Ziekte-ernst van RSV-lageluchtweginfectie: Klinische, virologische en immunologische determinanten

Lower respiratory tract infection (LRTI) by Respiratory Syncytial Virus (RSV) is a frequent cause of hospitalisation of young children during winter season. In this review, we will discuss the risk factors and pathophysiological mechanisms that contribute to disease severity of RSV-LRTI. Most important clinical risk factors are prematurity with or without chronic lung disease, being younger than six weeks of age and congenital heart disease. Host factors, are considered to be more important in disease pathogenesis than virus-related factors. Polymorphisms in gene that are known to be involved in the immune response, and diminished lung function at birth, are early determinants of severity in RSV lower respiratory tract infection. The role of the. immune response is complex and diverse. On the one hand there is the antiviral response, required for clearance of RSV, which has a direct cytopathologic effect on the air ways. In very young children, immaturity of the immune system may contribute to delayed viral clearance. On the other hand, an excessive immune response may also result in enhanced airway damage (immunopathology). The suggestion of an immune-mediated pathogenesis in RSV lower respiratory tract disease implies the possibility of beneficial effects of immune modulation therapy.