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Eccles R. Common cold. FRONTIERS IN ALLERGY 2023; 4:1224988. [PMID: 37426629 PMCID: PMC10324571 DOI: 10.3389/falgy.2023.1224988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
The common cold is a unique human disease, as it is arguably the most common disease and because of the large number of respiratory viruses causing colds it is one of the most complex of human diseases. This review discusses the respiratory viruses and notes that all these viruses may cause the illness complex recognised as the common cold. The common cold is discussed as part of the "iceberg concept" of disease which ranges from asymptomatic infection to severe illness and death. The factors influencing the incidence of colds are discussed: crowding and sociability, stress, smoking and alcohol, immune status, sex, age, sleep, season, chilling, nutrition and exercise. The mechanism of symptoms related to the innate immune response is explained and symptomatic treatments are tabulated. Morbidity associated with common cold is discussed and possible vaccines.
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Hawks SA, Prussin AJ, Kuchinsky SC, Pan J, Marr LC, Duggal NK. Infectious SARS-CoV-2 Is Emitted in Aerosol Particles. mBio 2021; 12:e0252721. [PMID: 34663099 PMCID: PMC8524342 DOI: 10.1128/mbio.02527-21] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/23/2021] [Indexed: 01/10/2023] Open
Abstract
Respiratory viruses such as SARS-CoV-2 are transmitted in respiratory droplets and aerosol particles, which are released during talking, breathing, coughing, and sneezing. Noncontact transmission of SARS-CoV-2 has been demonstrated, suggesting transmission via virus carried through the air. Here, we demonstrate that golden Syrian hamsters produce infectious SARS-CoV-2 in aerosol particles prior to and concurrent with the onset of mild clinical signs of disease. The average emission rate in this study was 25 infectious virions/hour on days 1 and 2 postinoculation, with average viral RNA levels 200-fold higher than infectious virus in aerosol particles. The majority of virus was contained within particles <5 μm in size. Thus, we provide direct evidence that, in hamsters, SARS-CoV-2 is an airborne virus. IMPORTANCE SARS-CoV-2 is a respiratory virus and has been isolated from the air near COVID-19 patients. Here, using a hamster model of infection, we demonstrate that SARS-CoV-2 is emitted in aerosol particles prior to and concurrent with the onset of mild disease. Virus is contained primarily within aerosol particles <5 μm in size, which can remain airborne and be inhaled. These findings indicate that SARS-CoV-2 is an airborne virus and support the use of ventilation to reduce SARS-CoV-2 transmission.
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Affiliation(s)
- Seth A. Hawks
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Aaron J. Prussin
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Sarah C. Kuchinsky
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Jin Pan
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Linsey C. Marr
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Nisha K. Duggal
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
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Adigal SS, Rayaroth NV, John RV, Pai KM, Bhandari S, Mohapatra AK, Lukose J, Patil A, Bankapur A, Chidangil S. A review on human body fluids for the diagnosis of viral infections: scope for rapid detection of COVID-19. Expert Rev Mol Diagn 2021; 21:31-42. [PMID: 33523770 DOI: 10.1080/14737159.2021.1874355] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: The unprecedented outbreaks of corona virus disease of 2019 (COVID-19) have highlighted the necessity of readily available, reliable, precise, and faster techniques for its detection. Nasopharyngeal swab has been the gold standard for the diagnosis of COVID-19. However, it is not an ideal screening procedure for massive screening as it implicates the patient's stay in the hospital or at home until diagnosis, thus causing crowding of the specimen at the diagnostic centers. Present study deal with the exploration of potential application of different body fluids using certain highly objective techniques (Optical and e-Nose) for faster detection of molecular markers thereby diagnosing viral infections.Areas covered: This report presents an evaluation of different body fluids, and their advantages for the rapid detection of COVID-19, coupled with highly sensitive optical techniques for the detection of molecular biomarkers.Expert opinion: Tears, saliva, and breath samples can provide valuable information about viral infections. Our brief review strongly recommends the application of saliva/tears and exhaled breath as clinical samples using technics such as high-performance liquid chromatography-laser-induced fluorescence, photoacoustic spectroscopy, and e-Nose, respectively, for the fast diagnosis of viral infections.
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Affiliation(s)
- Sphurti S Adigal
- Centre of Excellence for Biophotonics, Department of Atomic and Molecular Physics, Manipal Academic of Higher Education, Manipal, India
| | - Nidheesh V Rayaroth
- Centre of Excellence for Biophotonics, Department of Atomic and Molecular Physics, Manipal Academic of Higher Education, Manipal, India
| | - Reena V John
- Centre of Excellence for Biophotonics, Department of Atomic and Molecular Physics, Manipal Academic of Higher Education, Manipal, India
| | - Keerthilatha M Pai
- Department Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academic of Higher Education, Manipal, Karnataka, India
| | - Sulatha Bhandari
- Department of Ophthalmology, Kasturba Medical College, Manipal, Manipal Academic of Higher Education, Manipal, Karnataka, India
| | - Aswini Kumar Mohapatra
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academic of Higher Education, Manipal, Karnataka, India
| | - Jijo Lukose
- Centre of Excellence for Biophotonics, Department of Atomic and Molecular Physics, Manipal Academic of Higher Education, Manipal, India
| | - Ajeetkumar Patil
- Centre of Excellence for Biophotonics, Department of Atomic and Molecular Physics, Manipal Academic of Higher Education, Manipal, India
| | - Aseefhali Bankapur
- Centre of Excellence for Biophotonics, Department of Atomic and Molecular Physics, Manipal Academic of Higher Education, Manipal, India
| | - Santhosh Chidangil
- Centre of Excellence for Biophotonics, Department of Atomic and Molecular Physics, Manipal Academic of Higher Education, Manipal, India
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4
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Jartti T, Liimatainen U, Xepapadaki P, Vahlberg T, Bachert C, Finotto S, Kowalski ML, Sobanska A, Lukkarinen H, Pasioti M, Vuorinen T, Zhang N, Zimmermann T, Papadopoulos NG. Clinical correlates of rhinovirus infection in preschool asthma. Allergy 2021; 76:247-254. [PMID: 32621330 PMCID: PMC7818397 DOI: 10.1111/all.14479] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/06/2020] [Accepted: 06/16/2020] [Indexed: 12/15/2022]
Abstract
Background Investigation of preschool asthma is important since not all children outgrow their illness during this age. Data are scarce on the role of rhinovirus (RV) infections in this patient group. Objectives To investigate the role of RV infections in preschool asthma: (i) susceptibility factors, (ii) clinical course, and (iii) medium‐term outcome. Methods A total of 130 asthmatic children aged 4‐6 years from the multinational PreDicta cohort were prospectively followed for a 12‐month period. Allergy tests and a standard health questionnaire were carried out at study entry. Respiratory virus presence in nasopharyngeal washes was studied at illness visits and at 3 scheduled visits. Results At study entry, mean age of the children was 5.3 years. Of 571 visits, 54% were positive for any virus and 39% for RV. Patient characteristics were only assessed with RV infection due to low number of other viruses. The use of supplementary vitamin D was inversely associated with RV infection (P < .05). RV infection was associated with more severe course of acute illness in terms of more severe nighttime coughing, more sleep disturbances, and more days with runny nose (all P < .05). RV infection was also associated with more severe disease course during the 12‐month follow‐up in terms of more nights with awakenings and more days of exercise‐related symptoms (both P < .05). Conclusions Vitamin D supplementation may have an anti‐rhinovirus effect. Both short‐ and medium‐term outcomes suggest RV infection to be an important clinical marker of instable preschool asthma.
