Elsevier

Journal of Clinical Virology

Volume 63, February 2015, Pages 70-75
Journal of Clinical Virology

Clinical and molecular characterization of rhinoviruses A, B, and C in adult patients with pneumonia

https://doi.org/10.1016/j.jcv.2014.12.016Get rights and content

Highlights

  • HRV-C is associated with severe respiratory illness in children.

  • Characteristics of different HRV species were compared in adults with pneumonia.

  • HRV-B was associated with leukopenia, hospital acquisition, and fever.

  • Mean viral load was lower for HRV-B, and high viral load was frequent for HRV-C.

  • HRV-C was not associated with clinical severity or outcome in adults with pneumonia.

Abstract

Background

Human rhinoviruses (HRVs) have increasingly been reported to be associated with lower respiratory tract infections. HRV-C has been associated with more severe respiratory illnesses in children.

Objectives

We investigated the clinical and molecular characteristics of HRV-A, HRV-B, and HRV-C in adults with pneumonia.

Study design

HRV genotyping and quantitative real-time reverse-transcriptase polymerase chain reaction were performed on 392 adult respiratory specimens consecutively collected from June 2012 to May 2013. Pneumonia was identified by review of medical records and chest radiographs.

Results

Adult patients with pneumonia and identified HRV genotypes (n = 165) were included. HRV-A, HRV-B, and HRV-C were identified in 97, 28, and 40 patients, respectively. No differences in underlying diseases, APACHE II score, or frequency of co-infection were observed between the HRV species. Compared with HRV-A, HRV-B was more often associated with neutropenia (21.4% vs. 7.2%, p = 0.07), hospital acquisition (32.1% vs. 7.2%, p = 0.048), and fever (78.6% vs. 49.3%, p = 0.003). Mean viral load (copies/ml) was lower for HRV-B (102.6 vs. 104.1 in HRV-A and 104.3 in HRV-C), and high viral loads (≥104) occurred most frequently with HRV-C (70.0% vs. 57.7% for HRV-A and 21.4% for HRV-B). The incidence of severe pneumonia was similar for HRV-A (18.6%), HRV-B (21.4%), and HRV-C (20.0%), and in-hospital mortality rates did not differ significantly (15.5%, 10.7%, and 12.5%, respectively).

Conclusions

In contrast to previous pediatric studies, no differences were observed in clinical severity or outcomes between the different HRV species in adult patients with pneumonia.

Section snippets

Background

Human rhinovirus (HRV) is a leading cause of the common cold [1]. However, the scope of HRV research recently widened to include lower respiratory tract infections. Several experimental studies suggested that HRV could function as a lower respiratory tract pathogen [2], [3], and clinical studies reported that HRV was detected in 18–26% of pediatric patients with community-acquired pneumonia (CAP) [4], [5], [6] and in 2–17% of adult patients with CAP [7], [8], [9], [10]. In recent studies, we

Objectives

In the present study we determined the clinical and molecular characteristics of HRVs in adult patients with pneumonia, and compared the severities and outcomes of pneumonia in patients with HRV-A, HRV-B, and HRV-C.

Study design

This study was performed at Asan Medical Center, a 2700-bed tertiary care affiliated teaching hospital in Seoul, Republic of Korea. Consecutive patients whose respiratory specimens tested positive for HRV by polymerase chain reaction (PCR) were identified between June 2012 and May 2013. HRV genotyping and real-time reverse-transcriptase (RT) PCR for HRV quantification were performed on all HRV-positive respiratory specimens. Investigators subsequently reviewed medical records and chest

Results

During the study period, 392 adult patients had HRVs in their respiratory specimens. Of these, 210 admitted patients (53.6%) were tested by PCR for pneumonia. Of these, 13 were excluded from analysis because their specimens were unavailable for genotyping or were negative in repeated PCR testing, and another 32 were excluded because their specimens could not be typed as a result of poor sequence quality (average QV < 10) or low sequence resolution. Finally, a total of 165 adult admitted patients

Discussion

In this study, each HRV species exhibited certain characteristic features. HRV-A was the most common species and HRV-B was more frequently associated with hospital acquisition, neutropenia, and fever. In addition, the HRV-B species harbored a lower viral load in respiratory specimens than the other HRV species. Although patients with a respiratory viral load of ≥104 copies/ml were more commonly encountered in the HRV-C species, HRV-C was not associated with more severe clinical manifestations or

Conflict of interest

A conflicting interest exists when professional judgement concerning a primary interest (such as patient’s welfare or the validity of research) may be influenced by the secondary interest (such as financial gain or personal rivary). It may arise for the authors when they have financial interest that may influence their results or those of others. Examples of potential conflict of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent

Funding

None to reportinterpretation of the

Competing interests

None to report

Ethics approval

The study was approved by the Institutional Review Board of the Asan Medical Center.

Author Contributions

Conception and design: S. H. C., S. H. C., and H. S. Acquisition of data: S. H. C., T. K., S. H. C., and H. S. Analysis and interpretation: S. H. C., S. B. H., S. H. K., J. W. H., K. H. D., S. O. L., S. H. C., and H. S. Drafting the manuscript: S. H. C. and S. H. C. Critical revision of the manuscript for intellectual content: M. N. K., C. M. L., Y. S. K., Y. K., and J. H. W. Final approval: all authors.

Acknowledgement

This study was supported by grant 2014–389 from the Asan Institute of Life Sciences, Seoul, South Korea.

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