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Respiratory syncytial virus (RSV): a scourge from infancy to old age
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    To the Editor and to the Authors
    • Carl Persson, Professor emeritus Laboratory Medicine, University Hospital of Lund, Sweden

    To The Editor and to The Authors.

    I wish to congratulate the authors. I find their review on RSV-induced severe disease attractive in all respects. It impressively presents research ranging from epidemiology to molecular immunology, and includes promising treatment opportunities. My perhaps peripheral comments relate to the authors’ conclusion that “much remains to be discovered regarding the host response to RSV infection”.

    Loss of epithelial cells and pathogenic roles of exaggerated epithelial regeneration.
    I’d like to dwell somewhat on RSV-induced epithelial cell loss, which is mentioned in passing in the review. Bodies constituted of many epithelial cells clumped together in airway lumen material have been named Creola bodies by Naylor (1) who demonstrated numerous Creola bodies in association with exacerbations of asthma. However, Creola bodies, as a sign of widespread patches of epithelial shedding, may also be a prominent feature of RSV infection. Indeed, in RSV-infected infants Creola bodies in aspirates seem to be a requisite for the infection to be followed by development of asthma (2,3). This is of interest because epithelial regeneration processes alone, rather than the reputed increased permeability to inhaled material (which is not observed in vivo in asthma (4)) are causative regarding several facets of airway inflammation and remodelling (5,6).

    Lethal RSV infections in children are associated with extensive and patchy loss of bron...

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    Conflict of Interest:
    None declared.