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Affiliation(s)
- Tuomas Jartti
- Department of Pediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
| | - Unna Liimatainen
- Department of Pediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
| | - Paraskevi Xepapadaki
- Allergy Department 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
| | - Tero Vahlberg
- Department of Biostatistics University of Turku Turku Finland
| | - Claus Bachert
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - Susetta Finotto
- Department of Molecular Pneumology Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Universitätsklinikum Erlangen Erlangen Germany
| | - Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy Central University Hospital Lodz Poland
| | - Anna Sobanska
- Department of Immunology, Rheumatology and Allergy Central University Hospital Lodz Poland
| | - Heikki Lukkarinen
- Department of Pediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
| | - Maria Pasioti
- Allergy Department 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
| | - Tytti Vuorinen
- Department of Clinical Microbiology Turku University Hospital and Institute of Biomedicine University of Turku Turku Finland
| | - Nan Zhang
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - Theodor Zimmermann
- Department of Pediatrics and Adolescent Medicine Department of Allergy and Pneumology Children's Hospital Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Universitätsklinikum Erlangen Erlangen Germany
| | - Nikolaos G Papadopoulos
- Allergy Department 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
- Division of Infection, Immunity & Respiratory Medicine University of Manchester Manchester UK
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Fennelly KP. Particle sizes of infectious aerosols: implications for infection control. THE LANCET. RESPIRATORY MEDICINE 2020; 8:914-924. [PMID: 32717211 PMCID: PMC7380927 DOI: 10.1016/s2213-2600(20)30323-4] [Citation(s) in RCA: 320] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
The global pandemic of COVID-19 has been associated with infections and deaths among health-care workers. This Viewpoint of infectious aerosols is intended to inform appropriate infection control measures to protect health-care workers. Studies of cough aerosols and of exhaled breath from patients with various respiratory infections have shown striking similarities in aerosol size distributions, with a predominance of pathogens in small particles (<5 μm). These are immediately respirable, suggesting the need for personal respiratory protection (respirators) for individuals in close proximity to patients with potentially virulent pathogens. There is no evidence that some pathogens are carried only in large droplets. Surgical masks might offer some respiratory protection from inhalation of infectious aerosols, but not as much as respirators. However, surgical masks worn by patients reduce exposures to infectious aerosols to health-care workers and other individuals. The variability of infectious aerosol production, with some so-called super-emitters producing much higher amounts of infectious aerosol than most, might help to explain the epidemiology of super-spreading. Airborne infection control measures are indicated for potentially lethal respiratory pathogens such as severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Kevin P Fennelly
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ, Hau BJP, Yen HL, Li Y, Ip DKM, Peiris JSM, Seto WH, Leung GM, Milton DK, Cowling BJ. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med 2020. [PMID: 32371934 DOI: 10.21203/rs.3.rs-16836/v1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
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Affiliation(s)
- Nancy H L Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Daniel K W Chu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Eunice Y C Shiu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kwok-Hung Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - James J McDevitt
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Benien J P Hau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Hui-Ling Yen
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Dennis K M Ip
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - J S Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing-Hong Seto
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Pathology, Hong Kong Baptist Hospital, Hong Kong, China
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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7
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Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med 2020; 26:676-680. [PMID: 32371934 DOI: 10.1038/s41591-020-0843-2] [Citation(s) in RCA: 1292] [Impact Index Per Article: 323.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/20/2020] [Indexed: 12/28/2022]
Abstract
We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
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8
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Howard E, Orhurhu V, Huang L, Guthrie B, Phipatanakul W. The Impact of Ambient Environmental Exposures to Microbial Products on Asthma Outcomes from Birth to Childhood. Curr Allergy Asthma Rep 2019; 19:59. [PMID: 31781873 PMCID: PMC7088961 DOI: 10.1007/s11882-019-0890-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose of Review Asthma is a chronic respiratory condition with increasing domestic and worldwide prevalence that burdens individuals and the healthcare system with high costs associated with long-term treatments and acute emergency room (ER) visits. It can be triggered by ambient microbes, including bacteria, viruses, and fungi. In this review, we examine the outcomes of asthma patients in relation to environmental exposures to ambient microbe products, focusing on whether exposure leads to asthma development from birth to childhood and if particular microbes are associated with worsened asthma exacerbations. Recent Findings Bacterial endotoxin is more prominent in homes with pets and may cause cytokine cascades that lead to asthma exacerbation. However, some studies have demonstrated a protective effect with early exposure. Patients with positive Aspergillus skin testing are more prone to moderate-severe or severe-uncontrolled asthma. Fungal sensitization is also associated with earlier onset of asthma and demonstrates a dose-dependent relationship of symptom severity and duration. Among viruses, rhinovirus has the greatest association with decreased lung function, severe asthma, and asthma-related hospital admissions. Distribution of microbial products and associated asthma symptoms depends on the geographical climate. Genetic variations among individuals also mitigate the effects of microbial products on asthma development and symptom severity. Summary Microbial products of bacteria, fungi, and viruses are associated with the development of asthma, more severe asthma symptoms, and worse outcomes. However, some early exposure studies have also demonstrated a protective effect. Bacterial and fungal products are related to decreased lung function and earlier onset of asthma. Viral products are related to asthma-associated hospital admissions; and the climate and patient genetics can also temper or intensify the relationships between microbial products, asthma development, and asthma symptom severity. Further research should focus on the effects of early microbe exposure and its interaction with human immune systems and asthma-related outcomes.
