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. 2015 Oct:71:51-8.
doi: 10.1016/j.jcv.2015.07.309. Epub 2015 Jul 29.

Clinical and molecular epidemiology of human rhinovirus infections in patients with hematologic malignancy

Samantha E Jacobs  1 , Daryl M Lamson  2 , Rosemary Soave  3 , Brigitte Huertas Guzman  3 , Tsiporah B Shore  4 , Ellen K Ritchie  4 , Dana Zappetti  5 , Michael J Satlin  3 , John P Leonard  4 , Koen van Besien  4 , Audrey N Schuetz  6 , Stephen G Jenkins  6 , Kirsten St George  2 , Thomas J Walsh  3
Affiliations

Clinical and molecular epidemiology of human rhinovirus infections in patients with hematologic malignancy

Samantha E Jacobs et al. J Clin Virol. 2015 Oct.

Abstract

Background: Human rhinoviruses (HRVs) are common causes of upper respiratory tract infection (URTI) in hematologic malignancy (HM) patients. Predictors of lower respiratory tract infection (LRTI) including the impact of HRV species and types are poorly understood.

Objectives: This study aims to describe the clinical and molecular epidemiology of HRV infections among HM patients.

Study design: From April 2012-March 2013, HRV-positive respiratory specimens from symptomatic HM patients were molecularly characterized by analysis of partial viral protein 1 (VP1) or VP4 gene sequence. HRV LRTI risk-factors and outcomes were analyzed using multivariable logistic regression.

Results: One hundred and ten HM patients presented with HRV URTI (n=78) and HRV LRTI (n=32). Hypoalbuminemia (OR 3.0; 95% CI, 1.0-9.2; p=0.05) was independently associated with LRTI, but other clinical and laboratory markers of host immunity did not differ between patients with URTI versus LRTI. Detection of bacterial co-pathogens was common in LRTI cases (25%). Among 92 typeable respiratory specimens, there were 58 (64%) HRV-As, 12 (13%) HRV-Bs, and 21 (23%) HRV-Cs, and one Enterovirus 68. LRTI rates among HRV-A (29%), HRV-B (17%), and HRV-C (29%) were similar. HRV-A infections occurred year-round while HRV-B and HRV-C infections clustered in the late fall and winter.

Conclusions: HRVs are associated with LRTI in HM patients. Illness severity is not attributable to specific HRV species or types. The frequent detection of bacterial co-pathogens in HRV LRTIs further substantiates the hypothesis that HRVs predispose to bacterial superinfection of the lower airways, similar to that of other community-acquired respiratory viruses.

Keywords: Hematologic malignancy; Human rhinovirus; Immunocompromised hosts; Rhinovirus species; Viral pneumonia.

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Figures

Fig. 1
Fig. 1
(A) Phylogenetic analysis of VP1 gene of HRV-A and HRV-B reference strains and samples from this study. Phylogenetic tree constructed by neighbor-joining analysis of Maximum Likelihood method. Bootstrap values >70% shown (500 replicates). The analysis involved 91 nucleotide sequences and 108 positions. Reference strains are indicated by HRV-A or B-genotype and rooted to enterovirus D68; study samples are labeled with ●. VP: viral protein. (B) Phylogenetic analysis of VP1 gene of HRV-C reference strains and samples from this study. Phylogenetic tree constructed by neighbor-joining analysis of Maximum Likelihood method. Bootstrap values >70% shown (1000 replicates). The analysis involved 58 nucleotide sequences and 256 positions. Reference strains are indicated by HRV-C genotype and study samples are indicated by ●. VP: viral protein.
Fig. 1
Fig. 1
(A) Phylogenetic analysis of VP1 gene of HRV-A and HRV-B reference strains and samples from this study. Phylogenetic tree constructed by neighbor-joining analysis of Maximum Likelihood method. Bootstrap values >70% shown (500 replicates). The analysis involved 91 nucleotide sequences and 108 positions. Reference strains are indicated by HRV-A or B-genotype and rooted to enterovirus D68; study samples are labeled with ●. VP: viral protein. (B) Phylogenetic analysis of VP1 gene of HRV-C reference strains and samples from this study. Phylogenetic tree constructed by neighbor-joining analysis of Maximum Likelihood method. Bootstrap values >70% shown (1000 replicates). The analysis involved 58 nucleotide sequences and 256 positions. Reference strains are indicated by HRV-C genotype and study samples are indicated by ●. VP: viral protein.
Fig. 2
Fig. 2
HRV species by month in patients with hematologic malignancy, n = 92.
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