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Chawes BL, Wolsk HM, Carlsson CJ, Rasmussen MA, Følsgaard N, Stokholm J, Bønnelykke K, Brix S, Schoos AM, Bisgaard H. Neonatal airway immune profiles and asthma and allergy endpoints in childhood. Allergy 2021; 76:3713-3722. [PMID: 33864271 DOI: 10.1111/all.14862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The immune system plays a key role in the pathogenesis of asthma and allergy, but the role of the airway cytokine and chemokine composition in vivo in early life prior to symptom development has not been described previously. Here, we aimed to examine whether the neonatal airway immune composition associates with development of allergy and asthma in childhood. METHODS We measured unstimulated levels of 20 immune mediators related to the Type 1, Type 2, Type 17, or regulatory immune pathways in the airway mucosal lining fluid of 620 one-month-old healthy neonates from the COPSAC2010 birth cohort. Allergy and asthma were diagnosed at our research clinic by predefined algorithms and objective assessments at age 6 years. Principal component analyses were used to describe the airway cytokine and chemokine composition. RESULTS A neonatal airway immune profile particularly characterized by enhanced IL-1β and reduced CCL26 was significantly associated with later development of elevated specific IgE to inhaled allergens, a positive skin prick test, and allergic rhinitis, but not with food sensitization. Conversely, reduced Type 17 immune-associated markers, including IL-1β and CXCL8, showed trend of association with development of early asthma endpoints. CONCLUSIONS Development of early asthma endpoints and inhalant allergy during the first 6 years of life seems associated with distinctly perturbed airway immune profiles in neonatal life, which is suggestive of an early origin and different pathogenesis of childhood asthma and allergy. These exploratory findings suggest pre- and perinatal life as an important window of opportunity for prevention of asthma and inhalant allergy.
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Affiliation(s)
- Bo L. Chawes
- COPSAC Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Helene M. Wolsk
- COPSAC Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Christian J. Carlsson
- COPSAC Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Morten A. Rasmussen
- COPSAC Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
- Department of Food Science University of Copenhagen Frederiksberg C Denmark
| | - Nilofar Følsgaard
- COPSAC Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Jakob Stokholm
- COPSAC Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Klaus Bønnelykke
- COPSAC Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Susanne Brix
- Department of Biotechnology and Biomedicine Technical University of Denmark Lyngby Denmark
| | - Ann‐Marie M. Schoos
- COPSAC Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Hans Bisgaard
- COPSAC Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
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Zhu J, Mallia P, Footitt J, Qiu Y, Message SD, Kebadze T, Aniscenko J, Barnes PJ, Adcock IM, Kon OM, Johnson M, Contoli M, Stanciu LA, Papi A, Jeffery PK, Johnston SL. Bronchial mucosal inflammation and illness severity in response to experimental rhinovirus infection in COPD. J Allergy Clin Immunol 2020; 146:840-850.e7. [PMID: 32283204 PMCID: PMC7173046 DOI: 10.1016/j.jaci.2020.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/06/2020] [Accepted: 03/27/2020] [Indexed: 01/03/2023]
Abstract
Background Respiratory viral infection causes chronic obstructive pulmonary disease (COPD) exacerbations. We previously reported increased bronchial mucosa eosinophil and neutrophil inflammation in patients with COPD experiencing naturally occurring exacerbations. But it is unclear whether virus per se induces bronchial mucosal inflammation, nor whether this relates to exacerbation severity. Objectives We sought to determine the extent and nature of bronchial mucosal inflammation following experimental rhinovirus (RV)-16–induced COPD exacerbations and its relationship to disease severity. Methods Bronchial mucosal inflammatory cell phenotypes were determined at preinfection baseline and following experimental RV infection in 17 Global Initiative for Chronic Obstructive Lung Disease stage II subjects with COPD and as controls 20 smokers and 11 nonsmokers with normal lung function. No subject had a history of asthma/allergic rhinitis: all had negative results for aeroallergen skin prick tests. Results RV infection increased the numbers of bronchial mucosal eosinophils and neutrophils only in COPD and CD8+ T lymphocytes in patients with COPD and nonsmokers. Monocytes/macrophages, CD4+ T lymphocytes, and CD20+ B lymphocytes were increased in all subjects. At baseline, compared with nonsmokers, subjects with COPD and smokers had increased numbers of bronchial mucosal monocytes/macrophages and CD8+ T lymphocytes but fewer numbers of CD4+ T lymphocytes and CD20+ B lymphocytes. The virus-induced inflammatory cells in patients with COPD were positively associated with virus load, illness severity, and reductions in lung function. Conclusions Experimental RV infection induces bronchial mucosal eosinophilia and neutrophilia only in patients with COPD and monocytes/macrophages and lymphocytes in both patients with COPD and control subjects. The virus-induced inflammatory cell phenotypes observed in COPD positively related to virus load and illness severity. Antiviral/anti-inflammatory therapies could attenuate bronchial inflammation and ameliorate virus-induced COPD exacerbations.
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Affiliation(s)
- Jie Zhu
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Patrick Mallia
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Joseph Footitt
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Yusheng Qiu
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Simon D Message
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Tatiana Kebadze
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Julia Aniscenko
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Onn M Kon
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Marco Contoli
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Luminita A Stanciu
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Alberto Papi
- Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Peter K Jeffery
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sebastian L Johnston
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom.
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da Silva J, Hilzendeger C, Moermans C, Schleich F, Henket M, Kebadze T, Mallia P, Edwards MR, Johnston SL, Louis R. Raised interferon-β, type 3 interferon and interferon-stimulated genes - evidence of innate immune activation in neutrophilic asthma. Clin Exp Allergy 2016; 47:313-323. [PMID: 27622317 DOI: 10.1111/cea.12809] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 05/30/2016] [Accepted: 06/26/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Interferons play an important role in innate immunity. Previous studies report deficiency in virus induction of interferon (IFN)-α, IFN-β and IFN-λ in bronchial epithelial and bronchial lavage cells in atopic asthmatics. It is now recognized that asthma is a heterogeneous disease comprising different inflammatory phenotypes, some of which may involve innate immune activation in the absence of overt infection. OBJECTIVE The aim of this study was to investigate whether the severity of asthma or a specific cellular sputum pattern may be linked to evidence of innate immune activation. METHODS Here we investigate the expression of IFN-β, IFN-λ1 (IL-29), IFN-λ2/3 (IL-28A/B) and the interferon-stimulated genes (ISGs) such as myxovirus resistance 1 (Mx1), oligoadenylate synthetase (OAS) and viperin in unstimulated sputum cells in 57 asthmatics (including 16 mild, 19 moderate and 22 severe asthma patients) and compared them with 19 healthy subjects. RESULTS We observed increased expression of IFN-β, IFN-λ1/IL-29, OAS and viperin in asthmatics compared with healthy subjects, while IL-28 was not expressed in any group. The overexpression was restricted to neutrophilic asthmatics (sputum neutrophils ≥ 76%), while eosinophilic asthmatics (sputum eosinophils ≥ 3%) did not differ from healthy subjects or even showed a lower expression of Mx1. No difference in interferon or ISG expression was observed according to clinical asthma severity. CONCLUSION AND CLINICAL RELEVANCE Neutrophilic, but not eosinophilic, asthmatics display overexpression of IFN-β, IFN-λ1/IL-29 and ISGs in their sputum cells that may reflect ongoing innate immune activation.
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Affiliation(s)
- J da Silva
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium.,Allergy Service, University Hospital Professor Polydoro Ernani de São Thiago, Federal University of Santa Catarina (HU-UFSC), Florianopolis, SC, Brazil
| | - C Hilzendeger
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium.,Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - C Moermans
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium
| | - F Schleich
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium
| | - M Henket
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium
| | - T Kebadze
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - P Mallia
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - M R Edwards
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - S L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - R Louis
- Department of Respiratory Medicine, CHU Liege, GIGA I3 University of Liege, Liege, Belgium
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Hilzendeger C, da Silva J, Henket M, Schleich F, Corhay JL, Kebadze T, Edwards MR, Mallia P, Johnston SL, Louis R. Reduced sputum expression of interferon-stimulated genes in severe COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:1485-94. [PMID: 27418822 PMCID: PMC4934534 DOI: 10.2147/copd.s105948] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Exacerbations of COPD are frequent and commonly triggered by respiratory tract infections. The purpose of our study was to investigate innate immunity in stable COPD patients. METHODS Induced sputum was collected from 51 stable consecutive COPD patients recruited from the COPD Clinic of CHU Liege and 35 healthy subjects. Expression of interferons beta (IFN-β) and lambda1 (IL-29), IFN-stimulated genes (ISGs) MxA, OAS, and viperin were measured in total sputum cells by reverse transcription quantitative polymerase chain reaction (RT-qPCR). The presence of Picornaviruses was assessed by RT-PCR, while potential pathogenic microorganisms (PPM) were identified by sputum bacteriology. RESULTS Expression of IL-29 was found in 16 of 51 COPD patients (31%) and in nine of 35 healthy subjects (26%), while IFN-β was detected in six of 51 COPD patients (12%) and in two of 35 healthy subjects (6%). ISGs were easily detectable in both groups. In the whole group of COPD patients, OAS expression was decreased (P<0.05), while that of viperin was increased (P<0.01) compared to healthy subjects. No difference was found with respect to MxA. COPD patients from group D of Global Initiative for Chronic Obstructive Lung Disease (GOLD) had reduced expression of all three ISGs (P<0.01 for MxA, P<0.05 for OAS, and P<0.01 for viperin) as compared to those of group B patients. Picornaviruses were detected in eight of 51 (16%) COPD patients vs four of 33 (12%) healthy subjects, while PPM were detected in seven of 39 (18%) COPD patients and associated with raised sputum neutrophil counts. IFN-β expression was raised when either picornavirus or PPM were detected (P=0.06), but no difference was seen regarding IL-29 or ISGs. CONCLUSION ISGs expression was reduced in severe COPD that may favor exacerbation and contribute to disease progress by altering response to infection.
