Human Coronavirus-HKU1 Infection Among Adults in Cleveland, Ohio

Abstract

Background: Human coronaviruses (CoV) have been long recognized as a common cause of respiratory tract disease including severe respiratory tract illness. Coronavirus-HKU1 has been described predominantly among children less than 5 years of age in the United States with few studies characterizing the disease spectrum among adults.

Methods: Nasopharyngeal specimens of patients with respiratory symptoms were analyzed for CoV-HKU1 by NxTAG Respiratory Pathogen Panel multiplex assay from February 7, 2016 to April 30, 2016. Epidemiologic, clinical, and laboratory data were collected on adults (patients >18 years) whose samples screened positive.

Results: Of 832 adult respiratory specimens screened, 13 (1.6%) cases of CoV-HKU1 were identified. Adults age ranged between 23 and 75 years and 6 (46%) were males. All of whom had 1 or more respiratory symptoms, and 5 (38%) also reported 1 or more gastrointestinal symptoms. Eleven (85%) reported history of smoking and 5 (38%) used inhaled steroids. Seven (54%) required hospitalization, 5 (71%) of these needed supplemental oxygen, and 2 (29%) were admitted to intensive care. Median length of hospitalization was 5 days. Eight (62%) received antibiotics despite identification of CoV-HKU1. Infectious work-up in 1 patient who died did not reveal any other pathogen. In 2 (15%) CoV-HKU1-positive adults, the only viral coinfection detected was influenza A.

Conclusions: Coronavirus-HKU1 accounted for 1.6% of adult respiratory infections and should be considered in differential diagnosis of severe respiratory illnesses among adults.

Keywords: adults; clinical features; coronavirus; coronavirus-HKU1; respiratory infections..

Figure 1.

Weekly distribution of human coronavirus (HCoV) detection in Cleveland from February to April 2016. The number of CoV-HKU1-positive samples (light grey) and non-CoV-HKU1 CoV species (black) are displayed. Peak circulation of all CoV species was seen in February and early March.

Figure 2.

Representative anteroposterior (AP) chest x-ray of adult hospitalized with respiratory tract illness associated with coronavirus (CoV)-HKU1. Chest x-ray obtained from a patient at time of CoV-HKU1 diagnosis (A) is compared with chest x-ray obtained 1-year prior (B). Radiologic findings during this respiratory illness include prominence of interstitial markings with reticulonodular pattern, consolidative changes in right lower lobe with small right pleural effusion. No other respiratory pathogens were identified in this patient.