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Affiliation(s)
- Evin Howard
- Bouvé College of Health Sciences, Graduate School of Nursing, Northeastern University, Boston, MA, USA
| | - Vwaire Orhurhu
- Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Huang
- Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Barbara Guthrie
- Bouvé College of Health Sciences, Graduate School of Nursing, Northeastern University, Boston, MA, USA
| | - Wanda Phipatanakul
- Division of Asthma, Allergy, & Immunology, Harvard Medical School, Children's Hospital Boston, Boston, MA, USA.
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Walker GJ, Stelzer-Braid S, Shorter C, Honeywill C, Wynn M, Willenborg C, Barnes P, Kang J, Pierse N, Crane J, Howden-Chapman P, Rawlinson WD. Viruses associated with acute respiratory infection in a community-based cohort of healthy New Zealand children. J Med Virol 2019; 94:454-460. [PMID: 31017663 PMCID: PMC7228279 DOI: 10.1002/jmv.25493] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/16/2022]
Abstract
Acute respiratory infections (ARIs) are a major cause of morbidity among children. Respiratory viruses are commonly detected in both symptomatic and asymptomatic periods. The rates of infection and community epidemiology of respiratory viruses in healthy children needs further definition to assist interpretation of molecular diagnostic assays in this population. Children otherwise healthy aged 1 to 8 years were prospectively enrolled in the study during two consecutive winters, when ARIs peak in New Zealand. Parents completed a daily symptom diary for 8 weeks, during which time they collected a nasal swab from the child for each clinical ARI episode. A further nasal swab was collected by research staff during a clinic visit at the conclusion of the study. All samples were tested for 15 respiratory viruses commonly causing ARI using molecular multiplex polymerase chain reaction assays. There were 575 ARIs identified from 301 children completing the study, at a rate of 1.04 per child‐month. Swabs collected during an ARI were positive for a respiratory virus in 76.8% (307 of 400), compared with 37.3% (79 of 212) of swabs collected during asymptomatic periods. The most common viruses detected were human rhinovirus, coronavirus, parainfluenza viruses, influenzavirus, respiratory syncytial virus, and human metapneumovirus. All of these were significantly more likely to be detected during ARIs than asymptomatic periods. Parent‐administered surveillance is a useful mechanism for understanding infectious disease in healthy children in the community. Interpretation of molecular diagnostic assays for viruses must be informed by understanding of local rates of asymptomatic infection by such viruses. During winter, children experienced acute respiratory infections at a rate of 1.04/month. A virus was detected in 76.8% of acute respiratory infections. Specific viruses are more likely to be associated with respiratory symptoms.
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Affiliation(s)
- Gregory J Walker
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sacha Stelzer-Braid
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Caroline Shorter
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Claire Honeywill
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Matthew Wynn
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Christiana Willenborg
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Phillipa Barnes
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Janice Kang
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - William D Rawlinson
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Serology and Virology Division, South Eastern Area Laboratory Services Microbiology, Prince of Wales Hospital, Sydney, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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10
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Lewis TC, Metitiri EE, Mentz GB, Ren X, Goldsmith AM, Eder BN, Wicklund KE, Walsh MP, Comstock AT, Ricci JM, Brennan SR, Washington GL, Owens KB, Mukherjee B, Robins TG, Batterman SA, Hershenson MB. Impact of community respiratory viral infections in urban children with asthma. Ann Allergy Asthma Immunol 2018; 122:175-183.e2. [PMID: 30385348 PMCID: PMC6360098 DOI: 10.1016/j.anai.2018.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/13/2018] [Accepted: 10/21/2018] [Indexed: 12/13/2022]
Abstract
Background Upper respiratory tract viral infections cause asthma exacerbations in children. However, the impact of natural colds on children with asthma in the community, particularly in the high-risk urban environment, is less well defined. Objective We hypothesized that children with high-symptom upper respiratory viral infections have reduced airway function and greater respiratory tract inflammation than children with virus-positive low-symptom illnesses or virus-negative upper respiratory tract symptoms. Methods We studied 53 children with asthma from Detroit, Michigan, during scheduled surveillance periods and self-reported respiratory illnesses for 1 year. Symptom score, spirometry, fraction of exhaled nitric oxide (FeNO), and nasal aspirate biomarkers, and viral nucleic acid and rhinovirus (RV) copy number were assessed. Results Of 658 aspirates collected, 22.9% of surveillance samples and 33.7% of respiratory illnesses were virus-positive. Compared with the virus-negative asymptomatic condition, children with severe colds (symptom score ≥5) showed reduced forced expiratory flow at 25% to 75% of the pulmonary volume (FEF25%-75%), higher nasal messenger RNA expression of C-X-C motif chemokine ligand (CXCL)-10 and melanoma differentiation-associated protein 5, and higher protein abundance of CXCL8, CXCL10 and C-C motif chemokine ligands (CCL)-2, CCL4, CCL20, and CCL24. Children with mild (symptom score, 1-4) and asymptomatic infections showed normal airway function and fewer biomarker elevations. Virus-negative cold-like illnesses demonstrated increased FeNO, minimal biomarker elevation, and normal airflow. The RV copy number was associated with nasal chemokine levels but not symptom score. Conclusion Urban children with asthma with high-symptom respiratory viral infections have reduced FEF25%-75% and more elevations of nasal biomarkers than children with mild or symptomatic infections, or virus-negative illnesses.
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Affiliation(s)
- Toby C Lewis
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan; Department of Health Behavior/Health Education, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Ediri E Metitiri
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Graciela B Mentz
- Department of Health Behavior/Health Education, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Xiaodan Ren
- Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Adam M Goldsmith
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Breanna N Eder
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kyra E Wicklund
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Megan P Walsh
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Adam T Comstock
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jeannette M Ricci
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sean R Brennan
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ginger L Washington
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kendall B Owens
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Thomas G Robins
- Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Stuart A Batterman
- Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Marc B Hershenson
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan.