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Affiliation(s)
- Clarissa Hilzendeger
- Department of Respiratory Medicine, Centre Hospitalier Universitaire (CHU) Liege, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA) I University of Liege, Belgium
| | - Jane da Silva
- Department of Medicine, Post-graduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça-SC, Brazil
| | - Monique Henket
- Department of Respiratory Medicine, Centre Hospitalier Universitaire (CHU) Liege, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA) I University of Liege, Belgium
| | - Florence Schleich
- Department of Respiratory Medicine, Centre Hospitalier Universitaire (CHU) Liege, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA) I University of Liege, Belgium
| | - Jean Louis Corhay
- Department of Respiratory Medicine, Centre Hospitalier Universitaire (CHU) Liege, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA) I University of Liege, Belgium
| | - Tatiana Kebadze
- Airway Disease Division, Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, UK
| | - Michael R Edwards
- Airway Disease Division, Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, UK
| | - Patrick Mallia
- Airway Disease Division, Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, UK
| | - Sebastian L Johnston
- Airway Disease Division, Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, UK
| | - Renaud Louis
- Department of Respiratory Medicine, Centre Hospitalier Universitaire (CHU) Liege, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA) I University of Liege, Belgium
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Wolsk HM, Chawes BL, Følsgaard NV, Rasmussen MA, Brix S, Bisgaard H. Siblings Promote a Type 1/Type 17-oriented immune response in the airways of asymptomatic neonates. Allergy 2016; 71:820-8. [PMID: 26808998 DOI: 10.1111/all.12847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Siblings have been shown to reduce the risk of childhood asthma and allergy, but the mechanism driving this association is unknown. The objective was to study whether siblings affect the airway immune response in healthy neonates, which could represent an underlying immune modulatory pathway. METHODS We measured 20 immune mediators related to the Type 1, Type 2, Type 17, or regulatory immune pathways in the airway mucosa of 571 one-month-old asymptomatic neonates from the Copenhagen Prospective Studies on Asthma in Childhood2010 birth cohort (COPSAC2010 ). The association between airway mediator levels and presence of siblings was investigated using conventional statistics and principle component analysis (PCA). RESULTS Neonates with siblings had an upregulated level of airway immune mediators, with predominance of Type 1- and Type 17-related mediators. This was supported by the PCA showing a highly significant difference between children with vs without siblings: P < 10(-10) , which persisted after adjustment for potential confounders including pathogenic airway bacteria and viruses: P < 0.0001. The immune priming effect was inversely associated with time since last childbirth: P = 0.0015. CONCLUSIONS Siblings mediate a Type 1/Type 17-related immune-stimulatory effect in the airways of asymptomatic neonates, also after adjustment for pathogenic bacteria and viruses, indicating that siblings exert a transferable early immune modulatory effect. These findings may represent an in utero immune priming effect of the fetal immune system caused by previous pregnancies as the effect was attenuated with time since last childbirth, or it could relate to the presence of unidentified microbes, but further studies are needed to confirm our findings.
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Affiliation(s)
- H. M. Wolsk
- COPSAC; Copenhagen Prospective Studies on Asthma in Childhood; Herlev and Gentofte Hospital; University of Copenhagen; Copenhagen Denmark
| | - B. L. Chawes
- COPSAC; Copenhagen Prospective Studies on Asthma in Childhood; Herlev and Gentofte Hospital; University of Copenhagen; Copenhagen Denmark
| | - N. V. Følsgaard
- COPSAC; Copenhagen Prospective Studies on Asthma in Childhood; Herlev and Gentofte Hospital; University of Copenhagen; Copenhagen Denmark
| | - M. A. Rasmussen
- COPSAC; Copenhagen Prospective Studies on Asthma in Childhood; Herlev and Gentofte Hospital; University of Copenhagen; Copenhagen Denmark
- Department of Food Science; University of Copenhagen; Frederiksberg C Denmark
| | - S. Brix
- Department of Systems Biology; Center for Biological Sequence Analysis; Technical University of Denmark; Lyngby Denmark
| | - H. Bisgaard
- COPSAC; Copenhagen Prospective Studies on Asthma in Childhood; Herlev and Gentofte Hospital; University of Copenhagen; Copenhagen Denmark
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Wolsk HM, Følsgaard NV, Birch S, Brix S, Hansel TT, Johnston SL, Kebadze T, Chawes BL, Bønnelykke K, Bisgaard H. Picornavirus-Induced Airway Mucosa Immune Profile in Asymptomatic Neonates. J Infect Dis 2015; 213:1262-70. [PMID: 26655299 DOI: 10.1093/infdis/jiv594] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/27/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Bacterial airway colonization is known to alter the airway mucosa immune response in neonates whereas the impact of viruses is unknown. The objective was therefore to examine the effect of respiratory viruses on the immune signature in the airways of asymptomatic neonates. METHODS Nasal aspirates from 571 asymptomatic 1-month-old neonates from the Copenhagen Prospective Studies on Asthma in Childhood 2010 birth cohort were investigated for respiratory viruses. Simultaneously, unstimulated airway mucosal lining fluid was obtained and quantified for levels of 20 immune mediators related to type 1, type 2, type 17, and regulatory immune paths. The association between immune mediator levels and viruses was tested by conventional statistics and partial least square discriminant analysis. RESULTS Picornaviruses were detected in 58 neonates (10.2%) and other viruses in 10 (1.8%). A general up-regulation of immune mediators was found in the neonates with picornavirus (P < .0001; partial least square discriminant analysis). The association was pronounced for type 1- and type 2-related markers and was unaffected by comprehensive confounder adjustment. Detection of picornavirus and bacteria was associated with an additive general up-regulating effect. CONCLUSIONS Asymptomatic presence of picornavirus in the neonatal airway is a potent activator of the topical immune response. This is relevant to understanding the immune potentiating effect of early life exposure to viruses.
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Affiliation(s)
- Helene M Wolsk
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen
| | - Nilofar V Følsgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen
| | - Sune Birch
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen
| | - Susanne Brix
- Department of Systems Biology, Technical University of Denmark, Lyngby, Denmark
| | | | - Sebastian L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma and Centre for Respiratory Infections, Imperial College, London, United Kingdom
| | - Tatiana Kebadze
- Airway Disease Infection Section, National Heart and Lung Institute, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma and Centre for Respiratory Infections, Imperial College, London, United Kingdom
| | - Bo L Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen
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Clinical disease due to enterovirus D68 in adult hematologic malignancy patients and hematopoietic cell transplant recipients. Blood 2015; 125:1724-9. [PMID: 25593338 DOI: 10.1182/blood-2014-12-616516] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The United States Centers for Disease Control and Prevention reported over 1000 cases of severe respiratory disease in pediatric patients associated with enterovirus D68 (EV-D68) in the fall of 2014. We sought to identify and define the clinical burden of disease due to EV-D68 in adult patients with hematologic malignancy or undergoing hematopoietic cell transplant (HCT). Real-time reverse-transcriptase polymerase chain reaction (PCR) for EV-D68 was performed on all respiratory samples positive for human rhinovirus (HRV) or negative for all respiratory viruses by a laboratory-developed respiratory viral PCR panel from August 11, 2014, to November 7, 2014. Presumptive cases were defined as those with an EV-D68 PCR cycle threshold (CT) at least 4 cycles lower than the HRV CT for HRV-positive samples or any EV-D68 CT value for HRV-negative samples. Sequencing of a 150-bp fragment of the 5' noncoding region confirmed EV-D68 in 16 of 506 respiratory samples. Eight patients had a history of hematologic malignancy, and 6 of these had undergone HCT. Presentation ranged from mild upper respiratory symptoms to respiratory failure. EV-D68 can infect adult patients with hematologic malignancy and HCT recipients and may be associated with severe respiratory disease. Current commercial diagnostic assays cannot differentiate EV-D68 from other enteroviruses or HRV, and improved rapid diagnostic tools are needed.
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Martin EK, Kuypers J, Chu HY, Lacombe K, Qin X, Strelitz B, Bradford M, Jones C, Klein EJ, Englund JA. Molecular epidemiology of human rhinovirus infections in the pediatric emergency department. J Clin Virol 2014; 62:25-31. [PMID: 25542466 PMCID: PMC4403738 DOI: 10.1016/j.jcv.2014.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/29/2014] [Accepted: 11/05/2014] [Indexed: 11/04/2022]
Abstract
We analyzed rhinovirus (HRV) illness in children at a hospital emergency department. HRV-C was associated with lower respiratory tract illness (LRTI) compared to HRV-A. Specific HRV-A and C genotypes were more strongly associated with LRTI. Patients with multiple illness episodes had new HRV infections in each episode.
