rhinovirus pneumonia in adults

There were 123 males and 128 females. As shown in figure 2, one to two bacteria were identified in 6 (29%) patients with sequential rhinovirus detections including Haemophilus influenzae (n=3), Haemophilus parainfluenzae (n=1), Moraxella catarrhalis (n=1), Gram-negative Enterobacteriaceae (n=1), Candida spp. Sequential rhinovirus detections (p=0.004), specifically rhinovirus re-infections (p=0.04) were associated with COPD. The study was approved by the medical ethics committees of the participating countries. Comorbid disorders were prevailing (10 (91%) out of 11) in patients with rhinovirus re-infections (fig. Further research is needed to establish if sequential rhinovirus infections, particularly with a different rhinovirus species can lead to more severe symptoms. 1 One of our patients with … In adults, mixed infections with a respiratory virus and a bacterial pathogen, especially rhinovirus with pneumococci, have been shown to associate with more severe pneumonia and longer hospitalization period [14,15,16,17]. The average adult experiences two to three colds per year, while children average 8 to 12 colds per year [ 4 ]. SESSION TITLE: Pneumonia Diagnosis and Outcomes SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, October 26, 2016 at 02:45 PM - 04:15 PM Comparing Rhinovirus Pneumonia, Bacterial Pneumonia and Rhinovirus and Bacterial Pneumonia Infections in Adults at Charleston Area Medical Center The current study has certain limitations. Claas on behalf of the GRACE Study Group. We use cookies to help provide and enhance our service and tailor content and ads. In immunocompetent adults, the duration of rhinovirus shedding is usually 1–2 weeks and prolonged rhinovirus infection over 28 days has been reported only for patients with severe immune deficiencies [11, 18, 19]. The clinical spectrum of rhinovirus infection can range from asymptomatic to more severe lower respiratory tract illness such as obliterative bronchiolitis and pneumonia [1]. Neu-tropenia was defined as a neutrophil count of <500/mL of blood. The clinical spectrum of rhinovirus infection can range from asymptomatic to more severe lower respiratory tract illness such as obliterative bronchiolitis and pneumonia [1]. It is unclear how prior rhinovirus infections modulate the clinical outcome of successive rhinovirus infections and whether certain rhinovirus types can cause more severe and prolonged illness. Age range was 19 years of age to 95 years old. [28] demonstrated that in contrast to healthy individuals rhinovirus infection in subjects with COPD leads to a significant outgrowth of potentially pathogenic H. influenza. and Pseudomonas aeruginosa [23]. In immunocompetent individuals, rhinovirus infections are usually associated with a mild self-limiting upper respiratory tract illness that resolves spontaneously within 1–2 weeks [9]. Copyright © 2020 Elsevier Inc. except certain content provided by third parties. Bacterial and fungal co-infections were detected in the nasopharyngeal swab specimens by using conventional culture and/or molecular methods for Chlamydophila pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae, Streptococcus spp. Adults experience on average two to three infections and young children up to 12 infections per year [21]. Diagnosis and daily symptoms scores of patients with sequential rhinovirus-positive samples during a 28-day follow-up period. The initial site of replication of rhinoviruses is the respiratory epithelium of the nasal passages, Viruses are the most common cause of pneumonia in children, while in adults bacteria are a more common cause. Patients were enrolled prospectively by general practitioners from 12 European Union countries during three consecutive years (2007–2010). Other secondary infections. Rhinovirus is recognised as a … 0: “normal/not affected”; 1: “very little problem”; 2: “slight problem”; 3: “moderately bad”; 4: “bad”; 5: “very bad”; and 6: “as bad as it could be”. All hospitalized children and 26/43 children from outbreak orphanages tested positive for rhinovirus versus 9/40 control children (p = 0.0005). They have also been implicated in the induction of acute asthma exacerbations, most of which are preceded by a … Prolonged infections were caused by various RV-A and RV-B genotypes and the viral loads at the time of the first (V1) and second (V2) rhinovirus detection were comparable and relatively high for the majority of patients, indicating persistent viral replication (fig. This article has supplementary material available from erj.ersjournals.com. Potentially novel rhinovirus genotypes are indicated as provisionally assigned types (pat). Rhinovirus genotypes with respective cycle threshold (Ct) values and co-pathogens identified in visit 1 (day 