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Boggio GA, Moreno LB, Salbetti MBC, Villarreal V, Torres E, Adamo MP. Clinical characterization of human bocavirus 1 infection in infants hospitalized in an intensive care unit for severe acute respiratory tract disease. Diagn Microbiol Infect Dis 2023; 107:116050. [PMID: 37597460 DOI: 10.1016/j.diagmicrobio.2023.116050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/07/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023]
Abstract
Acute respiratory infections represent the leading cause of morbimortality in children and viruses are the main etiological agents. Here we describe the clinical characteristics and evolution of infants admitted to intensive care unit with severe acute respiratory infection (SARI) due to Human Bocavirus 1 mono-infection in patients without previous comorbidity. We also compared them with respiratory syncytial virus (RSV) cases. Of 141 cases included (age 5.43 ± 4.54 months, 52% male), 80% had at least 1 virus detected. RSV was the most frequent in the series (71.6%) followed by HBoV1 (28%). Five cases of HBoV1 mono-detection were identified. Pediatric acute respiratory distress syndrome was present in both groups, HBoV1 and RSV. The clinical presentation and evolution of HBoV1 single infection was similar to RSV. HBoV1 should be included among the agents investigated in cases of SARI in infants.
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Affiliation(s)
- Gabriel Amilcar Boggio
- Cátedra de Clínica Pediátrica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Hospital de Niños de la Santísima Trinidad de Córdoba, Córdoba, Argentina.
| | - Laura Beatriz Moreno
- Cátedra de Clínica Pediátrica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - María Belén Colazo Salbetti
- Instituto de Virología "Dr. J. M. Vanella", Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | - Erica Torres
- Hospital de Niños de la Santísima Trinidad de Córdoba, Córdoba, Argentina
| | - María Pilar Adamo
- Instituto de Virología "Dr. J. M. Vanella", Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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2
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Prevalence and Genetic Characteristics of Human Bocaviruses Detected in Patients with Acute Respiratory Infections in Bulgaria. Int J Microbiol 2021; 2021:7035081. [PMID: 34819956 PMCID: PMC8608525 DOI: 10.1155/2021/7035081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022] Open
Abstract
Нuman bocaviruses (hBoVs) are often associated with acute respiratory infections (ARIs). Information on the distribution and molecular epidemiology of hBoVs in Bulgaria is currently limited. The objectives of this study were to investigate the prevalence and genetic characteristics of hBoVs detected in patients with ARIs in Bulgaria. From October 2016 to September 2019, nasopharyngeal/oropharyngeal swabs were prospectively collected from 1842 patients of all ages and tested for 12 common respiratory viruses using a real-time RT-PCR. Phylogenetic and amino acid analyses of the hBoV VP1/VP2 gene/protein were performed. HBoV was identified in 98 (5.3%) patients and was the 6th most prevalent virus after respiratory-syncytial virus (20.4%), influenza A(H1N1)pdm09 (11.1%), A(H3N2) (10.5%), rhinoviruses (9.9%), and adenoviruses (6.8%). Coinfections with other respiratory viruses were detected in 51% of the hBoV-positive patients. Significant differences in the prevalence of hBoVs were found during the different study periods and in patients of different age groups. The detection rate of hBoV was the highest in patients aged 0-4 years (6.9%). In this age group, hBoV was the only identified virus in 9.7%, 5.8%, and 1.1% of the children diagnosed with laryngotracheitis, bronchiolitis, and pneumonia, respectively. Among patients aged ≥5 years, hBoV was detected as a single agent in 2.2% of cases of pneumonia. Phylogenetic analysis showed that all Bulgarian hBoV strains belonged to the hBoV1 genotype. A few amino acid substitutions were identified compared to the St1 prototype strain. This first study amongst an all-age population in Bulgaria showed a significant rate of hBoV detection in some serious respiratory illnesses in early childhood, year-to-year changes in the hBoV prevalence, and low genetic variability in the circulating strains.
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3
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Qian W, Huang J, Wang T, He X, Xu G, Li Y. Visual detection of human metapneumovirus using CRISPR-Cas12a diagnostics. Virus Res 2021; 305:198568. [PMID: 34555442 DOI: 10.1016/j.virusres.2021.198568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
Human metapneumovirus (HmPV) is a common and serious virus that causes respiratory tract infection. This study aimed to develop a detection technique by combining reverse transcription recombinase polymerase amplification (RT-RPA) with CRISPR-Cas12a (RT-RPA-Cas12a) for clinical diagnosis of HmPV. Herein, four primer pairs targeting partial nucleoprotein (N) gene of HmPV were designed and evaluated. Then, the products amplified by RT-RPA were detected using CRISPR-Cas12a combined with fluorescence or lateral flow (LF). RT-RPA-Cas12a-based fluorescence or LF assay can be completed within 35 min or 45 min, and the detection limit was up to 6.97 × 102 copies/mL. And there was no cross reaction with human bocavirus, respiratory syncytial virus, adenovirus and parainfluenza virus. By combining with LF, the detection results were evaluated by naked eyes. Furthermore, 28 clinical samples were applied to examine the performance of RT-RPA-Cas12a system. The detection coincidence rates of RT-RPA-Cas12a-fluorescence and RT-RPA-Cas12a-LF with quantitative RT-PCR were 96.4% and 92.9%, respectively. Together, the new method for detecting HmPV with high sensitivity and specificity based on RT-RPA-Cas12a-fluorescence or LF shows promising potential for clinical diagnosis of HmPV without professional skills or ancillary equipment.
