Afr J Thorac Crit Care Med. 2025 Dec 19;31(4):e3539. doi: 10.7196/AJTCCM.2025.v31i4.3539. eCollection 2025.
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.
STUDY SYNOPSIS: What the study adds. This study identified a distinct clinical and radiographic profile of adults hospitalised with respiratory syncytial virus (RSV)-associated severe respiratory illness in South Africa, where HIV infection, post-tuberculosis lung disease (PTLD) and polysubstance induced lung damage were the predominant comorbidities, unlike traditional cardiometabolic risk profiles seen elsewhere. It also found characteristic chest radiographic features such as lobar and diffuse ground-glass opacifications in these patients.Implications of the findings. The findings suggest the need to expand RSV vaccination recommendation protocols to include younger adults with HIV and PTLD. They also highlight the importance of improving antimicrobial stewardship and developing better diagnostic tools to differentiate viral from bacterial infections. These findings are crucial in our high burden of disease setting.
PMID:41685284 | PMC:PMC12892206 | DOI:10.7196/AJTCCM.2025.v31i4.3539