Study: Nose Swabs Show Promise in Predicting Severity of RSV Hospitalization for Infants


Investigators find that despite the same quantity of respiratory syncytial virus and presentation, some of the samples demonstrated signs of greater damage to cells.

Nose swabs show promise in predicting which children with respiratory syncytial virus (RSV) might need to stay in the pediatric intensive care unit (ICU) longer, according to the results of a study published in Frontiers in Immunology.1

Investigators found that despite the same quantity of RSV and presentation, some of the samples demonstrated signs of greater damage to the cells in the nose. The signs of damage to the cells correlated to long stays in the pediatric ICU.1

“We were excited to find that the severity of a child’s illness related to the different sets of genes turned on in their body’s response to RSV,” Bria Coates, MD, critical care physician at Ann & Robert H. Lurie Children’s Hospital of Chicago, said in a statement. “The ability to identify which infants with RSV in intensive care will recover quickly and which patients will require a longer stay would provide invaluable information to parents and medical providers.”1

Investigators used nasal biopsies from 33 infants who were in the pediatric ICU with critical RSV. The infants required invasive mechanical ventilation or non-invasive respiratory support.1

They performed RNA sequencing and compared the gene expression in the infants who required invasive respiratory support, which was greater than 3 days, and invasive, prolonged non mechanical ventilation, or shortened non-invasive respiratory support, which was 3 days or less.1

Despite both non-invasive respiratory support groups requiring the same degree of support at the time of sampling, a ciliated cell signature was found for those who required more than 3 days of support, while a basal cell signature was present for those who required 3 days or less. For those who required invasive mechanical ventilation, there was increased expression of genes that had neutrophil activation and cell death.2

Investigators also found the increased number of immune cells did not correlate with the duration of hospitalization for the infants.2

These findings would need to be validated in a larger sample group before they could be applied in a clinical setting, investigators said.1

If the results were confirmed, this could result in the development of a polymerase chain reaction test that could identify children who would take longer to recover from RSV.1

“At this stage, we saw that more injury in the nasal mucosal membranes of children with RSV may be a marker of a dysregulated response to the virus and predict more prolonged illness,” Coates said. “These are promising findings that ultimately might offer better answers to parents and the care team.”1

The investigators cited limitations of the study, which included the samples being collected at a single time point and the small sample size of the study. This means the findings require further validation.2


1. Nose swabs may distinguish babies with RSV needing longer intensive care. News release. EurekAlert. November 2, 2022. Accessed November 11, 2022.

2. Koch CM, Prigge AD, Setar L, et al. Cilia-related gene signature in the nasal mucosa correlates with disease severity and outcomes in critical respiratory syncytial virus bronchiolitis. Front Immunol. 2022;13:924792. doi:10.3389/fimmu.2022.924792

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