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Affiliation(s)
- Weidong Qian
- School of Food and Biological Engineering, Shaanxi University of Science and Technology, Xi'an, 710021, PR China.
| | - Jie Huang
- School of Food and Biological Engineering, Shaanxi University of Science and Technology, Xi'an, 710021, PR China
| | - Ting Wang
- School of Food and Biological Engineering, Shaanxi University of Science and Technology, Xi'an, 710021, PR China
| | - Xiaoxian He
- School of Food and Biological Engineering, Shaanxi University of Science and Technology, Xi'an, 710021, PR China
| | - Guozhang Xu
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, 315010, PR China
| | - Yongdong Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, 315010, PR China.
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Perchetti GA, Wilcox N, Chu HY, Katz J, Khatry SK, LeClerq SC, Tielsch JM, Jerome KR, Englund JA, Kuypers J. Human Metapneumovirus Infection and Genotyping of Infants in Rural Nepal. J Pediatric Infect Dis Soc 2021; 10:408-416. [PMID: 33137178 DOI: 10.1093/jpids/piaa118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acute respiratory tract infections are a serious clinical burden in infants; human metapneumovirus (HMPV) is an important etiological agent. We investigated genotypic variation and molecular epidemiological patterns among infants infected with HMPV in Sarlahi, Nepal, to better characterize infection in a rural, low-resource setting. METHODS Between May 2011 and April 2014, mid-nasal swabs were collected from 3528 infants who developed respiratory symptoms during a longitudinal maternal influenza vaccine study. Sequencing glycoprotein genes permitted genotyping and analyses among subtypes. RESULTS HMPV was detected by reverse-transcriptase polymerase chain reaction (RT-PCR) in 187 (5%) infants, with seasonality observed during fall and winter months. Phylogenetic investigation of complete and partial coding sequences for the F and G genes, respectively, revealed that 3 genotypes were circulating: A2, B1, and B2. HMPV-B was most frequently detected with a single type predominating each season. Both HMPV genotypes exhibited comparable median viral loads. Clinically significant differences between genotypes were limited to increased cough duration and general respiratory symptoms for type B. CONCLUSIONS In rural Nepal, multiple HMPV genotypes circulate simultaneously with an alternating predominance of a single genotype and definitive seasonality. No difference in viral load was detected by genotype and symptom severity was not correlated with RT-PCR cycle threshold or genotype.
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Affiliation(s)
- Garrett A Perchetti
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, Washington, USA
| | - Naomi Wilcox
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Subarna K Khatry
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA.,Nepal Nutrition Intervention Project Sarlahi, Kathmandu, Nepal
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA.,Nepal Nutrition Intervention Project Sarlahi, Kathmandu, Nepal
| | - James M Tielsch
- Department of Global Health, George Washington University, Washington, DC, USA
| | - Keith R Jerome
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Jane Kuypers
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, Washington, USA
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5
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Falahi S, Sayyadi H, Abdoli A, Kenarkoohi A, Mohammadi S. The prevalence of human bocavirus in <2-year-old children with acute bronchiolitis. New Microbes New Infect 2020; 37:100736. [PMID: 32983545 PMCID: PMC7493080 DOI: 10.1016/j.nmni.2020.100736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 11/23/2022] Open
Abstract
Acute bronchiolitis is one of the most common lower respiratory tract infections in children with less than 2 years of age. Nowadays, molecular methods provide an opportunity to better understand the etiology of bronchiolitis. Several viral agents including Respiratory syncytial virus (RSV), Rhinovirus, Parainfluenza and Human bocavirus (HBoV) are responsible for acute bronchiolitis. There are growing studies on the prevalence of HBoV in patients with bronchiolitis. The present systematic review and meta-analysis were conducted to determine the pooled prevalence of HBoV in the respiratory samples of children with acute bronchiolitis. A literature search was conducted in the databases of PubMed, Scopus and Web of Science to recruit studies reporting the frequency of HBoV in <2-year-old children with acute bronchiolitis from 2005 to 2019. Only studies that used polymerase chain reaction (PCR)-based methods to detect the virus in nasopharyngeal samples were included. A total of 22 studies assessing 6751 cases were analyzed. According to the meta-analysis based on the random-effects model, the overall prevalence of HBoV in children with <2 years old was obtained 13% (95% CI: 0.09-0.17). Additionally, the rates of single (as the sole organism) and mixed (in combination with other viruses) HBoV infections were 4% and 9%, respectively. This study showed a high rate of HBoV detection in children with acute bronchiolitis. This should be considered as part of a diagnostic test panel for respiratory infections in children with bronchiolitis.