1) and visit 2 (day 28 or later) samples are shown. Molecular diagnostic tests have greatly increased our understanding of the role of viruses in pneumonia, and findings indicate that the incidence of viral pneumonia has been underestimated. Only 2 autopsy reports have described the pulmonary pathology of rhinovirus pneumonia in humans with isolation of rhinoviruses from lung tissue [ 5, 6 ]. About 200 million cases of viral community-acquired pneumonia occur every year—100 million in children and 100 million in adults. Rhinovirus is the etiologic agent of most common colds and is responsible for one-third to one-half of cases in adults annually [ 2,3 ]. The virus is thought to be transmitted to the upper respiratory tract by airborne droplets. To our knowledge, this represents the first extensive population-based study on the incidence and clinical relevance of repeated rhinovirus detections among healthy adults. The clinical spectrum of rhinovirus infection can range from asymptomatic to more severe lower respiratory tract illness such as obliterative bronchiolitis and pneumonia [ 1 ]. Our observations are consistent with previous findings of asymptomatic secondary rhinovirus infections among adults [10]. High titers of serotype-specific antibodies in serum and respiratory secretions have been associated with reduced symptom severity or resistance to homologous rhinovirus infections [25]. Rhinovirus treatment Results: Of 356 patients who underwent bronchoscopic BAL and respiratory virus polymerase chain reaction (PCR), RV was the most commonly identified virus (8.1%) from BAL fluid. One or more viral, bacterial or fungal co-pathogens were identified in 187 (34%) of the 553 rhinovirus-positive V1 and V2 samples, consisting of 63 (11%) viral and 119 (22%) bacterial and 38 (7%) fungal co-infections. Patients with previous diagnoses of asthma, COPD and other comorbid disorders, such as diabetes; respiratory, cardiovascular and allergic diseases were not excluded and thus acute infective exacerbations were included as well. EV-C: enterovirus C; A, B and C refer to the RV species. Nasopharyngeal swab samples were tested by real-time PCR assays for the following viruses: human metapneumovirus (hMPV), respiratory syncytial virus (RSV), influenza viruses A and B (IFA and IFB), parainfluenza virus types 1 to 4 (PIV-1 to -4), human coronavirus (HCoV stains 229E, OC43, and NL63), adenovirus (AdV), human bocavirus (HBoV), polyomavirus WU (WUPyV) and KI (KIPyV) [23]. In the current study, most patients (77%) with sequential rhinovirus detections had at least one comorbid disorder; with COPD, allergic disease and asthma accounting for the majority of cases. 2a). In addition, broadly cross-reactive neutralising antibodies raised against conserved peptide sequences in the VP4, VP3 and VP1 capsid proteins have been previously reported [26, 27]. Rhinovirus (RV) infections are predominantly mild and self-limited; thus, treatment is generally focused on symptomatic relief and prevention of person-to-person spread and complications. However, there is a lack of research on whether this scoring system can be applied to viral community acquired pneumonia. According to published studies, viruses account for 29–55% of CAP cases among adults (1 - 5) and the most common virus detected is human rhinovirus (HRV) (4.9–30.6%) (2, 3, 5). In a study of 20 adults who had acute community-acquired sinusitis, rhinovirus was detected in 50% of patients by RT-PCR of maxillary sinus aspirates or nasal swabs, but it was detected in only 15% of patients when these specimens were cultured. 1). In that study, bacterial co-pathogens were identified in 29% (6 out of 21) of the patients with recurrent rhinovirus detections with H. influenzae being the most frequently observed bacterial species identified in three patients. Eur Respir J 2014; 44: 169–177. 10 To cause infection, virus must be deposited on the nasal mucosa or conjunctiva; oral inoculation is not sufficient. Re-infection with a different rhinovirus strain occurred in 11 (65%) out of 17 patients, including RV-A/RV-B (n=4), RV-A/RV-C (n=3), RV-C/RV-A (n=2), and two patients were re-infected with a different RV-A genotype (fig. 16 primary care networks from 12 European countries (Belgium, England, France, Germany, Italy, the Netherlands, Poland, Slovakia, Slovenia, Spain, Sweden and Wales) participated in a prospective recruitment of patients within the winter seasons between October 2007 and June 2010. Rhinovirus transmission occurs by small-particle aerosol, large-particle aerosol, or direct contact. The clinical characteristics of rhinovirus prolonged and re-infections are presented in table 2. Chest Infections Pneumonia Diagnosis and Outcomes, Application of Severity of Illness Scores in Viral