Background Human rhinovirus (HRV) infections are highly prevalent, genetically diverse, and associated with both mild upper respiratory tract and more severe lower tract illnesses (LRTI). Objective To characterize the molecular epidemiology of HRV infections in young children seeking acute medical care. Study design Nasal swabs collected from symptomatic children <3 years of age receiving care in the Emergency and Urgent Care Departments at Seattle Children's Hospital were analyzed by a rapid polymerase chain reaction (PCR) system (FilmArray®) for multiple viruses including HRV/enterovirus. HRV-positive results were confirmed by laboratory-developed real-time reverse transcription PCR (LD-PCR). Clinical data were collected by chart review. A subset of samples was selected for sequencing using the 5′ noncoding region. Associations between LRTI and HRV species and genotypes were estimated using logistic regression analysis. Results Of 595 samples with HRV/enterovirus detected by FilmArray, 474 (80%) were confirmed as HRV by LD-PCR. 211 (96%) of 218 selected samples were sequenced; HRV species A, B, and C were identified in 133 (63%), 6 (3%), and 72 (34%), respectively. LRTI was more common in HRV-C than HRV-A illness episodes (adjusted OR [95% CI] 2.35[1.03–5.35). Specific HRV-A and HRV-C genotypes detected in multiple patients were associated with a greater proportion of LRTI episodes. In 18 patients with >1 HRV-positive illness episodes, a distinct genotype was detected in each. Conclusion Diverse HRV genotypes circulated among symptomatic children during the study period. We found an association between HRV-C infections and LRTI in this patient population and evidence of association between specific HRV genotypes and LRTI.
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Affiliation(s)
- Emily K Martin
- Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA
| | - Jane Kuypers
- Department of Laboratory Medicine, University of Washington, Box 357110, 1959 NE Pacific Street, NW120, Seattle, WA 98195, USA
| | - Helen Y Chu
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Kirsten Lacombe
- Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA
| | - Xuan Qin
- Department of Laboratory Medicine, University of Washington, Box 357110, 1959 NE Pacific Street, NW120, Seattle, WA 98195, USA; Department of Laboratory Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Bonnie Strelitz
- Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA
| | - Miranda Bradford
- Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA
| | - Charla Jones
- Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA
| | - Eileen J Klein
- Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA; Department of Pediatrics, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Janet A Englund
- Center for Clinical and Translational Research, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA; Department of Pediatrics, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA. janet.englund.@seattlechildrens.org
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Rhinoviruses. VIRAL INFECTIONS OF HUMANS 2014. [PMCID: PMC7120790 DOI: 10.1007/978-1-4899-7448-8_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Comparison of Anyplex II RV16 with the xTAG respiratory viral panel and Seeplex RV15 for detection of respiratory viruses. J Clin Microbiol 2013; 51:1137-41. [PMID: 23363824 DOI: 10.1128/jcm.02958-12] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A novel multiplex real-time PCR approach (Anyplex II RV16 [RV16]; Seegene, South Korea) was compared with a multiplex endpoint PCR kit (Seeplex RV15 ACE detection kit [RV15]; Seegene) and a liquid bead-based assay (xTAG respiratory viral panel [xTAG]; Abbott, United States). Of nasopharyngeal swabs or aspirates and bronchoalveolar lavage fluid samples submitted for RV15 testing, 199 retrospectively collected positive specimens and 283 prospectively collected specimens were further tested with RV16 and xTAG. A true-positive result was defined as a positive result from all three methods or RV16 and xTAG or RV15 and xTAG. For specimens with discrepant results, monoplex PCR and sequencing of the target viruses were performed. In total, 300 virus-positive specimens yielded 386 viruses. When the bocavirus results were excluded, the overall sensitivities of RV16, RV15, and xTAG were 95.2%, 93.3%, and 87.2%, respectively (95% confidence intervals, 93.0 to 97.4%, 90.8 to 95.8%, and 83.8 to 90.6%, respectively). RV16 was more sensitive than xTAG for coronavirus OC43/HKU1 (100% versus 26.1%; P < 0.0001) and adenovirus (100% versus 79.5%; P < 0.01) but was less sensitive than xTAG for rhinovirus/enterovirus (89.4% versus 97.9%; P < 0.05). RV16 demonstrated higher sensitivity than RV15 for the detection of adenovirus (100% versus 82.1%; P < 0.05). The specificities of all three methods ranged from 98.6% to 100%. Sequencing analysis of 64 rhinovirus-positive samples revealed that RV16 accurately differentiated between rhinovirus and enterovirus. RV16 most frequently missed rhinovirus C. In conclusion, the overall sensitivity of RV16 was better than that of xTAG. However, improvement of the sensitivity for rhinovirus is required.
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Peng J, Kong W, Guo D, Liu M, Wang Y, Zhu H, Pang B, Miao X, Yu B, Luo T, Hu Q, Zhou D. The epidemiology and etiology of influenza-like illness in Chinese children from 2008 to 2010. J Med Virol 2012; 84:672-8. [PMID: 22337308 PMCID: PMC7166694 DOI: 10.1002/jmv.22247] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Influenza-like illness can be caused by a wide range of respiratory viruses. In order to investigate the epidemiology of viral pathogens related to influenza-like illness in children of Wuhan, the largest city in central China, throat swab samples were collected from 1,472 young patients, from July 2008 to June 2010, before and after the occurrence of the 2009 pandemic influenza A (H1N1) virus (pH1N1). It was found that 923 patients (62.7%) were positive for at least 1 virus and 90 patients (9.8%) were detected for multiple (≥2) respiratory viruses by real-time PCR detection of 16 viruses. Seasonal influenza A virus was the predominant pathogen among all the 16 viruses with a positive rate of 13.3% (196/1,472), which was followed by pH1N1 (159/1,472). It was also noted that the viral distribution pattern in Wuhan changed upon the introduction of the pH1N1 virus.
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Affiliation(s)
- Jinsong Peng
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
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12
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Microbiologic Diagnosis of Respiratory Illness. KENDIG & CHERNICKÂS DISORDERS OF THE RESPIRATORY TRACT IN CHILDREN 2012. [PMCID: PMC7151856 DOI: 10.1016/b978-1-4377-1984-0.00024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Sachs LA, Schnurr D, Yagi S, Lachowicz-Scroggins ME, Widdicombe JH. Quantitative real-time PCR for rhinovirus, and its use in determining the relationship between TCID50 and the number of viral particles. J Virol Methods 2010; 171:212-8. [PMID: 21070809 DOI: 10.1016/j.jviromet.2010.10.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 10/21/2010] [Accepted: 10/27/2010] [Indexed: 10/18/2022]
Abstract
The development of a quantitative real-time PCR (qPCR) assay for human rhinovirus serotype 16 (HRV16) is described using the plasmid pR16.11, which contains the full-length genome of HRV16. A standard curve was generated by plotting the critical threshold (C(t)) against numbers of plasmid. The limit of sensitivity was less than10 cDNA copies, and the curve showed a high degree of linearity over a range of 10(1) to 10(6) cDNA copies with r(2)≥0.9989. Amplification efficiency of the qPCR was greater than 97.6 percent. The standard curve was highly reproducible with low intra- and inter-assay coefficients of variation. Standard curves were also generated from cDNA derived from two viral suspensions of known TCID(50), and were exactly parallel to those generated from the plasmid. Comparison of the curves generated from the plasmid or viral cDNA showed that for the two suspensions, TCID(50) corresponded to either 142 or 2088 viral particles. This new qPCR will permit quantitative assessments of interactions between virus and epithelium such as determinations of the affinity and number of viral binding sites or of the number of virus produced per infected cell.
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Affiliation(s)
- Lorne A Sachs
- Department of Physiology and Membrane Biology, University of California-Davis, Davis, CA 95616-8643, USA.
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14
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Common Colds and Respiratory Viruses: Impact on Allergy and Asthma. ALLERGY FRONTIERS: CLINICAL MANIFESTATIONS 2009. [PMCID: PMC7121093 DOI: 10.1007/978-4-431-88317-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Human rhinoviruses (HRVs) are the most common cause of viral illness worldwide but today, less than half the strains have been sequenced and only a handful examined structurally. This viral super-group, known for decades, has still to face the full force of a molecular biology onslaught. However, newly identified viruses (NIVs) including human metapneumovirus and bocavirus and emergent viruses including SARS-CoV have already been exhaustively scrutinized. The clinical impact of most respiratory NIVs is attributable to one or two major strains but there are 100+ distinct HRVs and, because we have never sought them independently, we must arbitrarily divide the literature's clinical impact findings among them. Early findings from infection studies and use of inefficient detection methods have shaped the way we think of 'common cold' viruses today. OBJECTIVES To review past HRV-related studies in order to put recent HRV discoveries into context. RESULTS HRV infections result in undue antibiotic prescriptions, sizable healthcare-related expenditure and exacerbation of expiratory wheezing associated with hospital admission. CONCLUSION The finding of many divergent and previously unrecognized HRV strains has drawn attention and resources back to the most widespread and frequent infectious agent of humans; providing us the chance to seize the advantage in a decades-long cold war.