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Affiliation(s)
- S. Falahi
- Zoonotic Diseases Research Center, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - H. Sayyadi
- Department of Biostatistics, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - A. Abdoli
- Department of Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
- Zoonoses Research Centre, Jahrom University of Medical Sciences, Jahrom, Iran
| | - A. Kenarkoohi
- Department of Microbiology, Faculty of Medicine, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - S. Mohammadi
- Department of Operating Room, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
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Kenmoe S, Vernet MA, Penlap Beng V, Vabret A, Njouom R. Phylogenetic variability of Human Metapneumovirus in patients with acute respiratory infections in Cameroon, 2011–2014. J Infect Public Health 2020; 13:606-612. [PMID: 31530440 DOI: 10.1016/j.jiph.2019.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 08/26/2019] [Indexed: 12/20/2022] Open
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7
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Zhou Z, Zhang P, Cui Y, Zhang Y, Qin X, Li R, Liu P, Dou Y, Wang L, Zhao Y. Experiments Investigating the Competitive Growth Advantage of Two Different Genotypes of Human Metapneumovirus: Implications for the Alternation of Genotype Prevalence. Sci Rep 2020; 10:2852. [PMID: 32071381 PMCID: PMC7029021 DOI: 10.1038/s41598-020-59150-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/23/2020] [Indexed: 12/03/2022] Open
Abstract
Human metapneumovirus (hMPV) is an important pathogen that causes upper and lower respiratory tract infections in children worldwide. hMPV has two major genotypes, hMPV-A and hMPV-B. Epidemiological studies have shown that the two hMPV genotypes alternate in predominance worldwide in recent years. Co-circulation of the two genotypes of hMPV was usually observed and there is no study about the interaction between them, such as competitive replication, which maybe the possible mechanisms for alternating prevalence of subtypes. Our present study have used two different genotypes of hMPV (genotype A: NL/1/00; B: NL/1/99) in different proportions in animal model (BALB/c mice) and cell model (Vero-E6) separately. The result showed that the competitive growth does exist in BALB/c mice, genotype B had a strong competitive advantage. However, genotype B did not cause more severe disease than non-predominant (genotype A) or mixed strains in the study, which were evaluated by the body weight, airway hyperresponsiveness and lung pathology of mouse. In cell model, competitive growth and the two genotypes alternately prevalence were observed. In summary, we confirmed that there was a competitive replication between hMPV genotype A and B, and no difference in disease severity caused by the two subtypes. This study shows a new insight to understand the alternation of hMPV genotype prevalence through genotype competition and provide experimental evidence for disease control and vaccine design.
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Affiliation(s)
- Zhen Zhou
- Department of Pediatric Research Institute; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 400014, China
| | - Pan Zhang
- Department of Pediatric Research Institute; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 400014, China
| | - Yuxia Cui
- Department of Pediatrics, Guizhou Provincial People's Hospital, Guizhou, 550002, China
| | - Yongbo Zhang
- Department of Pediatric Research Institute; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 400014, China
| | - Xian Qin
- Department of Pediatric Research Institute; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 400014, China
| | - Rongpei Li
- Department of Pediatric Research Institute; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 400014, China
| | - Ping Liu
- Department of Pediatric Research Institute; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 400014, China
| | - Ying Dou
- Department of Pediatric Research Institute; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 400014, China
| | - Lijia Wang
- Department of Pediatric Research Institute; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 400014, China
| | - Yao Zhao
- Department of Pediatric Research Institute; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China. .,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 400014, China.
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8
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Shen H. Recombination analysis of coxsackievirus B5 genogroup C. Arch Virol 2017; 163:539-544. [PMID: 29134337 DOI: 10.1007/s00705-017-3608-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 10/09/2017] [Indexed: 01/17/2023]
Abstract
Coxsackievirus B5 (CVB5) is a member of the species Enterovirus B of the genus Enterovirus, family Picornaviridae. Based on its VP1 sequence, CVB5 is divided into four genogroups: A, B, C, and D. From 2002 to 2012, CVB5 serotype genogroup C caused an outbreak of aseptic meningitis in China. In order to study the evolution of CVB5 genogroup C, phylogenetic and recombination analysis was performed using the 399 available enterovirus B genome sequences in the GenBank database. The results indicated that 10 strains of CVB5 serotype genogroup C resulted from recombination between members of genogroup B and echovirus serotype E6, and another 5 strains resulted from recombination between members of genogroup C and serotype CVB4. These recombination events were confirmed by phylogenetic analysis.
