Potential Neurocognitive Symptoms Due to Respiratory Syncytial Virus Infection

Abstract

Respiratory infections are among the major public health burdens, especially during winter. Along these lines, the human respiratory syncytial virus (hRSV) is the principal viral agent causing acute lower respiratory tract infections leading to hospitalization. The pulmonary manifestations due to hRSV infection are bronchiolitis and pneumonia, where the population most affected are infants and the elderly. However, recent evidence suggests that hRSV infection can impact the mother and fetus during pregnancy. Studies have indicated that hRSV can infect different cell types from the placenta and even cross the placenta barrier and infect the fetus. In addition, it is known that infections during the gestational period can lead to severe consequences for the development of the fetus due not only to a direct viral infection but also because of maternal immune activation (MIA). Furthermore, it has been described that the development of the central nervous system (CNS) of the fetus can be affected by the inflammatory environment of the uterus caused by viral infections. Increasing evidence supports the notion that hRSV could invade the CNS and infect nervous cells, such as microglia, neurons, and astrocytes, promoting neuroinflammation. Moreover, it has been described that the hRSV infection can provoke neurological manifestations, including cognitive impairment and behavioral alterations. Here, we will review the potential effect of hRSV in brain development and the potential long-term neurological sequelae.

Keywords: central nervous system; human respiratory syncytial virus; maternal immune activation; neurological alterations.

Figure 1

Potential vertical transmission of hRSV from the mother to the fetus. The infection with hRSV can travel through the bloodstream until reaching the placenta, where it can infect the Syncytiotrophoblast and the Hofbauer cells, but not the cytotrophoblast. After the infection of the cells from the placenta, it might reach the fetus through the blood vessels of the fetus.

Figure 2

Possible consequences of the infection with hRSV during pregnancy on the fetus and infant. The infection with hRSV on a pregnant woman can develop mild symptoms such as cough, congestion, and in the more severe cases, the mother might need ICU-level care. Additionally, the infection with hRSV has been associated with preterm birth. This infection might cause alterations in the development of the fetus and promote more cases of neurological consequences on the infants, which can develop encephalitis, encephalopathy, and impaired language learning.