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11
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Alsuwaidi AR, Alkalbani AM, Alblooshi A, George J, Albadi G, Kamal SM, Narchi H, Souid AK. Nasopharyngeal isolates and their clinical impact on young children with asthma: a pilot study. J Asthma Allergy 2018; 11:233-243. [PMID: 30254474 PMCID: PMC6140756 DOI: 10.2147/jaa.s169966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Respiratory infections have significant effects on childhood asthma. Viral respiratory infections, such as rhinovirus and respiratory syncytial virus are likely to be important in the development and exacerbation of asthma. In this study, we investigated the nasopharyngeal colonization in children with asthma to determine the prevalence of pathogens and their contribution to respiratory symptoms and airway resistance during winter. Methods From December 2016 to March 2017, 50 nasopharyngeal specimens were collected from 18 patients (age, 5.0±1.1 years) with asthma and 9 specimens from 9 control children (age, 4.9±1.0 years). Samples were tested for 19 viruses and 7 bacteria, using multiplex real-time PCR. Respiratory disease markers included the Global Asthma Network Questionnaire, the Common-Cold Questionnaire, the Global Initiative for Asthma assessment of asthma control, and the airway resistance at 5 Hz by forced-oscillation technique. Results The most commonly isolated organisms in both groups (patients and controls) were Streptococcus pneumoniae, Haemophilus influenzae, and rhinovirus. Most patients had multiple isolates (median, 3.5; range, 1-5), which changed during the study period. Types of isolates were 4 bacteria (S. pneumoniae, H. influenzae, Bordetella pertussis, and Bordetella parapertussis) and 6 viruses (rhinovirus, enterovirus, metapneumovirus, adenovirus, coronaviruses, and parainfluenza viruses). Similar isolates, including influenza A-H3 virus and bocavirus, were detected in the controls. Of the 9 patients with "wheezing disturbing sleep ≥1 per week", 6 had rhinovirus, 2 coronaviruses, and 1 no detectable viruses. Patients with mild common cold symptoms had significantly higher airway resistance at 5 Hz z-score (P=0.025). Conclusion Multiple respiratory pathogens were isolated from many patients with asthma, which appeared to contribute to disease symptoms and airway resistance. Minimizing children's exposure to respiratory pathogens might be beneficial, especially during winter.
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Affiliation(s)
- Ahmed R Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates,
| | - Alia M Alkalbani
- Tawam Hospital, Abu Dhabi Health Services Company (SEHA), Al Ain, United Arab Emirates
| | - Afaf Alblooshi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates,
| | - Junu George
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates,
| | - Ghaya Albadi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates,
| | - Salwa M Kamal
- Ambulatory Healthcare Services, SEHA, Abu Dhabi, United Arab Emirates
| | - Hassib Narchi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates,
| | - Abdul-Kader Souid
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates,
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12
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Egilmezer E, Walker GJ, Bakthavathsalam P, Peterson JR, Gooding JJ, Rawlinson W, Stelzer-Braid S. Systematic review of the impact of point-of-care testing for influenza on the outcomes of patients with acute respiratory tract infection. Rev Med Virol 2018; 28:e1995. [PMID: 30101552 PMCID: PMC7169080 DOI: 10.1002/rmv.1995] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 12/23/2022]
Abstract
Acute respiratory tract infections are a major cause of morbidity and mortality and represent a significant burden on the health care system. Laboratory testing is required to definitively distinguish infecting influenza virus from other pathogens, resulting in prolonged emergency department (ED) visits and unnecessary antibiotic use. Recently available rapid point-of-care tests (POCT) may allow for appropriate use of antiviral and antibiotic treatments and decrease patient lengths of stay. We undertook a systematic review to assess the effect of POCT for influenza on three outcomes: (1) antiviral prescription, (2) antibiotic prescription, and (3) patient length of stay in the ED. The databases Medline and Embase were searched using MeSH terms and keywords for influenza, POCT, antivirals, antibiotics, and length of stay. Amongst 245 studies screened, 30 were included. The majority of papers reporting on antiviral prescription found that a positive POCT result significantly increased use of antivirals for influenza compared with negative POCT results and standard supportive care. A positive POCT result also led to decreased antibiotic use. The results of studies assessing the effect of POCT on ED length of stay were not definitive. The studies assessed in this systematic review support the use of POCT for diagnosis of influenza in patients suffering an acute respiratory infection. Diagnosis using POCT may lead to more appropriate prescription of treatments for infectious agents. Further studies are needed to assess the effect of POCT on the length of stay in ED.
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Affiliation(s)
- Ece Egilmezer
- Virology Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Gregory J Walker
- Virology Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Padmavathy Bakthavathsalam
- Australian Centre for NanoMedicine and School of Chemistry, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
| | - Joshua R Peterson
- Australian Centre for NanoMedicine and School of Chemistry, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
| | - J Justin Gooding
- Australian Centre for NanoMedicine and School of Chemistry, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
| | - William Rawlinson
- Virology Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia.,School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Sacha Stelzer-Braid
- Virology Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia.,School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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13
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Lethbridge R, Prastanti F, Robertson C, Oo S, Khoo SK, Le Souëf PN, Laing IA. Prospective Assessment of Rhinovirus Symptoms and Species Recurrence in Children With and Without an Acute Wheezing Exacerbation. Viral Immunol 2018; 31:299-305. [PMID: 29446705 DOI: 10.1089/vim.2017.0152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To assess if the difference in species-specific immune response to RV-C correlates with a higher frequency of reinfection, shorter time to reinfection, or different symptom severity than infections with RV-A or RV-B. Forty-three patients were enrolled of which 34 were successfully tracked longitudinally over 3 months, with nasal swabs and symptom questionnaires provided every 2 weeks to identify rhinovirus (RV) strains and the concurrent symptomatology. No difference was found in the time to reinfection with an RV species between RV-C and RV-A or RV-B (p = 0.866). There was a trend toward more rapid reinfection with the same species in RV-C than RV-A (55.1 days vs. 67.9 days), but this failed to reach statistical significance (p = 0.105). RV infections were generally associated with only minor symptoms, with rhinorrhea being the only significantly associated symptom (p = 0.01). RV-C was shown to have higher levels of lethargy and wheeze than other RV species. Time to reinfection with subsequent RV is not influenced by the species of the preceding RV.