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Affiliation(s)
- Hongxing Shen
- Medical College, Jiangsu University, 301 Xuefu Road, 212013, Zhenjiang, People's Republic of China.
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9
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Kenmoe S, Vernet MA, Njankouo-Ripa M, Penlap VB, Vabret A, Njouom R. Phylogenic analysis of human bocavirus detected in children with acute respiratory infection in Yaounde, Cameroon. BMC Res Notes 2017; 10:293. [PMID: 28716110 PMCID: PMC5514512 DOI: 10.1186/s13104-017-2620-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/12/2017] [Indexed: 01/19/2023] Open
Abstract
Objective Human Bocavirus (HBoV) was first identified in 2005 and has been shown to be a common cause of respiratory infections and gastroenteritis in children. In a recent study, we found that 10.7% of children with acute respiratory infections (ARI) were infected by HBoV. Genetic characterization of this virus remains unknown in Central Africa, particularly in Cameroon Leeding us to evaluate the molecular characteristics of HBoV strains in Cameroonian children with ARI. Results Phylogenetic analysis of partial HBoV VP1/2 sequences showed a low level of nucleotide variation and the circulation of HBoV genotype 1 (HBoV-1) only. Three clades were obtained, two clustering with each of the reference strains ST1 and ST2, and a third group consisting of only Cameroon strains. By comparing with the Swedish reference sequences, ST1 and ST2, Cameroon sequences showed nucleotide and amino acid similarities of respectively 97.36–100% and 98.35–100%. These results could help improve strategies for monitoring and control of respiratory infections in Cameroon.
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Affiliation(s)
- Sebastien Kenmoe
- Virology Unit, Centre Pasteur of Cameroon, Yaounde, BP 1274, Yaounde, Cameroon.,Biochemistry Department, Université of Yaounde 1, Yaounde, Cameroon.,Virology Service, Pôle de Biologie, CHU de Caen, Caen, France
| | - Marie-Astrid Vernet
- Virology Unit, Centre Pasteur of Cameroon, Yaounde, BP 1274, Yaounde, Cameroon
| | | | | | - Astrid Vabret
- Virology Service, Pôle de Biologie, CHU de Caen, Caen, France
| | - Richard Njouom
- Virology Unit, Centre Pasteur of Cameroon, Yaounde, BP 1274, Yaounde, Cameroon.
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10
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Abstract
Human metapneumovirus (HMPV) has been described as an important etiologic agent of upper and lower respiratory tract infections, especially in young children and the elderly. Most of school-aged children might be introduced to HMPVs, and exacerbation with other viral or bacterial super-infection is common. However, our understanding of the molecular evolution of HMPVs remains limited. To address the comprehensive evolutionary dynamics of HMPVs, we report a genome-wide analysis of the eight genes (N, P, M, F, M2, SH, G, and L) using 103 complete genome sequences. Phylogenetic reconstruction revealed that the eight genes from one HMPV strain grouped into the same genetic group among the five distinct lineages (A1, A2a, A2b, B1, and B2). A few exceptions of phylogenetic incongruence might suggest past recombination events, and we detected possible recombination breakpoints in the F, SH, and G coding regions. The five genetic lineages of HMPVs shared quite remote common ancestors ranging more than 220 to 470 years of age with the most recent origins for the A2b sublineage. Purifying selection was common, but most protein genes except the F and M2-2 coding regions also appeared to experience episodic diversifying selection. Taken together, these suggest that the five lineages of HMPVs maintain their individual evolutionary dynamics and that recombination and selection forces might work on shaping the genetic diversity of HMPVs.
