Speculation on Pathogenesis in Death from Respiratory Syncytial Virus Infection

The lungs of three infants, two with bronchiolitis and one with pneumonia, were examined by fluorescent antibody techniques for the distribution of respiratory syncytial (R.S.) virus, and also for the presence of human globulin. In bronchiolitis the lungs contained little virus, whereas in pneumonia virus was abundant and widespread; and, paradoxically, while in bronchiolitis human globulin had the same scanty distribution as virus it was absent in pneumonia. It is suggested that the essential process in bronchiolitis is a widespread type 1 allergic reaction dependent on a second encounter with R.S. virus antigen, whereas in R.S. virus pneumonia the mucosal necrosis and alveolar and interstitial inflammation are the result of direct virus damage to the lungs. The alternative explanation put forward is that the process may be a type 3 allergic reaction.