin Pulm Med. 2008; 14(3): 235-40. PubMed

Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet. 2011; 377(9773): 1264-75. PubMed

Walsh EE. Respiratory syncytial virus infection in adults. Semin Respir Crit Care Med. 2011; 32(4): 423-32. PubMed

References from the ARUP Institute for Clinical and Experimental Pathology®

Aldous WK, Gerber K, Taggart EW, Rupp J, Wintch J, Daly JA. A comparison of Thermo Electron RSV OIA to viral culture and direct fluorescent assay testing for respiratory syncytial virus. J Clin Virol. 2005; 32(3): 224-8. PubMed

Aldous WK, Gerber K, Taggart EW, Thomas J, Tidwell D, Daly JA. A comparison of Binax NOW to viral culture and direct fluorescent assay testing for respiratory syncytial virus. Diagn Microbiol Infect Dis. 2004; 49(4): 265-8. PubMed

Caram B, Chen J, Taggart W, Hillyard DR, She R, Polage CR, Twersky J, Schmader K, Petti CA, Woods CW. Respiratory syncytial virus outbreak in a long-term care facility detected using reverse transcriptase polymerase chain reaction: an argument for real-time detection methods. J Am Geriatr Soc. 2009; 57(3): 482-5. PubMed

Couturier MR, Barney T, Alger G, Hymas WC, Stevenson JB, Hillyard D, Daly JA. Evaluation of the FilmArray® Respiratory Panel for clinical use in a large children's hospital. J Clin Lab Anal. 2013; 27(2): 148-54. PubMed

Hymas WC, Hillyard DR. Evaluation of Nanogen MGB Alert Detection Reagents in a multiplex real-time PCR for influenza virus types A and B and respiratory syncytial virus. J Virol Methods. 2009; 156(1-2): 124-8. PubMed

Medical Reviewers

Last Update: August 2017