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11
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Shen H, Zhang W, Wang H, Shao S. Identification of recombination in the NS1 and VPs genes of parvovirus B19. J Med Virol 2016; 88:1457-61. [DOI: 10.1002/jmv.24471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Hongxing Shen
- Medical College; Jiangsu University; Zhenjiang P.R. China
| | - Wen Zhang
- Medical College; Jiangsu University; Zhenjiang P.R. China
| | - Hua Wang
- Medical College; Jiangsu University; Zhenjiang P.R. China
| | - Shihe Shao
- Medical College; Jiangsu University; Zhenjiang P.R. China
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12
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Pacheco-Gonzalez RM, Mallol J, Solé D, Brand PLP, Perez-Fernandez V, Sanchez-Solis M, Garcia-Marcos L. Factors associated with the time to the first wheezing episode in infants: a cross-sectional study from the International Study of Wheezing in Infants (EISL). NPJ Prim Care Respir Med 2016; 26:15077. [PMID: 26796896 PMCID: PMC4721498 DOI: 10.1038/npjpcrm.2015.77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 12/17/2022] Open
Abstract
Male gender, asthmatic heredity, perinatal tobacco smoke exposure and respiratory infections have been associated with wheeze in the first years of life, among other risk factors. However, information about what factors modify the time to the first episode of wheeze in infants is lacking. The present study analyses which factors are associated with shorter time to the first episode of wheeze in infants. Parents of 11- to 24-month-old children were surveyed when attending their health-care centres for a control visit. They answered a questionnaire including the age in months when a first wheeze episode (if any) had occurred (outcome variable). The study was performed in 14 centres in Latin America (LA) and in 8 centres in Europe (EU) (at least 1,000 infants per centre). Factors known to be associated with wheezing in the cohort were included in a survival analysis (Cox proportional hazards model). Summary hazard ratios adjusted for all risk factors (aHR) were calculated using the meta-analysis approach with random effects. A total of 15,067 infants had experienced wheezing at least once, out of 35,049 surveyed. Male gender in LA (aHR 1.05, 95% confidence interval (CI) 1.00-1.10, P=0.047), parental asthma in LA and EU (aHR 1.05, 95% CI 1.00-1.11, P=0.037), infant eczema in EU (aHR 1.25, 95% CI 1.12-1.39, P<0.001) and having a cold during the first 3 months in LA and EU (aHR 1.97, 95% CI 1.90-2.04, P<0.001), in LA (aHR 1.98, 95% CI 1.90-2.06, P<0.001) and in EU (aHR 1.91, 95% CI 1.75-2.09, P<0.001) were associated with a shorter period of time to the first episode. Breast feeding for at least 3 months was associated with a longer period, only in LA (aHR 0.91, 95% CI 0.86-0.96, P<0.001). Cold symptoms during the first 3 months is the most consistent factor shortening the time to the first episode of wheezing; breast feeding for ⩾3 months delays it only in LA, whereas eczema shortens it only in EU. Avoiding a common cold in the first months of life could be a good strategy to delay the first wheeze episode; however, cohort studies will help to elucidate this association.
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Affiliation(s)
- Rosa M Pacheco-Gonzalez
- Pediatric Respiratory and Allergy Unit, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Murcia, Spain
| | - Javier Mallol
- Department of Pediatric Respiratory Medicine, Hospital El Pino, University of Santiago de Chile (USACH), Chile, USA
| | - Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Paul L P Brand
- Princess Amalia Children's Clinic, Isala Klinieken, Zwolle, The Netherlands.,UMCG Postgraduate School of Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Manuel Sanchez-Solis
- Pediatric Respiratory and Allergy Unit, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Murcia, Spain
| | - Luis Garcia-Marcos
- Pediatric Respiratory and Allergy Unit, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Murcia, Spain.,IMIB Bioresearch Institute, Murcia, Spain
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Wu JJ, Jin Y, Lin N, Xie ZP, Yu JM, Li JS, Cao CQ, Yuan XH, Song JR, Zhang J, Zhao Y, Gao XQ, Duan ZJ. Detection of human bocavirus in children with acute respiratory tract infections in Lanzhou and Nanjing, China. BIOMEDICAL AND ENVIRONMENTAL SCIENCES : BES 2014; 27:841-848. [PMID: 25374017 PMCID: PMC7134634 DOI: 10.3967/bes2014.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 07/01/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of this study was to explore the prevalent characteristics of HBoV1 and its co-infection. METHODS PCR was used to detect HBoV1-DNA (HBoV1) and other viruses. A multivariate logistic regression model was used to explore possibility of co-detected for related viruses. RESULTS The positivity rates in Nanjing and Lanzhou were 9.38% (74/789) and 11.62% (161/1386), respectively (P>0.05). The HBoV1 positive group was younger than negative group (P<0.05). Seasonal differences were noted, with a higher frequency of infection in December and July. HBoV1-positive children [72.34% (169/235)] were co-infected with other respiratory viruses. Multifactorial analysis showed no correlations between HBoV1 and the clinical classification, region, gender, age, or treatment as an outpatient or in a hospital. Correlations were identified between HBoV1 infections with ADV (OR=1.53, 95% CI 1.03-2.28), RSV (OR=0.71, 95% CI 0.52-0.98), and IFVA (OR=1.77, 95% CI 1.00-3.13). CONCLUSION Presence of HBoV1 in nasopharyngeal aspirates did not correlate with region or gender, although the prevalence of HBoV1 was higher in younger children. There were no correlations between HBoV1 and other variables, except for the season and ADV, RSV, or IFVA infections.