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Affiliation(s)
- Robert Lethbridge
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Franciska Prastanti
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Cassandra Robertson
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Stephen Oo
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Siew-Kim Khoo
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Peter N Le Souëf
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
| | - Ingrid A Laing
- School of Paediatrics and Child Health, University of Western Australia , Perth, Australia
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14
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Zheng SY, Wang LL, Ren L, Luo J, Liao W, Liu EM. Epidemiological analysis and follow-up of human rhinovirus infection in children with asthma exacerbation. J Med Virol 2017; 90:219-228. [PMID: 28500687 PMCID: PMC7167043 DOI: 10.1002/jmv.24850] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 04/19/2017] [Indexed: 12/20/2022]
Abstract
To determine the prevalence of human rhinovirus (HRV) infection in children with acute asthma exacerbations, investigation of HRV viral load and severity of asthma exacerbations is also required. Nasopharyngeal aspirates and swabs were collected and assessed for respiratory viruses. HRV-positive samples were sequenced to identify types and determine viral load. Outpatients with asthma exacerbations underwent follow-up evaluations, their swabs were collected and clinical outcomes were recorded at their next clinic visit 4 weeks later. One hundred forty-three inpatients and 131 outpatients, including 88 patients with asthma exacerbations and 43 controls with stable asthma were recruited. HRV-A was mainly detected in September and February (45.5% and 33.3%, respectively), while HRV-C was mainly detected in November and April (70.0% and 55.6%, respectively). HRV-C was the primary type and was primarily found in inpatients with severe asthma exacerbations. HRV-A viral load in the group of inpatients with severe exacerbations was higher than in the mild and moderate groups (P < 0.001 and P = 0.022). The HRV-A viral load of both inpatients and outpatients was higher than that of HRV-C (P < 0.001 and P = 0.036). The main genotypes were HRV-C53 and HRV-A20 among inpatients, and this genotype caused more severe clinical manifestations. HRV persisted for no more than 4 weeks, and their symptoms or signs of disease were well-controlled well. HRV-C was most frequently detected in asthma exacerbations. HRV-A with high viral load led to severe asthma exacerbations.
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Affiliation(s)
- Shou-Yan Zheng
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li-Li Wang
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Luo Ren
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jian Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Liao
- Department of Pediatrics, Southwest Hospital of The Third Military Medical University, Chongqing, China
| | - En-Mei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
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15
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Kast JI, McFarlane AJ, Głobińska A, Sokolowska M, Wawrzyniak P, Sanak M, Schwarze J, Akdis CA, Wanke K. Respiratory syncytial virus infection influences tight junction integrity. Clin Exp Immunol 2017; 190:351-359. [PMID: 28856667 DOI: 10.1111/cei.13042] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 12/26/2022] Open
Abstract
Respiratory syncytial virus (RSV) is an important risk factor of asthma development and is responsible for severe respiratory tract infections. However, the influence of RSV infection on barrier function of bronchial epithelial cells in vitro and in vivo is still unclear. The aim of this study was to analyse the role of RSV in tight junction (TJ) regulation and to compare epithelial integrity between asthmatic and healthy individuals upon RSV infection. Healthy and asthmatic human bronchial epithelial cells (HBECs) were differentiated at air-liquid interface (ALI) and infected with RSV and ultraviolet (UV)-irradiated RSV. TJ expression and their integrity were analysed by quantitative polymerase chain reaction (qPCR), transepithelial resistance (TER) and paracellular flux. To determine the effect in vivo, BALB/c mice were infected intranasally with RSV or UV-irradiated RSV A2. Bronchoalveolar lavage and TJ integrity were analysed on days 1, 2, 4 and 6 post-infection by qPCR, bioplex and confocal microscopy. RSV increased barrier integrity in ALI cultures of HBEC from healthy subjects, but no effect was found in HBECs from asthmatics. This was not associated with an increase in TJ mRNA expression. In vivo, RSV induced lung inflammation in mice and down-regulated claudin-1 and occludin mRNA expression in whole lungs. Surprisingly, RSV infection was not observed in bronchial epithelial cells, but was found in the lung parenchyma. Decreased expression of occludin upon RSV infection was visible in mouse bronchial epithelial cells in confocal microscopy. However, there was no regulation of claudin-1 and claudin-7 at protein level.
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Affiliation(s)
- J I Kast
- Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos, Switzerland.,CK-CARE, Christine Kühne Center of Allergy Research and Education, Davos, Switzerland
| | - A J McFarlane
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - A Głobińska
- Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos, Switzerland.,CK-CARE, Christine Kühne Center of Allergy Research and Education, Davos, Switzerland.,Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland
| | - M Sokolowska
- Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos, Switzerland.,CK-CARE, Christine Kühne Center of Allergy Research and Education, Davos, Switzerland
| | - P Wawrzyniak
- Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos, Switzerland.,CK-CARE, Christine Kühne Center of Allergy Research and Education, Davos, Switzerland
| | - M Sanak
- Department of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - J Schwarze
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.,Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos, Switzerland.,CK-CARE, Christine Kühne Center of Allergy Research and Education, Davos, Switzerland
| | - K Wanke
- Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos, Switzerland.,CK-CARE, Christine Kühne Center of Allergy Research and Education, Davos, Switzerland
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16
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Liu AH, Anderson WC, Dutmer CM, Searing DA, Szefler SJ. Advances in asthma 2015: Across the lifespan. J Allergy Clin Immunol 2017; 138:397-404. [PMID: 27497278 DOI: 10.1016/j.jaci.2016.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 12/19/2022]
Abstract
In 2015, progress in understanding asthma ranged from insights to asthma inception, exacerbations, and severity to advancements that will improve disease management throughout the lifespan. 2015's insights to asthma inception included how the intestinal microbiome affects asthma expression with the identification of specific gastrointestinal bacterial taxa in early infancy associated with less asthma risk, possibly by promoting regulatory immune development at a critical early age. The relevance of epigenetic mechanisms in regulating asthma-related gene expression was strengthened. Predicting and preventing exacerbations throughout life might help to reduce progressive lung function decrease and disease severity in adulthood. Although allergy has long been linked to asthma exacerbations, a mechanism through which IgE impairs rhinovirus immunity and underlies asthma exacerbations was demonstrated and improved by anti-IgE therapy (omalizumab). Other key molecular pathways underlying asthma exacerbations, such as cadherin-related family member 3 (CDHR3) and orosomucoid like 3 (ORMDL3), were elucidated. New anti-IL-5 therapeutics, mepolizumab and reslizumab, were US Food and Drug Administration approved for the treatment of patients with severe eosinophilic asthma. In a clinical trial the novel therapeutic inhaled GATA3 mRNA-specific DNAzyme attenuated early- and late-phase allergic responses to inhaled allergen. These current findings are significant steps toward addressing unmet needs in asthma prevention, severity modification, disparities, and lifespan outcomes.
