The clinical and chest radiographic features of respiratory syncy- tial virus-associated severe respiratory illness in hospitalised adults in South Africa, 2022 - 2023
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Abstract
Background. In most healthy adults, respiratory syncytial virus (RSV) causes mild self-limiting respiratory infection. However, vulnerable populations may present differently or have more complicated courses of disease.
Objectives. To describe the clinical and radiographic features of adults hospitalised with RSV-associated severe respiratory illness (SRI) in two urban hospitals during 2022 and 2023.
Methods. Patients aged ≥18 years were enrolled through systematic sentinel surveillance for SRI. Clinical characteristics and radiographic profiles of RSV-infected adults were reviewed.
Results. Eighteen (2%) of 916 enrolled hospitalised patients with SRI tested positive for RSV at the two hospitals. Other pathogens detected included SARS-CoV-2 (n=69/916; 8%), influenza (n=49/916; 5%) and pertussis (n=10/916; 1%). The median (range) age was 50 (35 - 75) years, and 12 (67%) were female. All had at least one comorbidity, including immunocompromising conditions (n=15/18; 83%), metabolic conditions (n=8/18; 44%), structural lung disease (n=12/18; 66%) and cardiovascular conditions (n=3/18; 16%). Among persons living with HIV (n=11/18; 61%), 72% (n=8/11) had suppressed HIV viral loads, and 9/11 (81%) had CD4 counts <250 cells/μL. Median (range) length of hospital stay was 4.5 (1 - 15) days. All patients received empirical antibiotics, intravenously in 12/18 (66%); only 5/12 (41%) de-escalated to oral antibiotics. Radiographic findings demonstrated post-tuberculosis lung disease (PTLD) in 50% of patients (n=9/18), of whom 11 (61%) had new ground-glass opacifications, with lobar v. diffuse in 55% (n=6/11) v. 45% (n=5/11).
Conclusion. The high prevalence of underlying conditions in adults with RSV-associated SRI, specifically HIV and PTLD, suggests that targeted vaccination in these groups may prevent hospitalisation with RSV-associated SRI.
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