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Affiliation(s)
- Jian Jun Wu
- School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu, China; National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
| | - Yu Jin
- School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu, China
| | - Na Lin
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
| | - Zhi Ping Xie
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
| | - Jie Mei Yu
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
| | - Jin Song Li
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
| | - Chang Qing Cao
- School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu, China; National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
| | - Xin Hui Yuan
- School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu, China; National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
| | - Jin Rong Song
- School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu, China; National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
| | - Jing Zhang
- School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu, China; National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
| | - Yang Zhao
- School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu, China; National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
| | - Xiao Qian Gao
- School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu, China; National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
| | - Zhao Jun Duan
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing 100052, China
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Ghietto LM, Majul D, Ferreyra Soaje P, Baumeister E, Avaro M, Insfrán C, Mosca L, Cámara A, Moreno LB, Adamo MP. Comorbidity and high viral load linked to clinical presentation of respiratory human bocavirus infection. Arch Virol 2014; 160:117-27. [PMID: 25269520 DOI: 10.1007/s00705-014-2238-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/19/2014] [Indexed: 12/21/2022]
Abstract
Human bocavirus (HBoV) is a new parvovirus associated with acute respiratory tract infection (ARTI). In order to evaluate HBoV significance as an agent of acute respiratory disease, we screened 1,135 respiratory samples from children and adults with and without symptoms during two complete calendar years. HBoV1 prevalence in patients with ARTI was 6.33 % in 2011 and 11.64 % in 2012, including neonatal and adult patients. HBoV1 was also detected in 3.77 % of asymptomatic individuals. The co-detection rate was 78.1 %. Among children, 87 % were clinically diagnosed with lower respiratory infection (no significant differences between patients with and without coinfection), and 31 % exhibited comorbidities. Pediatric patients with comorbidities were significantly older than patients without comorbidities. Patients with ARTI had either high or low viral load, while controls had only low viral load, but there were no clinical differences between patients with high or low viral load. In conclusion, we present evidence of the pathogenic potential of HBoV1 in young children with ARTI. Since patients with HBoV1-single infection are not significantly different from those with coinfection with respect to clinical features, the virus can be as pathogenic by itself as other respiratory agents are. Furthermore, an association between high HBoV1 load and disease could not be demonstrated in this study, but all asymptomatic individuals had low viral loads. Also, children with comorbidities are susceptible to HBoV1 infection at older ages than previously healthy children. Thus, the clinical presentation of infection may occur depending on both viral load and the particular interaction between the HBoV1 and the host.
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Affiliation(s)
- Lucía María Ghietto
- Facultad de Ciencias Médicas, Instituto de Virología "Dr. J. M. Vanella", Universidad Nacional de Córdoba, Calle Enf. Grodillo Gómez S/N, Ciudad Universitaria, CP 5016, Córdoba, Argentina
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15
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Roy Mukherjee T, Chanda S, Mullick S, De P, Dey‐Sarkar M, Chawla‐Sarkar M. Spectrum of respiratory viruses circulating in eastern India: prospective surveillance among patients with influenza-like illness during 2010-2011. J Med Virol 2013; 85:1459-65. [PMID: 23765782 PMCID: PMC7166942 DOI: 10.1002/jmv.23607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 11/07/2022]
Abstract
In developing countries, viruses causing respiratory disease are a major concern of public health. During January 2010-December 2011, 2,737 patients with acute respiratory infection from the outpatient departments as well as patients admitted to hospitals were screened for different respiratory viruses. Nasal and or throat swabs were collected and transported to the laboratory where initial screening of influenza A and influenza B viruses was performed. The samples were tested further for influenza C virus, parainfluenza viruses 1-4, human rhinovirus, metapneumovirus and respiratory syncytial virus by conventional RT- PCR. The study revealed that the majority of the patients were under 5 years of age; both due to their higher susceptibility to respiratory infections and presentation to hospitals. Out of 2,737 patients enrolled in this study, 59% were found positive for one or more respiratory viruses. Influenza B infection was detected in 12% of patients followed by influenza A (11.7%), respiratory syncytial virus (7.1%), parainfluenza virus-2 (6%), metapneumovirus (3%), parainfluenza virus-3 (1%), parainfluenza virus-4 (0.6%), parainfluenza virus-1 (0.3%), influenza C (0.2%) and human rhinovirus (0.2%). Distinct seasonal infection was observed only for influenza A and influenza B viruses.