Pneumonia, The Natural History and Clinical Relevance of Colonization With Methicillin-Resistant Staphylococcus Aureus (MRSA), We use cookies to help provide and enhance our service and tailor content and ads. The objectives of this study were: 1) to investigate the incidence of prolonged rhinovirus shedding and re-infection among adult GP patients with acute cough/lower respiratory illness; and 2) to establish the clinical severity related to prolonged rhinovirus shedding and re-infection. Rhinovirus (RV) is a major cause of acute respiratory disease in both children and adults. Nasopharyngeal samples were collected at the initial general practitioner consultation and 28 days thereafter and symptom scores were recorded by patients over that period. Thus, it is a disease of older adults. Rhinoviruses are the most common precipitants of the common cold and have been associated with different infections of the respiratory tract, such as otitis media and sinusitis. Still, the overall clinical manifestation appeared to be more severe than prolonged rhinovirus infections, presenting with higher symptom scores and a longer duration of more severe symptoms. Background: In adults, viral causes of community-acquired pneumonia (CAP) are poorly characterised. The latter detection was due to cross-reactivity of our rhinovirus real-time RT-PCR assay with certain enterovirus types and therefore this case (patient 22) was excluded from further analysis. 2b). To discriminate between prolonged rhinovirus shedding and re-infection, virus typing was conducted for patients with sequential rhinovirus-positive samples (figs 1 and 2). In agreement with our results, two previous reports suggested that rhinovirus was the major cause of viral pneumonia, with infection rates of 17.1% and 10.2% of patients with CAP. In the present study, rhinovirus was detected in 18% of immunocompetent adults with acute cough or any other reason for suspecting a lower respiratory tract infection. 12 (57%) of the 21 patients with sequential rhinovirus-positive samples had no clinical symptoms on day 28 following the first V1 rhinovirus detection, seven (33%) patients had “very little problem” (symptom scores ≤1.2), and two (9%) patients had “slight problem” (symptom scores ∼2). Outbreak rhinoviruses formed a distinct genetic cluster. 2). Sputum samples were used for culture of Streptococcus pneumoniae and Haemophilus spp. Further information regarding the molecular typing assays and rhinovirus genotype assignment is provided in the online supplementary material. RESULTS: 168 patients were diagnosed with Rhinovirus alone, 25 patients were diagnosed with Rhinovirus and bacterial pneumonia, 58 patients had bacterial pneumonia alone. Rhinovirus RNA was detected in 444 (18%) out of 2485 visit one samples and in 110 (4.4%) out of 2485 visit two respiratory samples. Rhinovirus infections occur frequently throughout life and have been reported in about one-third of asymptomatic cases. The median duration of illness was longer for patients with a prolonged infection (25 versus 18 days), but the median maximal symptom score and median duration of symptoms ≥2, were higher for rhinovirus re-infections. Our findings indicate that in immunocompetent adults rhinovirus re-infections are more common than prolonged infections, and chronic airway comorbidities might predispose to more frequent rhinovirus re-infections. Importantly, the presence of synonymous and non-synonymous changes in the VP2 and VP3 capsid genes in two RV-A strains suggests that the elderly may represent a potential reservoir for the emergence and spread of rhinovirus variants with modified antigenic properties. These viruses enter the respiratory system when you touch a surface that has been contaminated by the virus and then touch your eyes, nose or mouth. In contrast to previous studies that have identified RV-B infections less frequently in children with respiratory tract illness [20, 24], in the current study, RV-B was the second most common species after RV-A and was identified in three out of the six patients with prolonged rhinovirus shedding. Published by Elsevier Inc. All rights reserved. Patients with RV-associated pneumonia were more likely to be immunocompromised than patients with IFV-associated pneumonia (81.5% vs. 33.3%, p<0.001). Pneumonia severity index (PSI) is an important scoring system that can assess the severity of community acquired pneumonia and determine admission status. Immunocompromised adults can have more severe disease, including lower respiratory infections (1, 8, 12, 17, 18) and increased mortality . Rhinovirus exacerbates COPD, and patients with COPD are at increased risk for bacterial infection following rhinovirus infection. To determine the incidence and clinical relevance of sequential