RSV infection is an important illness in elderly and high-risk adults, with a disease burden similar to that of nonpandemic influenza A in a population in which the prevalence of vaccination for influenza is high. An effective RSV vaccine may offer benefits for these adults.

Diagnosis of respiratory syncytial virus (RSV) during acute infection in adults is difficult because of the poor sensitivity of viral culture and antigen detection. A recently developed single-tube nested reverse transcription-PCR (RT-PCR) was compared to viral culture and serology by enzyme immunoassay for the diagnosis of RSV in adults with respiratory illness. Nasal swab samples were collected during respiratory illnesses from five groups of subjects: healthy young adults, healthy elderly adults, adults with chronic heart and lung disease, nursing home residents, and adults admitted to the hospital during the winter with cardiopulmonary illnesses. Of 1,112 samples for which all three tests were available, 117 were positive by at least one method and 995 were negative by all methods. One hundred ten were considered true positives because culture and/or serology was positive. Of these, 80 (73%) were PCR positive compared to 43 (39%) that were culture positive. Seven PCR results were considered false positives due to negative culture and serology. The overall RT-PCR sensitivity was 73%, and specificity was 99%. These data indicate that RT-PCR is an excellent method for the diagnosis of acute RSV infection in adults.Respiratory syncytial virus (RSV) is an enveloped, negativesense RNA virus belonging to the Paramyxoviridae family. It is the major cause of lower respiratory tract illness in young children. (6). In recent years it has been recognized that RSV infection may be severe in certain adult populations, including the elderly, persons with cardiopulmonary disease, and the immunocompromised (2, 4, 10, 12). Diagnosis of RSV infection by either culture or antigen detection from nasopharyngeal specimens is difficult with adults, presumably due to low viral titers in secretions (3). In addition, nasal swabs, rather than nasal washes, are frequently obtained from elderly persons because nasal washes are difficult to perform with frail or uncooperative patients. In the elderly, virus can be isolated in fewer than half of illnesses even when samples are processed under optimal conditions (4). Thus, many investigators have relied primarily on serology for diagnosis of RSV infection in adults. Serologic diagnosis is useful for epidemiological studies but not for patient management because of the delay required for convalescent-phase sera. Reverse transcription-PCR (RT-PCR) is a highly sensitive method for diagnosis of viral infection and has been used successfully in children with RSV (5, 8, 11). We previously described a novel, single-tube hangingdroplet nested RT-PCR for detection of RSV in respiratory secretions (14). This method was found to be 100-fold more sensitive than single-round PCR and was capable of detecting 0.05 PFU of tissue culture-passaged virus. The purpose of this report is to define the sensitivity and specificity of this RT-PCR method in clinical samples from adults with respiratory illnesses and to compare the results to those from standard viral culture and serology. MATERIALS AND METHODSStudy ...

Bacterial coinfection is associated with approximately 40% of viral respiratory tract infections requiring hospitalization. Patients with positive results of viral tests should be carefully evaluated for concomitant bacterial infection. Early empirical antibiotic therapy for patients with an unstable condition is appropriate but is not without risk.

Rationale: Recently, respiratory syncytial virus (RSV) RNA has been identified by reverse transcriptase-polymerase chain reaction (RT-PCR) from a high percentage of patients with stable chronic obstructive pulmonary disease (COPD). These data raise the possibility of persistent low-grade infection in this population, which could have implications in COPD pathogenesis. Objectives: RSV persistence was investigated by testing respiratory secretions from subjects with COPD during illness and at regular intervals over 1 yr. Methods: Nasal and sputum samples from subjects with COPD were tested by one-tube nested RT-PCR for RSV every 2 mo and during respiratory illnesses for 1 yr. Subjects positive for RSV were evaluated weekly until negative in two consecutive samples. Nasal secretions and serum were tested for RSV antibody. A rise of fourfold or greater was defined as evidence of RSV infection. Results: A total of 112 patients were enrolled and the illnesses of 92 patients were evaluated. RSV was detected by RT-PCR in 6/92 (6.5%) illness nasal samples versus 0/685 routine nasal samples and in 5/69 (7.2%) illness sputum samples versus 3 /315 (0.9%) routine. Four additional RSV infections were identified by serum antibody responses. Of the RSV infections 86% were associated with serum or nasal antibody responses and 73% had symptoms of acute respiratory illness. Conclusions: Most RSV infections in patients with COPD are associated with symptomatic respiratory illnesses and measurable immune responses. Our data do not support the concept of RSV persistence in this population. Keywords: chronic obstructive pulmonary disease exacerbation; persistent infection; viral infectionChronic obstructive pulmonary disease (COPD) is a group of disorders characterized by airflow obstruction that can be associated with breathing-related symptoms such as chronic cough, dyspnea, and wheezing (1). It is estimated that approximately 24 million adults in the United States have impaired lung function due to COPD. During 2000, COPD was responsible for 8 million physician office visits, 1.5 million emergency room visits, 726,000 hospitalizations, and 119,000 deaths. Recurrent acute exacerbations of COPD contribute substantially to the morbidity and mortality of this condition and may be due to infections with bacteria, viruses, or both (2-4). In studies of COPD exacerbation, respiratory syncytial virus (RSV) has been identified with variable frequency ranging from 0.8 to 22% depending on the diagnostic methods used (5-16). Recently investigators from the United Kingdom and Germany identified RSV RNA by reverse In our laboratory, we have developed a sensitive and specific real-time, one-tube nested RT-PCR for the diagnosis of RSV in adults (19,20). Because the assay is performed without opening the reaction tube, PCR contamination has been markedly reduced while the sensitivity of a nested assay is retained. Therefore, we sought to explore the question of RSV persistence in patients with COPD by testing upper-and lower-respiratorytract secreti...