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Affiliation(s)
| | - Shampa Chanda
- National Institute of Cholera and Enteric DiseasesBeliaghata, KolkataIndia
| | - Satarupa Mullick
- National Institute of Cholera and Enteric DiseasesBeliaghata, KolkataIndia
| | - Papiya De
- National Institute of Cholera and Enteric DiseasesBeliaghata, KolkataIndia
| | - Malay Dey‐Sarkar
- National Institute of Cholera and Enteric DiseasesBeliaghata, KolkataIndia
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16
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Pogka V, Moutousi A, Kossyvakis A, Kalliaropoulos A, Sgouras DN, Giannaki M, Mentis AF. Genetic variability of human metapneumo- and bocaviruses in children with respiratory tract infections. Influenza Other Respir Viruses 2013; 8:107-15. [PMID: 24373295 PMCID: PMC4177804 DOI: 10.1111/irv.12185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2013] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The genotypic analysis of human metapneumo-(HMPV) and boca-(HBoV) viruses circulating in Greece and their comparison to reference and other clinical strains. DESIGN Genetic analysis of representative strains over three consecutive winter seasons of the years 2005-2008. SETTING Representative positive specimens for HMPV and HBoV from paediatric patients of healthcare units and hospitals in Southern Greece with influenza-like illness or other respiratory tract infections. SAMPLE Seven to ten positive specimens for either HMPV or HBoV from each winter period. In total, 24 specimens positive for HMPV and 26 for HBoV, respectively. MAIN OUTCOME MEASURES Sequence diversity of HMPV and HBoV strains by sequencing the complete G and VP1/VP2 genes, respectively. RESULTS In total, 24 HMPV strains were found to have a 92-100% nucleotide and a 85.9-100% amino acid identity. Phylogenetic analysis based on the number of amino acid differences, revealed circulation of 4 different subclusters belonging to genetic lineage B2. Similarly, analysis of 26 HBoV strains indicated that 22 clustered within genotype St2, 2 into genotype St1 and the remaining 2 formed a third cluster derived from potential recombination between different St1 genotype strains. St2 HBoV genotype was observed throughout the whole observation period whereas St1 only during the second and the third winter period. Higher levels of heterogeneity were observed between HMPV compared to HBoV strains. CONCLUSIONS Phylogenetic analysis revealed circulation of one single lineage (B2) for HMPV viruses and predominance of St2 genotype for HBoV viruses. A possible recombination between St1 genotype strains of HBoV was observed.
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Affiliation(s)
- Vasiliki Pogka
- National Influenza Reference Laboratory of Southern Greece, Hellenic Pasteur Institute, Athens, Greece
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17
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Narayanan H, Sankar S, Simoes EAF, Nandagopal B, Sridharan G. Molecular detection of human metapneumovirus and human bocavirus on oropharyngeal swabs collected from young children with acute respiratory tract infections from rural and peri-urban communities in South India. Mol Diagn Ther 2013; 17:107-15. [PMID: 23559038 PMCID: PMC7099897 DOI: 10.1007/s40291-013-0030-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Acute respiratory tract infections (ARTIs) are one of the major causes of morbidity and mortality among young children in developing countries. Information on the incidence of human metapneumovirus (hMPV) and human bocavirus (HBoV) infections in developing countries, especially among rural children, is very limited. Objectives This study was conducted to identify whether these viruses were associated with ARTI among children ≤5 years of age in rural and peri-urban populations in South India. Methods The study was cross-sectional with prospective sample collection. Oropharyngeal swabs were collected from children ≤5 years of age presenting with ARTI. None of the children in this study were known to have any immunosuppressive conditions. The two viruses, hMPV and HBoV, were identified using semi-nested polymerase chain reaction (PCR) assays and one-step PCR assays, respectively. The lower limits of detection of hMPV and HBoV were 6.69 × 105 plasmid copies and 5.77 × 103 plasmid copies, respectively, per 5 μL PCR reaction input. Results The frequency of hMPV infection in children was higher than that of HBoV infection. The different frequencies of hMPV in patients in various age groups with upper and lower respiratory tract infections were compared, and the variance was found to be insignificant. In the 38 children who were hMPV positive, the majority (73.7 %) were from rural communities. The overall hMPV-positive rate was higher in the rural population than in the peri-urban population, but the difference was statistically insignificant. The youngest age at which hMPV-positive status was recorded was 5 months. Conclusion This study demonstrated that hMPV was associated with a significant number (i.e. >10 %) of ARTIs in children in South India, whereas a relatively smaller number of HBoV infections was observed.