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Affiliation(s)
- Andrew H Liu
- Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
| | - William C Anderson
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Cullen M Dutmer
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Daniel A Searing
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Stanley J Szefler
- Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
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17
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Stelzer-Braid S, Liu N, Doumit M, D'Cunha R, Belessis Y, Jaffe A, Rawlinson WD. Association of rhinovirus with exacerbations in young children affected by cystic fibrosis: Preliminary data. J Med Virol 2017; 89:1494-1497. [PMID: 28213960 DOI: 10.1002/jmv.24794] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/09/2017] [Indexed: 11/10/2022]
Abstract
Rhinovirus (RV) is a common respiratory viral infection linked to worsening of chronic respiratory diseases including cystic fibrosis (CF) and asthma. RV was tested by RT-PCR in samples (n = 465) collected from the upper (nasal swab, oropharyngeal suction, and sputum) and lower (bronchoalveolar washings) respiratory tract of 110 children with CF. Air samples (n = 52) collected from the operating theatres and outpatient clinics were tested for RV. RV was found in 43% of children <5 years suffering an exacerbation, and 12% of older children (5-17 years). RV particles were detected in the air of clinic rooms. Detection of RV is important in better understanding viral infections in patients with CF.
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Affiliation(s)
- Sacha Stelzer-Braid
- Virology Research Laboratory, Prince of Wales Hospital, New South Wales, Australia.,Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Nancy Liu
- Virology Research Laboratory, Prince of Wales Hospital, New South Wales, Australia.,Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Michael Doumit
- Sydney Children's Hospital, New South Wales, Australia.,Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Russell D'Cunha
- Virology Research Laboratory, Prince of Wales Hospital, New South Wales, Australia.,Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Yvonne Belessis
- Sydney Children's Hospital, New South Wales, Australia.,Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Adam Jaffe
- Sydney Children's Hospital, New South Wales, Australia.,Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - William D Rawlinson
- Virology Research Laboratory, Prince of Wales Hospital, New South Wales, Australia.,Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
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18
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Wesolowska-Andersen A, Everman JL, Davidson R, Rios C, Herrin R, Eng C, Janssen WJ, Liu AH, Oh SS, Kumar R, Fingerlin TE, Rodriguez-Santana J, Burchard EG, Seibold MA. Dual RNA-seq reveals viral infections in asthmatic children without respiratory illness which are associated with changes in the airway transcriptome. Genome Biol 2017; 18:12. [PMID: 28103897 PMCID: PMC5244706 DOI: 10.1186/s13059-016-1140-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/16/2016] [Indexed: 12/01/2022] Open
Abstract
Background Respiratory illness caused by viral infection is associated with the development and exacerbation of childhood asthma. Little is known about the effects of respiratory viral infections in the absence of illness. Using quantitative PCR (qPCR) for common respiratory viruses and for two genes known to be highly upregulated in viral infections (CCL8/CXCL11), we screened 92 asthmatic and 69 healthy children without illness for respiratory virus infections. Results We found 21 viral qPCR-positive and 2 suspected virus-infected subjects with high expression of CCL8/CXCL11. We applied a dual RNA-seq workflow to these subjects, together with 25 viral qPCR-negative subjects, to compare qPCR with sequencing-based virus detection and to generate the airway transcriptome for analysis. RNA-seq virus detection achieved 86% sensitivity when compared to qPCR-based screening. We detected additional respiratory viruses in the two CCL8/CXCL11-high subjects and in two of the qPCR-negative subjects. Viral read counts varied widely and were used to stratify subjects into Virus-High and Virus-Low groups. Examination of the host airway transcriptome found that the Virus-High group was characterized by immune cell airway infiltration, downregulation of cilia genes, and dampening of type 2 inflammation. Even the Virus-Low group was differentiated from the No-Virus group by 100 genes, some involved in eIF2 signaling. Conclusions Respiratory virus infection without illness is not innocuous but may determine the airway function of these subjects by driving immune cell airway infiltration, cellular remodeling, and alteration of asthmogenic gene expression. Electronic supplementary material The online version of this article (doi:10.1186/s13059-016-1140-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jamie L Everman
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Rebecca Davidson
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Cydney Rios
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Rachelle Herrin
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Andrew H Liu
- Department of Pediatrics, National Jewish Health, 1400 Jackson St, Denver, CO, 80206, USA.,Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Sam S Oh
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Rajesh Kumar
- Department of Pediatrics, The Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tasha E Fingerlin
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA.,Department of Biomedical Research, National Jewish Health, Denver, CO, USA
| | | | - Esteban G Burchard
- Department of Medicine, University of California, San Francisco, CA, USA.,Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Max A Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA. .,Department of Pediatrics, National Jewish Health, 1400 Jackson St, Denver, CO, 80206, USA. .,Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
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19
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Mitchell AB, Mourad B, Tovey E, Buddle L, Peters M, Morgan L, Oliver BG. Spirometry filters can be used to detect exhaled respiratory viruses. J Breath Res 2016; 10:046002. [PMID: 27669334 DOI: 10.1088/1752-7155/10/4/046002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Respiratory viruses are very common in the community and contribute to the burden of illness for patients with chronic respiratory diseases, including acute exacerbations. Traditional sampling methods are invasive and problematic to repeat. Accordingly, we explored whether respiratory viruses could be isolated from disposable spirometry filters and whether detection of viruses in this context represented presence in the upper or lower respiratory tract. Discovery (n = 53) and validation (n = 49) cohorts were recruited from a hospital outpatient department during two different time periods. Spirometry mouthpiece filters were collected from all participants. Respiratory secretions were sampled from the upper and lower respiratory tract by nasal washing (NW), sputum, and bronchoalveolar lavage (BAL). All samples were examined using RT-PCR to identify a panel of respiratory viruses (rhinovirus, respiratory syncytial virus, influenza A, influenza B, parainfluenza virus 1, 2 & 3, and human metapneumovirus). Rhinovirus was quantified using qPCR. Paired filter-NW samples (n = 29), filter-sputum samples (n = 24), filter-BAL samples (n = 39) and filter-NW-BAL samples (n = 10) provided a range of comparisons. At least one virus was detected in any sample in 85% of participants in the discovery cohort versus 45% in the validation cohort. Overall, 72% of viruses identified in the paired comparator method matched those detected in spirometry filters. There was a high correlation between viruses identified in spirometry filters compared with viruses identified in both the upper and lower respiratory tract using traditional sampling methods. Our results suggest that examination of spirometry filters may be a novel and inexpensive sampling method for the presence of respiratory viruses in exhaled breath.