rhinovirus detections, nasopharyngeal samples from 2485 adults with acute cough/lower respiratory illness were analysed. Haemophilus spp., Gram-negative Enterobacteriaceae, Candida sp., Aspergillus sp. Another limitation is that sampling was not conducted on a more frequent (weekly) basis; thus, the time of the second rhinovirus infection cannot be precisely determined. Patients with sequential rhinovirus detections included 11 males and 11 females with a median age of 55 years (range 22–78 years). Chronic airway comorbidities might predispose to more frequent rhinovirus re-infections in immunocompetent adults http://ow.ly/vdB3g. These data suggest that, in adults, follow-up rhinovirus infections are likely to be mild or asymptomatic. The high rate of respiratory comorbidities in these patients could possibly explain the more severe disease outcome. In adults or children, a common cold that doesn’t resolve can lead to inflammation and infection of the sinuses (sinusitis). 74 patients had the diagnosis of obesity. Enter multiple addresses on separate lines or separate them with commas. Of those subjects who were positive for S. pneumoniae , 72% (55 of 76) were positive for rhinovirus on the same and/or previous sampling date, as compared with 35% of S. pneumoniae –negative subjects (231 of 666). a) Patients with prolonged rhinovirus shedding, b) rhinovirus re-infections and c) not typed rhinovirus sequential findings. DOI: https://doi.org/10.1016/j.chest.2016.08.155. Rhinovirus genotyping revealed that the majority (65%) of subjects were re-infected with a different rhinovirus (fig. Eligible patients were aged 18 years or older and consulting their general practitioner (GP) for the first time with a respiratory illness presenting with an acute or worsened cough (≤28 days duration) as the main symptom, or any clinical presentation that suggested a lower respiratory tract infection. The analysis showed no significant differences between the symptom severities of prolonged rhinovirus shedding and rhinovirus re-infections, as well as when compared with rhinovirus mono- and co-pathogen infections. Asthma was the second most frequent comorbid disorder that was associated with rhinovirus re-infections (p=0.02). Support statement: This work was supported by the 6th Framework Programme of the European Commision (Reference: LSHM-CT-2005-518226) and the Dept of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands. These include strep throat (streptococcal pharyngitis), pneumonia, and croup or bronchiolitis in children. Human rhinovirus (9.8%) was the most frequently identified virus, followed by influenza A (3.9%) and respiratory syncytial virus (3.9%). Threshold cycle (Ct) values were normalised using the same fluorescence threshold and were used as an approximate measure of viral load. If present, the severity of each symptom was rated on a 7-point scale from 0 to 6. Rhinovirus was associated with severe disease (Pneumonia Severity Index IV-V) in 29% of cases, the percentage being somewhat lower than the 39% of severe rhinovirus associated infections reported by Jennings and colleagues. The disease severity associated with prolonged rhinovirus shedding and rhinovirus re-infection was also compared to that of 210 cases with rhinovirus mono-infection and 123 cases with co-infections with other viral or bacterial pathogens (table 2). The role of advanced age and immunosenescence in prolonged rhinovirus shedding and transmission warrants further investigation. The maximal symptom score was estimated as the highest mean daily symptom score based on the 13 symptoms evaluated in the patient diary during the 28-day follow-up period. In our study, rhinovirus re-infected patients did not experience apparent aggravation of disease symptoms during the 28-day follow-up period (fig. The data presented here indicate that in immunocompetent adults sequential rhinovirus infections are primarily due to re-infection with a different rhinovirus genotype. 2017 Jun 1;195(11):1535-1536. doi: 10.1164/rccm.201609-1908LE. Rhinovirus is recognised as a major trigger of asthma and chronic obstructive pulmonary disease (COPD) exacerbations [2]. Pneumonia can be caused by bacteria, viruses, fungi, or parasites. Both V1 and V2 rhinovirus infections could be typed for 17 (81%) out of 21 patients, and for the remaining 4 (19%) patients, only the first V1 sample was characterised (fig. Rhinovirus-positive samples that failed amplification by all three genotyping assays had significantly lower viral loads corresponding to median Ct value of 38 versus 29 for genotyped rhinoviruses (p=0.002 Mann–Whitney U-test). 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Zlateva, Jutte J.C. de Vries, Frank E.J.

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