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Affiliation(s)
- Ian M Mackay
- Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewski Virus Research Centre, Royal Children's Hospital, Queensland, Australia.
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16
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Real-time reverse transcription-PCR assay for comprehensive detection of human rhinoviruses. J Clin Microbiol 2007; 46:533-9. [PMID: 18057136 DOI: 10.1128/jcm.01739-07] [Citation(s) in RCA: 229] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human rhinoviruses (HRVs) are important contributors to respiratory disease, but their healthcare burden remains unclear, primarily because of the lack of sensitive, accurate, and convenient means of determining their causal role. To address this, we developed and clinically validated the sensitivity and specificity of a real-time reverse transcription-PCR (RT-PCR) assay targeting the viral 5' noncoding region defined by sequences obtained from all 100 currently recognized HRV prototype strains and 85 recently circulating field isolates. The assay successfully amplified all HRVs tested and could reproducibly detect 50 HRV RNA transcript copies, with a dynamic range of over 7 logs. In contrast, a quantified RNA transcript of human enterovirus 68 (HEV68) that showed the greatest sequence homology to the HRV primers and probe set was not detected below a concentration of 5 x 10(5) copies per reaction. Nucleic acid extracts of 111 coded respiratory specimens that were culture positive for HRV or HEV were tested with the HRV real-time RT-PCR assay and by two independent laboratories that used different in-house HRV/HEV RT-PCR assays. Eighty-seven HRV-culture-positive specimens were correctly identified by the real-time RT-PCR assay, and 4 of the 24 HEV-positive samples were positive for HRV. HRV-specific sequences subsequently were identified in these four specimens, suggesting HRV/HEV coinfection in these patients. The assay was successfully applied in an investigation of a coincidental outbreak of HRV respiratory illness among laboratory staff.
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Chung JY, Han TH, Kim SW, Hwang ES. Respiratory picornavirus infections in Korean children with lower respiratory tract infections. ACTA ACUST UNITED AC 2007; 39:250-4. [PMID: 17366056 DOI: 10.1080/00365540600999126] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Recently, human rhinoviruses (RVs) and enteroviruses have been suggested as important etiological agents in young children with lower respiratory tract infections (LRTIs). We investigated the role of respiratory picornaviruses in hospitalized children with LRTI. A total of 233 nasopharyngeal samples were collected from hospitalized children with LRTIs from July 2004 to January 2006. All specimens were tested for the presence of human respiratory syncytial virus (hRSV), influenza virus A, influenza B, parainfluenzavirus, and adenovirus using direct immunofluorescent assay, and for human metapneumovirus (HMPV) by RT-PCR. Detection of RV was performed in nasopharyngeal samples by a RT-PCR assay that incorporated a BglI restriction enzyme digestion of the picornavirus RT-PCR amplicon, and detection of enterovirus was accomplished by hemi-nested RT-PCR using specific primers. Viral agents were detected in 70.4% (164/233) of the study population. The most frequently detected viruses were RV (64/233, 27.4%), hRSV (48/233, 20.6%), and enterovirus (43/233, 18.4%). Picornaviruses were detected as the sole viral agents in 27.0% (63/233) of children, whereas mixed viral infection was detected in 12.0%. These results suggest that picronavirus infection is an important etiological cause of LRTIs in Korean children.
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Affiliation(s)
- Ju-Young Chung
- Department of Pediatrics, Sanggyepaik Hospital, College of Medicine, Inje University, Seoul, Korea
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18
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Manoha C, Espinosa S, Aho SL, Huet F, Pothier P. Epidemiological and clinical features of hMPV, RSV and RVs infections in young children. J Clin Virol 2007; 38:221-6. [PMID: 17241812 DOI: 10.1016/j.jcv.2006.12.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 11/09/2006] [Accepted: 12/06/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Human metapneumovirus (hMPV) has recently been isolated from children with acute respiratory tract infections (RTIs). The epidemiological and clinical characteristics of hMPV infection need further investigation. OBJECTIVES The purpose of this study was to compare the clinical features of hMPV, respiratory syncytial virus (RSV) and rhinoviruses (RV) infections in children less than 3 years of age presenting to an emergency department with acute respiratory illness. STUDY DESIGN From December 2002 to April 2004, all children under age three (n=931) admitted for acute respiratory illness to Dijon Hospital, France, were investigated for respiratory viruses in nasal washes. RESULTS hMPV was detected in 6% of children (in 10.1% (n=38) the first winter and in 3.3% (n=17) the second winter); RSV was detected in 28.5% of the children, while rhinoviruses were found in 18.3%. Five hMPV-infected children had evidence of dual infection, two with RSV and three others with RV. The median age of the patients with hMPV infection was 6 months, and the main clinical symptoms were rhinorrhea (74.5%) and cough (67%). A lower tract disease occurred in 66% of hMPV-positive patients. Gene sequencing of hMPV isolates revealed co-circulation of the two major groups of hMPV during the study period; no difference in pathogenicity was found. There was no difference in the prevalence of bronchiolitis where hMPV, RSV or rhinoviruses were present. Asthma was found more often in hospitalized children with hMPV and rhinoviruses than among those with RSV (p<0.001). CONCLUSIONS These results provide further evidence of the importance of hMPV as a pathogen associated with respiratory tract infection in children.
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Dosanjh A. Transforming growth factor-beta expression induced by rhinovirus infection in respiratory epithelial cells. Acta Biochim Biophys Sin (Shanghai) 2006; 38:911-4. [PMID: 17151785 DOI: 10.1111/j.1745-7270.2006.00234.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Rhinovirus infection of the lower airways is now a recognized disease, associated with bronchiolitis and asthma. The bronchial epithelial cells are the host cells when rhinovirus infection occurs in the airway. It was hypothesized that a pro-fibrotic growth factor response may occur in these infected cells, leading to production of a key transforming growth factor, TGF-beta-1. Bronchial epithelial cells were inoculated with human rhinovirus and compared at day 1, 3 and 5 to control non-infected cells. Cell culture supernatant fluid and cellular RNA were isolated. The amount of released TGF-beta protein was measured by enzyme-linked immunosorbent assay (ELISA). Expression of TGF-beta at the level of transcription was measured by polymerase chain reaction (PCR) and gel electrophoresis. The results show that at all time points studied, TGF-beta production is greater in the infected cells, as demonstrated by ELISA (P<0.05) and by semi-quantitative PCR analysis. It was concluded that bronchial epithelial cells infected with common cold virus and rhinovirus, showed higher levels of TGF-beta. The production of TGF-beta may be indicative of a normal repair mechanism to counter inflammation, or in the setting of persistent asthma, could potentially lead to increased fibrosis and collagen deposition.
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Affiliation(s)
- Amrita Dosanjh
- Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla 92037, USA.
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20
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Chantzi FM, Papadopoulos NG, Bairamis T, Tsiakou M, Bournousouzis N, Constantopoulos AG, Liapi G, Xatzipsalti M, Kafetzis DA. Human rhinoviruses in otitis media with effusion. Pediatr Allergy Immunol 2006; 17:514-8. [PMID: 17014626 DOI: 10.1111/j.1399-3038.2006.00448.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Frequent viral upper respiratory tract infections (URTI) are considered to be risk factors for otitis media with effusion (OME). Atopy has also been associated with both OME and viral infections. The aim of this study was to evaluate the presence of viruses in middle ear effusions (MEE) in children 2-7 yr old with OME, and to determine risk factors for virus detection in the MEE. MEE samples, collected at the time of myringotomy from 37 children with OME were assessed. Physical examination, skin prick tests and a standardized questionnaire on OME and allergy were also performed. Viral RNA was detected by the use of reverse transcription PCR (RT-PCR). Fifteen samples (40.5%) were positive for rhinovirus (RV). One enterovirus and no other respiratory viruses were detected. Two out of five (40%), 3/7 (43%) and 10/25 (40%) were positive for RV in acute, subacute and chronic cases, respectively. Children with frequent episodes of OM, with early onset of OM (<2 yr old), and a positive family history of allergy had a statistically increased risk of RV detection. The two groups were comparable with respect to all other parameters examined. RV is the predominant virus recovered by RT-PCR in the middle ear cavity of children with asymptomatic OME, especially those with a history of longstanding OME or repeated episodes, or children with a family history of allergy. Interactions between allergy and RV infections are likely to predispose to middle ear disease.
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Affiliation(s)
- F M Chantzi
- 2nd Pediatric Clinic, University of Athens, P & A Kyriakou Children's Hospital, Athens, Greece.