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Affiliation(s)
- Alicia B Mitchell
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia. Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW 2139, Australia. Molecular Biosciences, School of Life Sciences, University of Technology Sydney, NSW 2007, Australia. Author to whom any correspondence should be addressed. University of Technology Sydney, Building 4, 15 Broadway, Ultimo, NSW 2007, Australia
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20
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Time-Based Measurement of Personal Mite Allergen Bioaerosol Exposure over 24 Hour Periods. PLoS One 2016; 11:e0153414. [PMID: 27192200 PMCID: PMC4871444 DOI: 10.1371/journal.pone.0153414] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/29/2016] [Indexed: 01/01/2023] Open
Abstract
Allergic diseases such as asthma and rhinitis are common in many countries. Globally the most common allergen associated with symptoms is produced by house dust mites. Although the bed has often been cited as the main site of exposure to mite allergens, surprisingly this has not yet been directly established by measurement due to a lack of suitable methods. Here we report on the development of novel methods to determine the pattern of personal exposure to mite allergen bioaerosols over 24-hour periods and applied this in a small field study using 10 normal adults. Air was sampled using a miniature time-based air-sampler of in-house design located close to the breathing zone of the participants, co-located with a miniature time-lapse camera. Airborne particles, drawn into the sampler at 2L/min via a narrow slot, were impacted onto the peripheral surface of a disk mounted on the hour-hand of either a 12 or 24 hour clock motor. The impaction surface was either an electret cloth, or an adhesive film; both novel for these purposes. Following a review of the time-lapse images, disks were post-hoc cut into subsamples corresponding to eight predetermined categories of indoor or outdoor location, extracted and analysed for mite allergen Der p 1 by an amplified ELISA. Allergen was detected in 57.2% of the total of 353 subsamples collected during 20 days of sampling. Exposure patterns varied over time. Higher concentrations of airborne mite allergen were typically measured in samples collected from domestic locations in the day and evening. Indoor domestic Der p 1 exposures accounted for 59.5% of total exposure, whereas total in-bed-asleep exposure, which varied 80 fold between individuals, accounted overall for 9.85% of total exposure, suggesting beds are not often the main site of exposure. This study establishes the feasibility of novel methods for determining the time-geography of personal exposure to many bioaerosols and identifies new areas for future technical development and clinical applications.
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21
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Kvaskoff D, Heath AK, Simila HA, Ko P, English DR, Eyles DW. Minimizing Matrix Effects for the Accurate Quantification of 25-Hydroxyvitamin D Metabolites in Dried Blood Spots by LC-MS/MS. Clin Chem 2016; 62:639-46. [DOI: 10.1373/clinchem.2015.251538] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/28/2016] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The noncalcemic actions of vitamin D in multiple organs are now widely recognized. Vitamin D status has been linked with a wide variety of conditions, which has led to an increasing demand for vitamin D screening. In particular, there is intense interest in the impact of vitamin D on a variety of developmental conditions. The most readily accessible pediatric samples are dried blood spots, and health organizations are increasingly archiving such samples for later assessment of the antecedents of disease.
METHODS
In 2009, we developed a method to quantify the major circulatory form of vitamin D, 25-hydroxyvitamin D, in archived dried blood spots. Over the last 6 years, we have made substantial alterations to the published method to enhance throughput, sensitivity, and assay robustness.
RESULTS
With the alterations, the assay was 3 times faster than the previously published assay and had a >10-fold increase in signal strength. Intraassay imprecision decreased from 13.4% to 6.9%, and there was a 5-fold reduction in interfering phospholipids. In actual use over 2 years, the assay showed an interassay imprecision of 11.6%.
CONCLUSIONS
This assay has performed reliably over the past 6 years. The practical changes we have made should allow clinical chemists to successfully adapt this method.
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Affiliation(s)
- David Kvaskoff
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Alicia K Heath
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Henry A Simila
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Pauline Ko
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Darryl W Eyles
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
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22
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[Seasonality in asthma: Impact and treatments]. Presse Med 2016; 45:1005-1018. [PMID: 27039335 DOI: 10.1016/j.lpm.2016.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 12/12/2022] Open
Abstract
The role of seasons should be taken into account in the management of asthma. The environment varies between seasons and it is well documented that asthma is modulated by environment. Viruses cause asthma exacerbations peak, in winter, in adults while the peak is present in September in children. Allergens are probably a less powerful source of asthma exacerbation than viruses but pollen involvement in spring and summer and dust mites in autumn are indisputable. Air pollutants, present in summer during the hottest periods, are also highly involved in asthma exacerbations. Indoor air pollution, in winter, is also implicated in asthma disease. All these environmental factors are synergistic and increase the risk of asthma exacerbation. Therapies should be adapted to each season depending on environmental factors potentially involved in the asthma disease.