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Affiliation(s)
- Harikrishnan Narayanan
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital and Research Centre, Sripuram, Vellore, 632 055 Tamil Nadu India
| | - Sathish Sankar
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital and Research Centre, Sripuram, Vellore, 632 055 Tamil Nadu India
| | - Eric A. F. Simoes
- Department of Pediatrics, Division of Infectious Diseases, The Children’s Hospital, Aurora, CO USA
| | - Balaji Nandagopal
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital and Research Centre, Sripuram, Vellore, 632 055 Tamil Nadu India
| | - Gopalan Sridharan
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital and Research Centre, Sripuram, Vellore, 632 055 Tamil Nadu India
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18
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Ghietto LM, Cámara A, Zhou Y, Pedranti M, Ferreyra S, Frey T, Cámara J, Adamo MP. High prevalence of human bocavirus 1 in infants with lower acute respiratory tract disease in Argentina, 2007-2009. Braz J Infect Dis 2012; 16. [PMID: 22358354 PMCID: PMC7129757 DOI: 10.1016/s1413-8670(12)70272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED Human bocavirus (HBoV) is a parvovirus whose association with respiratory disease is currently under investigation. OBJECTIVE To determine HBoV prevalence in children with lower acute respiratory infection. METHODS We investigated HBoV in 433 nasopharyngeal aspirates collected in 2007-2009 from children 0 to 5 years old hospitalized with bronchiolitis or pneumonia in Córdoba, Argentina. RESULTS The general prevalence of HBoV was 21.5% and the positive cases (HBoV+) were more frequent during winter and spring. The mean age of HBoV+ patients was 6.9 months, with 87.1% of the detections corresponding to infants less than 1 year old (among which the prevalence of HBoV was 26.3% in patients < 3 months of age, 22.1% in 3 to 6 months, 25.3% in 6 to 9 months, and 18.8% in 9 to 12 months). The sequence analysis of the NP1 coding region of 15 isolates showed that all isolates from Cordoba were HBoV1 which exhibited a homology of nearly 100% both among themselves and with the originally discovered virus from 2005. CONCLUSION Overall, our results indicate that HBoV is a significant pathogen that contributes to acute respiratory infection both on its own and during coinfection with other viruses.
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Affiliation(s)
- Lucía María Ghietto
- Instituto de Virología “Dr. J.M. Vanella”, Medical School, Universidad Nacional de Córdoba, Argentina
| | - Alicia Cámara
- Instituto de Virología “Dr. J.M. Vanella”, Medical School, Universidad Nacional de Córdoba, Argentina
| | - Yumei Zhou
- Department of Biology, Georgia State University, Atlanta, USA
| | - Mauro Pedranti
- Instituto de Virología “Dr. J.M. Vanella”, Medical School, Universidad Nacional de Córdoba, Argentina
| | | | - Teryl Frey
- Department of Biology, Georgia State University, Atlanta, USA
| | - Jorge Cámara
- Instituto de Virología “Dr. J.M. Vanella”, Medical School, Universidad Nacional de Córdoba, Argentina
| | - Maria Pilar Adamo
- Instituto de Virología “Dr. J.M. Vanella”, Medical School, Universidad Nacional de Córdoba, Argentina,Corresponding author at: Calle Enf. Grodillo Gómez S/N, Ciudad Universitaria, CP 5016, Córdoba, Argentina
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19
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Guido M, Quattrocchi M, Campa A, Zizza A, Grima P, Romano A, De Donno A. Human metapneumovirus and human bocavirus associated with respiratory infection in Apulian population. Virology 2011; 417:64-70. [PMID: 21636105 PMCID: PMC7173056 DOI: 10.1016/j.virol.2011.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 04/04/2011] [Accepted: 04/25/2011] [Indexed: 01/11/2023]
Abstract
We have studied the occurrence of hBoV, hMPV and InfA-B in an Apulian population with respiratory tract infections. During influenza season 2008-2009, 116 oropharingeal swabs were collected from patients affected by Influenza-Like Illness (ILI). The PCR products of hMPV M and HBoV NP-1 genes were sequenced. 78 out of 116 samples were positive for at least one respiratory virus; hBoV was detected in 53, hMPV in 22 and InfA-B in 41 out of 116 swabs. A high rate of hBoV infection in adult (18.9%) and elderly (26.4%) subjects was found. The co-infection rate was higher for hMPV (18/22 cases, 81.8%) compared to hBoV (26/53 cases, 49.1%), and InfA-B (25/41 cases, 61.0%). Co-infections were common in children. hBoV positive samples shared a high level of genetic similarity with the hBoV1 genotype, and hMPV positive samples clustered with A2 subgroup. Our results suggest that hBoV and hMPV play a role in ILI.
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Affiliation(s)
- M. Guido
- Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, Faculty of Sciences, University of Salento, Lecce, Italy,Corresponding author. Fax: + 39 832 298626
| | - M. Quattrocchi
- Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, Faculty of Sciences, University of Salento, Lecce, Italy
| | - A. Campa
- Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, Faculty of Sciences, University of Salento, Lecce, Italy
| | - A. Zizza
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - P. Grima
- Division of Infectious Diseases, HIV Center, S. Caterina Novella Hospital, Galatina, Lecce, Italy
| | - A. Romano
- Laboratory of General Physiology, Department of Biological and Environmental Sciences and Technologies, Faculty of Sciences, University of Salento, Lecce, Italy
| | - A. De Donno
- Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, Faculty of Sciences, University of Salento, Lecce, Italy
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