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21
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Mallia P, Message SD, Kebadze T, Parker HL, Kon OM, Johnston SL. An experimental model of rhinovirus induced chronic obstructive pulmonary disease exacerbations: a pilot study. Respir Res 2006; 7:116. [PMID: 16956406 PMCID: PMC1578567 DOI: 10.1186/1465-9921-7-116] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 09/06/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute exacerbations of COPD are a major cause of morbidity, mortality and hospitalisation. Respiratory viruses are associated with the majority of exacerbations but a causal relationship has not been demonstrated and the mechanisms of virus-induced exacerbations are poorly understood. Development of a human experimental model would provide evidence of causation and would greatly facilitate understanding mechanisms, but no such model exists. METHODS We aimed to evaluate the feasibility of developing an experimental model of rhinovirus induced COPD exacerbations and to assess safety of rhinovirus infection in COPD patients. We carried out a pilot virus dose escalating study to assess the minimum dose of rhinovirus 16 required to induce experimental rhinovirus infection in subjects with COPD (GOLD stage II). Outcomes were assessed by monitoring of upper and lower respiratory tract symptoms, lung function, and virus replication and inflammatory responses in nasal lavage. RESULTS All 4 subjects developed symptomatic colds with the lowest dose of virus tested, associated with evidence of viral replication and increased pro-inflammatory cytokines in nasal lavage. These were accompanied by significant increases in lower respiratory tract symptoms and reductions in PEF and FEV1. There were no severe exacerbations or other adverse events. CONCLUSION Low dose experimental rhinovirus infection in patients with COPD induces symptoms and lung function changes typical of an acute exacerbation of COPD, appears safe, and provides preliminary evidence of causation.
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Affiliation(s)
- Patrick Mallia
- Department of Respiratory Medicine, National Heart and Lung Institute and Wright Fleming Institute of Infection & Immunity, Imperial College London, UK
| | - Simon D Message
- Department of Respiratory Medicine, National Heart and Lung Institute and Wright Fleming Institute of Infection & Immunity, Imperial College London, UK
| | - Tatiana Kebadze
- Department of Respiratory Medicine, National Heart and Lung Institute and Wright Fleming Institute of Infection & Immunity, Imperial College London, UK
| | - Hayley L Parker
- Department of Respiratory Medicine, National Heart and Lung Institute and Wright Fleming Institute of Infection & Immunity, Imperial College London, UK
| | - Onn M Kon
- St Mary's NHS Trust, Praed Street, London, UK
| | - Sebastian L Johnston
- Department of Respiratory Medicine, National Heart and Lung Institute and Wright Fleming Institute of Infection & Immunity, Imperial College London, UK
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22
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Abstract
The role of respiratory viral infection in the development of asthma remains unclear. A number of factors play crucial roles, including the type of virus, the severity of the disease, the time of the infection, and, most important, the host predisposition. On the other hand, there is little doubt that a strong association exists between viral respiratory infections and induction of wheezing illnesses and asthma exacerbations. The underlying mechanisms, although not fully clarified, are likely to be multifactorial, involving inflammation of the bronchial mucosa, which interacts under certain circumstances with allergic inflammation. In addition, repetitive infections play an important role in perpetuating inflammation and airway hyperresponsiveness, especially in the presence of atopy, leading from childhood asthma to a more persistent asthma phenotype.
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Affiliation(s)
- Ioanna M Velissariou
- Second Department of Pediatrics, P and A Kyriakou Children's Hospital, University of Athens, Greece.
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23
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Choi EH, Lee HJ, Kim SJ, Eun BW, Kim NH, Lee JA, Lee JH, Song EK, Park SHKJY, Sung JY. The association of newly identified respiratory viruses with lower respiratory tract infections in Korean children, 2000-2005. Clin Infect Dis 2006; 43:585-92. [PMID: 16886150 PMCID: PMC7107986 DOI: 10.1086/506350] [Citation(s) in RCA: 273] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Accepted: 05/28/2006] [Indexed: 11/17/2022] Open
Abstract
Background. This study was performed to evaluate the associations of newly recognized viruses, namely, human metapneumovirus (hMPV), human coronavirus (HCoV)–NL63, and human bocavirus (HBoV) with lower respiratory tract infections (LRTIs) in previously healthy children. Methods. To determine the prevalences of 11 viruses—respiratory syncytial virus (RSV), adenovirus, rhinovirus, parainfluenza viruses (PIVs) 1 and 3, influenza viruses A and B, hMPV, HCoV, HCoV-NL63, and HBoV—among infants or children with LRTIs, in association with their epidemiologic characteristics, we performed multiplex reverse-transcriptase polymerase chain reaction on nasopharyngeal aspirates obtained from 515 children 5 years old with LRTIs during the period 2000–2005. Results. Viruses were identified in 312 (60.6%) of the 515 patients. RSV was detected in 122 (23.7%), HBoV in 58 (11.3%), adenovirus in 35 (6.8%), PIV-3 in 32 (6.2%), rhinovirus in 30 (5.8%), hMPV in 24 (4.7%), influenza A in 24 (4.7%), PIV-1 in 9 (1.7%), influenza B in 9 (1.7%), and HCoV-NL63 in 8 (1.6%). Coinfections with 2 viruses were observed in 36 patients (11.5%). Twenty-two patients (37.9%) infected with HBoV had a coinfection. Bronchiolitis was frequently diagnosed in patients who tested positive for RSV, PIV-3, or rhinovirus, whereas influenza A, PIV-1, and HCoV-NL63 were commonly found in patients with croup. The age distributions of patients with viral infections differed; notably, RSV was responsible for 77% of LRTIs that occurred in infants 3 months old. The number of hMPV infections peaked between February and April, whereas the number of HCoV-NL63 infections peaked between April and May. Conclusions. This study describes the features of LRTIs associated with newly identified viruses in children, compared with those associated with known viruses. Additional investigations are required to define the role of HBoV in LRTI.
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Affiliation(s)
- Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
- Seoul Medical Science Research Institute, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Hoan Jong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
- Virus Research Center, Clinical Research Institute, Seoul National University Hospital, Seoul
- Reprints or correspondence: Dr. Hoan Jong Lee, Seoul National University College of Medicine, 28, Yeongeon-dong, Jongno-gu, Seoul, Korea 110-744 ()
| | - Sun Jung Kim
- Seoul Medical Science Research Institute, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Byung Wook Eun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Nam Hee Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Jin A Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Jun Ho Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | - Eun Kyung Song
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
| | | | - Ji Yeon Sung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul
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Papi A, Bellettato CM, Braccioni F, Romagnoli M, Casolari P, Caramori G, Fabbri LM, Johnston SL. Infections and Airway Inflammation in Chronic Obstructive Pulmonary Disease Severe Exacerbations. Am J Respir Crit Care Med 2006; 173:1114-21. [PMID: 16484677 DOI: 10.1164/rccm.200506-859oc] [Citation(s) in RCA: 700] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Severe exacerbations of chronic obstructive pulmonary disease (COPD) are major causes of health care costs mostly related to hospitalization. The role of infections in COPD exacerbations is controversial. OBJECTIVES We investigated whether COPD exacerbations requiring hospitalization are associated with viral and/or bacterial infection and evaluated relationships among infection, exacerbation severity, assessed by reduction of FEV1, and specific patterns of airway inflammation. METHODS We examined 64 patients with COPD when hospitalized for exacerbations, and when in stable convalescence. We measured lung function, blood gases, and exhaled nitric oxide, and examined sputum for inflammation and for viral and bacterial infection. RESULTS Exacerbations were associated with impaired lung function (p < 0.01) and increased sputum neutrophilia (p < 0.001). Viral and/or bacterial infection was detected in 78% of exacerbations: viruses in 48.4% (6.2% when stable, p < 0.001) and bacteria in 54.7% (37.5% when stable, p = 0.08). Patients with infectious exacerbations (29.7% bacterial, 23.4% viral, 25% viral/bacterial coinfection) had longer hospitalizations (p < 0.02) and greater impairment of several measures of lung function (all p < 0.05) than those with noninfectious exacerbations. Patients with exacerbations with coinfection had more marked lung function impairment (p < 0.02) and longer hospitalizations (p = 0.001). Sputum neutrophils were increased in all exacerbations (p < 0.001) and were related to their severity (p < 0.001), independently of the association with viral or bacterial infections; sputum eosinophils were increased during (p < 0.001) virus-associated exacerbations. CONCLUSIONS Respiratory infections are associated with the majority of COPD exacerbations and their severity, especially those with viral/bacterial coinfection. Airway neutrophilia is related to exacerbation severity regardless of viral and/or bacterial infections. Eosinophilia is a good predictor of viral exacerbations.
