A recently identified rhinovirus genotype is associated with severe respiratory-tract infection in children in Germany

Abstract

Acute respiratory infection is a significant cause of morbidity and mortality in children worldwide. Accurate identification of causative agents is critical to case management and to prioritization in vaccine development. Sensitive multiplex diagnostics provide us with an opportunity to investigate the relative contributions of individual agents and may also facilitate the discovery of new pathogens. Recently, application of MassTag polymerase chain reaction (PCR) to undiagnosed influenza-like illness in New York State led to the discovery of a novel rhinovirus genotype. Here we report the investigation, by MassTag PCR, of pediatric respiratory-tract infections in Germany, studying 97 cases for which no pathogen was identified through routine laboratory evaluation. Respiratory viruses were identified in 49 cases (51%); of the 55 identified viruses, 41 (75%) were rhinoviruses. The novel genotype represented 73% of rhinoviruses and 55% of all identified viruses. Infections with the novel genotype were associated with upper-respiratory-tract symptoms but, more frequently, with bronchitis, bronchiolitis, and pneumonia.

Figure 1.

Phylogenetic analysis of the VP4/VP2 coding region of viruses identified in association with pediatric respiratory disease in Germany. Neighbor-joining analysis of the VP4/VP2 nucleotide sequence was performed by applying the Kimura 2-parameter model; the scale bar indicates nucleotide substitutions per site. Included for comparison are sequences belonging to the novel genotype recently identified in New York State (NY-003, -028, -042, -060, and -078); selected human rhinovirus (HRV)-A serotypes (the GenBank accession numbers for all reference sequences are indicated in parentheses); HRV-B serotypes; human enterovirus (HEV)-C viruses human coxsackievirus A1, A21, and A24 (CV-A1, CV-A21, and CV-A24, respectively); human poliovirus 2 (HPV-2); HEV-B viruses human echovirus 5 and 6 (HEV-5 and HEV-6, respectively); human coxsackievirus B4 (CV-B4), and swine vesicular disease virus (CV-B5); HEV-D viruses human enterovirus 68 and 70 (HEV-68 and HEV-70, respectively); Porcine enterovirus B virus porcine enterovirus 9 (PEV-9); Bovine enterovirus virus bovine enterovirus 1 (BEV-1); and HEV-A viruses human coxsackievirus A16 (CV-A16), and human enterovirus 71 (HEV-71). Major clinical symptoms associated with the specimen in which the respective virus was detected are indicated in square brackets: bronchitis/bronchiolitis [B], cough [C], fever [F], pharyngitis [Ph], pneumonia [P], and rhinitis [R].

Table 1.

Viral pathogens detected by MassTag polymerase chain reaction, in children hospitalized with respiratory disease.

Table 2.

Patient and clinical data.