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23
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Brouard J, Dupont C, Tran L, Ribault M, Vabret A. [Rhinovirus during childhood: Asthma at adolescence? The chicken or the egg causality dilemma]. Arch Pediatr 2016; 23:557-60. [PMID: 27021809 PMCID: PMC7133363 DOI: 10.1016/j.arcped.2016.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 11/27/2022]
Affiliation(s)
- J Brouard
- Service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France; EA 4655 U2RM, équipe E3 : « virologie respiratoire comparée », 14032 Caen, France.
| | - C Dupont
- Service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - L Tran
- Service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - M Ribault
- Service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - A Vabret
- Laboratoire de virologie, CHU de Caen, avenue Clemenceau, 14033 Caen, France; EA 4655 U2RM, équipe E3 : « virologie respiratoire comparée », 14032 Caen, France
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24
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Bruning AHL, Thomas XV, van der Linden L, Wildenbeest JG, Minnaar RP, Jansen RR, de Jong MD, Sterk PJ, van der Schee MP, Wolthers KC, Pajkrt D. Clinical, virological and epidemiological characteristics of rhinovirus infections in early childhood: A comparison between non-hospitalised and hospitalised children. J Clin Virol 2015; 73:120-126. [PMID: 26599608 PMCID: PMC7185867 DOI: 10.1016/j.jcv.2015.10.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 10/21/2015] [Accepted: 10/30/2015] [Indexed: 11/28/2022]
Abstract
Rhinoviruses (RV) frequently cause respiratory tract infections in young children. We evaluated characteristics of RV infections in relation to clinical outcome. In young children clinical outcome was not related to RV species or types. Outcome of RV disease is more likely influenced by multiple (host-specific) factors.
Background Several studies have been published regarding the epidemiology and clinical significance of the different rhinovirus (RV) species (-A, -B and -C). However, data on RV types and the associations with clinical outcome in young children are limited. Here, we investigated the clinical, virological and epidemiological characteristics of RV infections in young children with mild or asymptomatic infection (non-hospitalised children) and in symptomatic young children admitted to the hospital. Objectives The aim of this study was to evaluate associations between different characteristics of RV infections and clinical outcome in young children. Study design RV-infected children were retrospectively selected from a Dutch birth cohort (EUROPA-study) and from hospitalised children admitted to the hospital because of respiratory symptoms. In total 120 RV-typed samples could be selected from 65 non-hospitalised and 49 hospitalised children between November 2009 and December 2012. Results RV-A was the predominant species in both study populations, followed closely by RV-C. RV-B was observed only sporadically. The distribution of the RV species was comparable in non-hospitalised and hospitalised children. In children with respiratory distress who required ICU-admission the distribution of RV species did not differ significantly from the non-hospitalised children. No predominant RV type was present in non-hospitalised nor hospitalised children. However, hospitalised children were younger, had more often an underlying illness, a higher RV load and more frequently a bacterial co-infection. Conclusions Clinical outcome of RV infected young children was not related to RV species or types, but may more likely be influenced by multiple (host-specific) factors.
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Affiliation(s)
- Andrea H L Bruning
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
| | - Xiomara V Thomas
- Department of Medical Microbiology, Laboratory of Clinical Virology, Academic Medical Center, Amsterdam, The Netherlands
| | - Lonneke van der Linden
- Department of Medical Microbiology, Laboratory of Clinical Virology, Academic Medical Center, Amsterdam, The Netherlands
| | - Joanne G Wildenbeest
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - René P Minnaar
- Department of Medical Microbiology, Laboratory of Clinical Virology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rogier R Jansen
- Department of Medical Microbiology, Laboratory of Clinical Virology, Academic Medical Center, Amsterdam, The Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology, Laboratory of Clinical Virology, Academic Medical Center, Amsterdam, The Netherlands
| | - Peter J Sterk
- Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc P van der Schee
- Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Katja C Wolthers
- Department of Medical Microbiology, Laboratory of Clinical Virology, Academic Medical Center, Amsterdam, The Netherlands
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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25
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Stelzer-Braid S, Tovey ER, Willenborg CM, Toelle BG, Ampon R, Garden FL, Oliver BG, Strachan R, Belessis Y, Jaffe A, Reddel HK, Crisafulli D, Marks GB, Rawlinson WD. Absence of back to school peaks in human rhinovirus detections and respiratory symptoms in a cohort of children with asthma. J Med Virol 2015; 88:578-87. [PMID: 26331908 DOI: 10.1002/jmv.24371] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 01/01/2023]
Abstract
Much of what is known about the seasonality of human rhinovirus (hRV) infections has been learned from the study of acute asthma exacerbations presenting to emergency care, including those among children at the start of the school term. Much less is known about the patterns of hRVs in the community. In this study, viruses and day-to-day symptoms of asthma and colds were monitored twice weekly in 67 children with asthma aged 5-12 years, over a 15 month period in Sydney, Australia. Overall hRV was detected in 314/1232 (25.5%) of nasal wash samples and 142/1231 (11.5%) of exhaled breath samples; of these, 231 and 24 respectively were genotyped. HRVs were detected with similar prevalence rate throughout the year, including no peak in hRV prevalence following return to school. No peaks were seen in asthma and cold symptoms using twice-weekly diary records. However, over the same period in the community, there were peaks in asthma emergency visits both at a large local hospital and in state-wide hospitalizations, following both return to school (February) and in late autumn (May) in children of the same age. This study suggests that hRV infections are common throughout the year among children, and differences in virus prevalence alone may not account for peaks in asthma symptoms.
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Affiliation(s)
- Sacha Stelzer-Braid
- Virology Research Laboratory, SEALS, Prince of Wales Hospital, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Australia
| | - Euan R Tovey
- Woolcock Institute of Medical Research, University of Sydney, Australia
| | | | - Brett G Toelle
- Woolcock Institute of Medical Research, University of Sydney, Australia.,Sydney Local Health District, Sydney, Australia
| | - Rose Ampon
- Woolcock Institute of Medical Research, University of Sydney, Australia
| | - Frances L Garden
- Woolcock Institute of Medical Research, University of Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Brian G Oliver
- Woolcock Institute of Medical Research, University of Sydney, Australia.,University of Technology, Sydney, Australia
| | | | - Yvonne Belessis
- Sydney Children's Hospital, Randwick, Australia.,School of Women's and Children's Health, University of New South Wales, Australia
| | - Adam Jaffe
- Sydney Children's Hospital, Randwick, Australia.,School of Women's and Children's Health, University of New South Wales, Australia
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Australia
| | - Daniel Crisafulli
- Woolcock Institute of Medical Research, University of Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Australia
| | - William D Rawlinson
- Virology Research Laboratory, SEALS, Prince of Wales Hospital, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Australia.,School of Biotechnology and Biomolecular Sciences, University of New South Wales, Australia
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