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Affiliation(s)
- Alberto Papi
- Research Center on Asthma and COPD, Department of Respiratory Diseases, University of Modena and Reggio Emilia, Via del Pozzo 71, I-41100 Modena, Italy
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25
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Psarras S, Volonaki E, Skevaki CL, Xatzipsalti M, Bossios A, Pratsinis H, Tsigkos S, Gourgiotis D, Constantopoulos AG, Papapetropoulos A, Saxoni-Papageorgiou P, Papadopoulos NG. Vascular endothelial growth factor-mediated induction of angiogenesis by human rhinoviruses. J Allergy Clin Immunol 2006; 117:291-7. [PMID: 16461129 DOI: 10.1016/j.jaci.2005.11.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Revised: 10/31/2005] [Accepted: 11/01/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Human rhinoviruses, major precipitants of asthma exacerbations, infect the lower airway epithelium inducing inflammation. The possibility that viral infection may mediate angiogenesis, thus contributing to airway remodeling, has not been evaluated. OBJECTIVE To investigate whether epithelial infection with rhinovirus mediates angiogenesis in vitro, evaluate possible modulation by an atopic environment, and confirm angiogenic factor induction after in vivo rhinovirus infection. METHODS Bronchial epithelial cells were infected with rhinovirus and levels of vascular endothelial growth factor (VEGF), and angiopoietins were measured. The angiogenic effect of epithelial products was assessed in in vitro models of angiogenesis. PBMCs, obtained from patients with atopic asthma and normal controls, were exposed to rhinovirus; the ability of supernatants from these cultures differentially to affect rhinovirus-mediated epithelial VEGF production was evaluated. VEGF levels were measured in respiratory secretions from patients with asthma, before and during rhinovirus-induced exacerbations. RESULTS Epithelial infection with rhinovirus specifically stimulated mRNA expression and release of VEGF, but not angiopoietins, in a time-dependent and dose-dependent manner. Supernatants from these cultures were able to induce angiogenesis in vitro, significantly inhibited by a neutralizing anti-VEGF antibody. When bronchial cells were exposed to supernatants of rhinovirus-infected mononuclear cells from normal subjects or atopic patients with asthma, VEGF induction was significantly higher under the influence of the atopic environment. VEGF was elevated during rhinovirus-associated asthma exacerbations. CONCLUSION Rhinovirus infection, a frequent event, induces VEGF production in bronchial epithelial cells and human airways, an effect enhanced in an atopic environment. Rhinovirus-associated, VEGF-mediated angiogenesis may contribute to airway remodeling in asthma.
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Affiliation(s)
- Stelios Psarras
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Greece
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26
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Creer DD, Dilworth JP, Gillespie SH, Johnston AR, Johnston SL, Ling C, Patel S, Sanderson G, Wallace PG, McHugh TD. Aetiological role of viral and bacterial infections in acute adult lower respiratory tract infection (LRTI) in primary care. Thorax 2005; 61:75-9. [PMID: 16227331 PMCID: PMC2080713 DOI: 10.1136/thx.2004.027441] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lower respiratory tract infections (LRTI) are a common reason for consulting general practitioners (GPs). In most cases the aetiology is unknown, yet most result in an antibiotic prescription. The aetiology of LRTI was investigated in a prospective controlled study. METHODS Eighty adults presenting to GPs with acute LRTI were recruited together with 49 controls over 12 months. Throat swabs, nasal aspirates (patients and controls), and sputum (patients) were obtained and polymerase chain reaction (PCR) and reverse transcriptase polymerase chain reaction (RT-PCR) assays were used to detect Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, influenza viruses (AH1, AH3 and B), parainfluenza viruses 1-3, coronaviruses, respiratory syncytial virus, adenoviruses, rhinoviruses, and enteroviruses. Standard sputum bacteriology was also performed. Outcome was recorded at a follow up visit. RESULTS Potential pathogens were identified in 55 patients with LRTI (69%) and seven controls (14%; p<0.0001). The identification rate was 63% (viruses) and 26% (bacteria) for patients and 12% (p<0.0001) and 6% (p = 0.013), respectively, for controls. The most common organisms identified in the patients were rhinoviruses (33%), influenza viruses (24%), and Streptococcus pneumoniae (19%) compared with 2% (p<0.001), 6% (p = 0.013), and 4% (p = 0.034), respectively, in controls. Multiple pathogens were identified in 18 of the 80 LRTI patients (22.5%) and in two of the 49 controls (4%; p = 0.011). Atypical organisms were rarely identified. Cases with bacterial aetiology were clinically indistinguishable from those with viral aetiology. CONCLUSION Patients presenting to GPs with acute adult LRTI predominantly have a viral illness which is most commonly caused by rhinoviruses and influenza viruses.
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Xepapadaki P, Papadopoulos NG, Bossios A, Manoussakis E, Manousakas T, Saxoni-Papageorgiou P. Duration of postviral airway hyperresponsiveness in children with asthma: effect of atopy. J Allergy Clin Immunol 2005; 116:299-304. [PMID: 16083783 PMCID: PMC7172284 DOI: 10.1016/j.jaci.2005.04.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Revised: 03/28/2005] [Accepted: 04/04/2005] [Indexed: 12/16/2022]
Abstract
Background Respiratory viruses induce asthma exacerbations and airway hyperresponsiveness (AHR). Atopy is an important risk factor for asthma persistence. Objective We sought to evaluate whether atopy is a risk factor for prolonged AHR after upper respiratory tract infections (URIs). Methods Twenty-five children (13 atopic and 12 nonatopic children) with intermittent virus-induced asthma were studied. Clinical evaluation, skin prick tests, methacholine bronchoprovocation, questionnaires, and a nasal wash specimen were obtained at baseline. For 9 months, subjects completed diary cards with respiratory symptoms. During their first reported cold, a nasal wash specimen was obtained. Methacholine provocation was performed 10 days and 5, 7, 9, and 11 weeks later. In case a new cold developed, the provocation schedule was followed from the beginning. Results Viruses were detected in 17 (68%) of 25 patients during their first cold, with rhinovirus being most commonly identified (82%). AHR increased significantly 10 days after the URI, equally in both groups (P = .67), and remained so up to the fifth week. Duration of AHR in subjects experiencing a single URI ranged from 5 to 11 weeks, without a significant difference between groups. In the duration of the study, atopic children experienced more colds and asthma exacerbations than nonatopic children. Thus for duration of AHR, significant prolongation was noted in the atopic group when assessed cumulatively. Conclusion In asthmatic children the duration of AHR after a single natural cold is 5 to 11 weeks. However, an increased rate of symptomatic cold and asthma episodes in atopic children is associated with considerable cumulative prolongation of AHR, which might help explain the role of atopy as a risk factor for asthma persistence.
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Affiliation(s)
- Paraskevi Xepapadaki
- Reprint requests: Paraskevi Xepapadaki, MD, PhD, UPC Research Laboratories, 13, Levadias 11527, Goudi, Greece.
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Xatzipsalti M, Kyrana S, Tsolia M, Psarras S, Bossios A, Laza-Stanca V, Johnston SL, Papadopoulos NG. Rhinovirus viremia in children with respiratory infections. Am J Respir Crit Care Med 2005; 172:1037-40. [PMID: 15994468 DOI: 10.1164/rccm.200502-315oc] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Viremia has been implicated in many viral infections; however, viremia due to rhinovirus (RV; rhinoviremia) has been considered not to occur in normal individuals. OBJECTIVE To evaluate whether RV enters the bloodstream and identify the possible risk factors. METHODS Nasopharyngeal washes (NPWs) of 221 children with respiratory infections were examined for the presence of RV by reverse transcription-polymerase chain reaction. Blood from 88 children, whose NPW was RV-positive, and 31 of RV-negative control subjects was subsequently examined for the presence of RV in the blood by semi-nested reverse transcription-polymerase chain reaction. Rhinoviremia was then correlated with clinical characteristics of the disease. RESULTS RV was detected in the blood of 10 out of 88 NPW RV-positive cases (11.4%): 7 of 28 children with asthma exacerbations (25.0%), 2 of 26 with common cold (7.7%), 1 of 25 with bronchiolitis (4.0%), and 0 of 9 with pneumonia (0%). All NPW RV-negative cases were negative in the blood. The proportion of rhinoviremia in children with asthma exacerbation was significantly higher compared with children suffering from the other diseases (25 vs. 5%, p = 0.01). Significant risk factors were: sampling <or= 24 hours from symptom initiation, personal history of asthma, and male sex. Age, fever, family, and personal history of atopy did not affect the presence of RV in the blood. CONCLUSIONS Viremia may occur during RV respiratory infections in normal children and is rather common in the early course of acute asthma exacerbations, suggesting that rhinoviremia may be involved in asthma exacerbation pathogenesis.
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Affiliation(s)
- Maria Xatzipsalti
- Allergy Department, Second Pediatric Clinic, University of Athens, Athens, Greece
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Jennings LC, Anderson TP, Werno AM, Beynon KA, Murdoch DR. Viral etiology of acute respiratory tract infections in children presenting to hospital: role of polymerase chain reaction and demonstration of multiple infections. Pediatr Infect Dis J 2004; 23:1003-7. [PMID: 15545854 DOI: 10.1097/01.inf.0000143648.04673.6c] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Viral lower respiratory tract infections are a leading cause of hospitalization for young children. METHODS We used polymerase chain reaction (PCR) and conventional methods of cell culture and antigen detection to establish the viral etiology of acute respiratory tract infections in 75 hospitalized children. RESULTS One or more viral pathogens were detected in 65 (87%) children, with respiratory syncytial virus being the most commonly identified virus (36 children). Other viruses identified included influenza virus types A and B, parainfluenzavirus type 3, adenovirus, enterovirus, rhinovirus, coronavirus and human metapneumovirus. PCR increased the diagnostic yield significantly compared with antigen detection and culture, with 39 (21%) diagnoses identified by this method. Multiple infections were identified in 20 (27%) children. CONCLUSIONS PCR-based methodologies offer increased sensitivity for the detection of most respiratory viruses in young children. The inclusion of PCR into diagnostic testing strategies is needed to broaden our understanding of the natural ecology of respiratory viruses and the significance of multiple infections.
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Affiliation(s)
- Lance C Jennings
- Microbiology Unit, Canterbury Health Laboratories, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand
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Abstract
Several epidemiological studies using sensitive detection methodologies have confirmed that the majority of acute asthma exacerbations follow upper respiratory tract infections--common colds. Most of these colds are due to human rhinoviruses (RVs). RVs are able to reach and replicate in epithelial cells of the lower airways and can activate these cells to produce pro-inflammatory mediators. Under some circumstances, RVs can also become cytotoxic to the epithelium. Atopic asthmatic individuals produce less interferon-gamma and more interleukin-10 than normal subjects in response to RV infection. Symptom severity as well as viral shedding after experimental RV infection, is inversely correlated with 'atopic' status, expressed as the interferon-gamma to interleukin-5 ratio. Expression of co-stimulatory molecules on immune cells is also affected in atopic asthmatics, suggesting an aberrant immune response to RV that may lead to suboptimal viral clearance and viral persistence. Some of the above effects can be reversed in vitro by corticosteroids, second-generation antihistamines or anti-oxidants; however, the optimal strategy for treating acute asthma exacerbations requires further research at both mechanistic and clinical levels.
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Tsolia MN, Psarras S, Bossios A, Audi H, Paldanius M, Gourgiotis D, Kallergi K, Kafetzis DA, Constantopoulos A, Papadopoulos NG. Etiology of community-acquired pneumonia in hospitalized school-age children: evidence for high prevalence of viral infections. Clin Infect Dis 2004; 39:681-6. [PMID: 15356783 PMCID: PMC7107828 DOI: 10.1086/422996] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2003] [Accepted: 04/14/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) in young children is most commonly associated with viral infections; however, the role of viruses in CAP of school-age children is still inconclusive. METHODS Seventy-five school-age children hospitalized with CAP were prospectively evaluated for the presence of viral and bacterial pathogens. Nasopharyngeal washes were examined by polymerase chain reaction for viruses and atypical bacteria. Antibody assays to detect bacterial pathogens in acute-phase and convalescent-phase serum samples were also performed. RESULTS A viral infection was identified in 65% of cases. Rhinovirus RNA was detected in 45% of patients; infection with another virus occurred in 31%. The most common bacterial pathogen was Mycoplasma pneumoniae, which was diagnosed in 35% of cases. Chlamydia pneumoniae DNA was not detected in any patient; results of serological tests were positive in only 2 patients (3%). Mixed infections were documented in 35% of patients, and the majority were a viral-bacterial combination. CONCLUSIONS The high prevalence of viral and mixed viral-bacterial infections supports the notion that the presence of a virus, acting either as a direct or an indirect pathogen, may be the rule rather than the exception in the development of CAP in school-age children requiring hospitalization.
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Affiliation(s)
- M N Tsolia
- Second Department of Pediatrics, University of Athens School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece.
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Dagher H, Donninger H, Hutchinson P, Ghildyal R, Bardin P. Rhinovirus detection: comparison of real-time and conventional PCR. J Virol Methods 2004; 117:113-21. [PMID: 15041207 DOI: 10.1016/j.jviromet.2004.01.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2003] [Revised: 12/11/2003] [Accepted: 01/08/2004] [Indexed: 11/20/2022]
Abstract
Rhinoviruses are important human respiratory viruses and the major causative agents of the common cold. Historically, detection of rhinovirus has been by virus culture and this was significantly improved by the use of PCR assays. Recently real-time PCR was developed but to date there have been no reported comparisons of conventional and real-time PCR assays for detection of rhinovirus. In this study, we first compared real-time PCR (SYBR Green I) to conventional PCR for the detection of rhinovirus in serially diluted standard DNA and rhinovirus stock to determine the limits of detection. Next, assays were compared for sensitivity to detect rhinovirus in cell culture with a known number of infected cells. Finally, the assays were compared using clinical samples known to contain rhinovirus. Real-time PCR was 10-fold more sensitive than conventional PCR to detect rhinovirus in standard DNA and in virus stock and >10-fold more sensitive to detect rhinovirus in cultured cells. Real-time PCR was significantly superior for detection of rhinovirus in patients' nasal aspirates (sensitivity 72% versus 39%, P < 0.05). In summary, we found that real-time PCR was more sensitive than conventional PCR and reduced post-PCR processing. Hence, real-time PCR is suitable for both research and clinical purposes.
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Affiliation(s)
- Hayat Dagher
- Department of Respiratory Medicine, Monash Centre for Inflammatory Diseases, Monash Medical Centre and University, Melbourne, Australia.
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Abstract
BACKGROUND Community studies have shown that approximately 30% of patients with acute respiratory tract symptoms have no identifiable infective aetiology. This may not be applicable in general practice. OBJECTIVE The purpose of this study was to determine the infective aetiology in patients who presented to primary care doctors with acute respiratory symptoms. METHODS A prospective study was carried out in all nine primary care clinics belonging to the National Healthcare Group Polyclinics (NHGPs) in Singapore. The subjects comprised 594 consecutive patients (318 males, 276 females) aged > or = 21 years who presented with complaints of any one of cough, nasal or throat symptoms of <7 days duration. Data collection was through interview using structured questionnaire, physical examination, throat swabs for bacterial culture and nasal swabs for virus identification by immunofluorescence (IF) and polymerase chain reaction (PCR). Additional PCR was performed on a subsample of 100 patients. Patients were followed-up until resolution of symptoms. RESULTS The aetiological diagnosis by infective agent is as follows: 150 patients (25.2%) had virus infections, of which 90.7% (136/150) were by rhinovirus. Fourteen patients (2.4%) had bacterial infections, of which 10 were due to group G streptococcus. Group A streptococcus was not detected. Nineteen patients with new pathogens were identified by further PCR. These included parainfluenza 4, human coronavirus OC43, adenovirus, enterovirus and Chlamydia pneumoniae. No pathogen could be identified in 49% of patients. There were no differences in clinical presentation and socio-demographic variables between patients who had viral infections and those in whom no pathogen could be identified. CONCLUSION In about half of patients who presented at NHGPs, no pathogens could be identified even after PCR. A non-infective aetiology could be considered in these patients.
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Affiliation(s)
- Ching-Ye Hong
- Special Projects Department, Research and Data Management Division, Health Promotion Board, KK Women's and Children's Hospital, Singapore.
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Abstract
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. They have also been implicated in the induction of acute asthma exacerbations, most of which are preceded by a common cold. Although in several occasions, mainly in immunocompromised hosts, severe lower respiratory tract infections have been attributed to rhinovirus infections, it is still unclear whether and to what extent these viruses contribute as pathogens in community-acquired pneumonia. Current mechanistic data suggest that rhinoviruses could be the cause of pneumonia in immunocompetent subjects. This notion is supported by epidemiological evidence, however, more clinical studies are needed to assess the actual burden.
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Whiteman SC, Bianco A, Knight RA, Spiteri MA. Human rhinovirus selectively modulates membranous and soluble forms of its intercellular adhesion molecule-1 (ICAM-1) receptor to promote epithelial cell infectivity. J Biol Chem 2003; 278:11954-61. [PMID: 12551926 DOI: 10.1074/jbc.m205329200] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Human rhinoviruses are responsible for many upper respiratory tract infections. 90% of rhinoviruses utilize intercellular adhesion molecule-1 (ICAM-1) as their cellular receptor, which also plays a critical role in recruitment of immune effector cells. Two forms of this receptor exist; membrane-bound (mICAM-1) and soluble ICAM-1 (sICAM-1). The soluble receptor may be produced independently from the membrane-bound form or it may be the product of proteolytic cleavage of mICAM-1. The ratio of airway epithelial cell expression of mICAM-1 to the sICAM-1 form may influence cell infectivity and outcome of rhinovirus infection. We therefore investigated the effect of rhinovirus on expression of both ICAM-1 receptors in normal human bronchial epithelial cells. We observed separate distinct messenger RNA transcripts coding for mICAM-1 and sICAM-1 in these cells, which were modulated by virus. Rhinovirus induced mICAM-1 expression on epithelial cells while simultaneously down-regulating sICAM-1 release, with consequent increase in target cell infectivity. The role of protein tyrosine kinases was investigated as a potential mechanistic pathway. Rhinovirus infection induced rapid phosphorylation of intracellular tyrosine kinase, which may be critical in up-regulation of mICAM-1. Elucidation of the underlying molecular mechanisms involved in differential modulation of both ICAM-1 receptors may lead to novel therapeutic strategies.
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Affiliation(s)
- Suzanne C Whiteman
- Lung Injury and Inflammation Research, Directorate of Respiratory Medicine, North Staffordshire Hospital Trust, Stoke-on-Trent ST4 6QG, United Kingdom.
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Papadopoulos NG, Moustaki M, Tsolia M, Bossios A, Astra E, Prezerakou A, Gourgiotis D, Kafetzis D. Association of rhinovirus infection with increased disease severity in acute bronchiolitis. Am J Respir Crit Care Med 2002; 165:1285-9. [PMID: 11991880 DOI: 10.1164/rccm.200112-118bc] [Citation(s) in RCA: 264] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the major pathogen responsible for acute bronchiolitis in infancy. However, evaluation of the relative importance of rhinovirus or multiple viral infections has been hampered by the lack of sensitive diagnostic methodologies. Therefore, in this study we used the reverse transcription-polymerase chain reaction for 11 respiratory pathogens to assess the etiology in infants with acute bronchiolitis and correlate it with clinical characteristics of the disease. Viruses were detected in 73.7% of patients. RSV was identified in 72.4% of virologically confirmed cases, rhinovirus in 29%, whereas multiple infections represented 19.5% of cases, most of which (69%) were combinations of rhinovirus with RSV. In a logistic regression model controlling for age, sex, birth weight, presence of fever, and day of disease on admission, the presence of rhinovirus was found to increase by approximately five-fold, the risk for severe disease. Multiple pathogens had a similar trend in the univariate analysis, which was eliminated in the multivariate model. Multiple virus cases were admitted to the hospital later in the course of their disease than unique pathogen cases, suggesting successive infections. In conclusion, rhinovirus is second only to RSV as a causative agent of bronchiolitis and is associated with more severe disease. The presence of more than one pathogen may influence the natural history of acute bronchiolitis.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Research Laboratories, Second Department of Pediatrics, University of Athens School of Medicine, Athens, Greece.
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37
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van Elden LJR, van Kraaij MGJ, Nijhuis M, Hendriksen KAW, Dekker AW, Rozenberg-Arska M, van Loon AM. Polymerase chain reaction is more sensitive than viral culture and antigen testing for the detection of respiratory viruses in adults with hematological cancer and pneumonia. Clin Infect Dis 2002; 34:177-83. [PMID: 11740705 PMCID: PMC7109912 DOI: 10.1086/338238] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2001] [Revised: 08/27/2001] [Indexed: 11/19/2022] Open
Abstract
We retrospectively analyzed the value of polymerase chain reaction (PCR) for the detection of respiratory viral infections in 43 patients with hematological cancer whose bronchoalveolar lavage (BAL) samples had been stored. In addition, 17 nose-throat (NT) swabs and 29 blood samples had been obtained. PCR was performed to detect parainfluenza viruses 1-3, respiratory syncytial virus, rhinovirus, influenza viruses A and B, enteroviruses, and coronaviruses. Viral cultures or antigen testing of BAL samples revealed 9 respiratory viruses in 8 patients. By use of PCR, 8 more respiratory viruses were detected in another 7 patients, increasing the rate of identification from 19% to 35% (P<.0005). Available NT swabs yielded the same results with PCR as did BAL samples. We conclude that PCR is more sensitive than viral culture or antigen or serologic testing for detection of respiratory viruses in patients with hematological malignancies, and that it offers the possibility for early, more rapid diagnosis.
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Affiliation(s)
- Leontine J. R. van Elden
- Eijkman-Winkler Institute of Medical Microbiology, Infectious Diseases and Inflammation, Department of Virology, Utrecht, The Netherlandss
| | | | - Monique Nijhuis
- Eijkman-Winkler Institute of Medical Microbiology, Infectious Diseases and Inflammation, Department of Virology, Utrecht, The Netherlandss
| | - Karin A. W. Hendriksen
- Eijkman-Winkler Institute of Medical Microbiology, Infectious Diseases and Inflammation, Department of Virology, Utrecht, The Netherlandss
| | - Ad W. Dekker
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maja Rozenberg-Arska
- Eijkman-Winkler Institute of Medical Microbiology, Infectious Diseases and Inflammation, Department of Virology, Utrecht, The Netherlandss
| | - Anton M. van Loon
- Eijkman-Winkler Institute of Medical Microbiology, Infectious Diseases and Inflammation, Department of Virology, Utrecht, The Netherlandss
- Reprints or correspondence: Dr. Anton M. van Loon, Eijkman-Winkler Institute for Microbiology, Infectious Diseases and Inflammation, Dept. of Virology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands ()
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O'Sullivan S, Cormican L, Faul JL, Ichinohe S, Johnston SL, Burke CM, Poulter LW. Activated, cytotoxic CD8(+) T lymphocytes contribute to the pathology of asthma death. Am J Respir Crit Care Med 2001; 164:560-4. [PMID: 11520715 DOI: 10.1164/ajrccm.164.4.2102018] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigates the presence of CD8(+) T lymphocytes and their possible association with viral infection in bronchi of victims of fatal asthma. Postmortem samples from the peribronchial region of the lung were obtained from seven patients who died an asthma death (AD), seven asthmatic patients who died of unrelated causes (AUC), and seven postmortem cases with no history of lung disease (control subjects). Using immunohistochemical techniques, the CD8(+) cytotoxic T-cell population in peribronchial tissue was characterized in three patient groups. The percentage of CD8(+) cells expressing the activation marker CD25 was higher in the AD group than in both the AUC and control groups (11.91 +/- 1.92% versus 3.93 +/- 1.63% and 1.09 +/- 0.56%, respectively (p < 0.001). Perforin expression, a marker of cytotoxicity, was highest in the AD group (9.16 +/- 1.5%) compared with 1.39 +/- 0.9; 1.8 +/- 0.6% in the AUC and control groups respectively (p < 0.001). Expression of interleukin-4 (IL-4) and interferon gamma (IFN-gamma) by CD8(+) T cells was higher in the AD group than the control group (p < 0.05). Furthermore, the IFN-gamma/IL-4 ratio in the AD group was less than half that of the control group (1.46 +/- 0.2 versus 3.2 +/- 0.1; p = 0.02). Using polymerase chain reaction (PCR), viral genome for rhinovirus (RV) was detected in lung tissue from three of the seven cases in the AD group. Two of these cases also had detectable respiratory syncytial virus (RSV). Viral genome for RSV was detected in five of the AUC group and in one of these cases, RV was also detected. No viral genome was detected in the lungs of the control group. In conclusion, this study provides novel evidence of an aberrant CD8(+) T-cell population, possibly in response to viral infection in subjects who die of acute asthma.
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Affiliation(s)
- S O'Sullivan
- Department of Respiratory Medicine, James Connolly Memorial Hospital, Dublin, Ireland.
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van Elden LJ, van Essen GA, Boucher CA, van Loon AM, Nijhuis M, Schipper P, Verheij TJ, Hoepelman IM. Clinical diagnosis of influenza virus infection: evaluation of diagnostic tools in general practice. Br J Gen Pract 2001; 51:630-4. [PMID: 11510391 PMCID: PMC1314072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND With the development of new antiviral agents for influenza, the urge for rapid and reliable diagnosis of influenza becomes increasingly important. Respiratory virus infections are difficult to distinguish on clinical grounds. General practitioners (GPs) however, still depend on their clinical judgement. AIM To evaluate the importance of clinical symptoms in the diagnosis of influenza virus infection. DESIGN OF STUDY A multicentre questionnaire study. SETTING Eighty-one patients from 14 general practices. METHOD Patients with fever and at least one constitutional symptom and one respiratory symptom were included. A questionnaire with the medical history and clinical symptoms was completed and a combined nose-throat swab was taken. Virus culture, rapid culture, and polymerase chain reaction (PCR) amplification were performed on each specimen. Multivariate analysis was used to obtain the best predictive model. RESULTS By using PCR, an increase was seen in the detection of the viral pathogens compared with the results of culture. In 42 out of 81 patients PCR was positive for influenza. A positive predictive value (PPV) of 75% was observed for the combination of headache at onset, feverishness at onset, cough, and vaccination status during the period of increase influenza activity. Criteria used by the ICHPPC-2 resulted in a PPV of 54%. The PPV for diagnosis made by the GP was 76%. CONCLUSION Although influenza is difficult to diagnose on clinical grounds, the GPs in this study were able to diagnose influenza as such more accurately on their judgement than by the other criteria.
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Affiliation(s)
- L J van Elden
- Department of Virology, Eijkman-Winkler Institute for Microbiology, Infectious Diseases and Inflammation, The Netherlands.
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Abstract
Viral respiratory infections have been related to asthma in several ways. It is well established that viral common colds precipitate exacerbations of asthma. Severe bronchiolitis in early life is related to subsequent wheezing and therefore may represent a marker of susceptibility to asthma; alternatively, it could be involved in the initiation of the disease. Finally, it is possible that some infections may protect from the development of asthma and allergies by promoting a type-1 host response. However, whether respiratory or other viruses could mediate such a protective effect is debated. The design and implementation of novel anti- or proviral strategies targeting asthma depends on the resolution of these questions. This review presents current evidence on the epidemiologic correlations and proposed mechanisms for the involvement of viral infections in the development and progression of asthma.
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Affiliation(s)
- Nikolaos G. Papadopoulos
- BPPK Research Laboratories, Allergy & Clinical Immunology Unit, 2nd Department of Pediatrics, University of Athens, 13 Levadias Str., 11527 Goudi, Greece
| | - Sebastian L. Johnston
- National Heart and Lung Institute at St Mary’s, Imperial College School of Medicine, Norfolk Place, W2 1PG London, UK
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