key: cord-0008296-jksx27j7 authors: da Silva, Ellen Ricci Monteiro; Watanabe, Aripuana; Carraro, Emerson; Granato, Celso; Bellei, Nancy title: Rhinovirus genetic diversity among immunosuppressed and immunocompetent patients presenting with a severe respiratory infection date: 2012-09-29 journal: J Clin Virol DOI: 10.1016/j.jcv.2012.09.001 sha: a56a34a0b5c0ac62e608459da30c0348cf337d2c doc_id: 8296 cord_uid: jksx27j7 nan To the Editor, Three species of HRV are currently known: A, B and C. HRV C has been detected primarily in children and immunosuppressed patients in association with severe disease. 1-7 HRV species and their associated clinical outcomes in different patient groups are not well defined. [8] [9] [10] We evaluated the occurrence and clinical outcomes of HRV species infections in two distinct populations, immunocompetent and immunosuppressed patients. A total of 400 swab/nasal wash samples were collected from two populations of hospitalized patients at Hospital São Paulo. Adults patients in a Hematopoietic Stem Cell Transplantation program (HSCT, n = 202) and patients (children and adults) hospitalized due to severe acute respiratory syndrome who were suspected of having an influenza A (H1N1)pdm09 infection (SII -suspect of influenza virus infection, n = 198). The inclusion criteria for HSCT was the presence of acute respiratory illness of probable viral etiology. For the SII population was suspicion of severe influenza A (H1N1)pdm09 virus infection with a negative test for this virus. Criteria for a severe clinical outcome were admission to the intensive care unit (ICU), length of hospitalization and mortality. Viral RNA was extracted using the QIAamp Viral RNA Extraction Kit (Qiagen, Germany). RT-PCR was accomplished as described previously. 11 DNA sequencing was performed with the BigDye Terminator Cycle Sequencing Ready Reaction Kit (Applied Biosystems, USA). The phylogenetic relationships were assessed by maximum likelihood (Topali software v2.5.). All data were analyzed with SPSS version 11.0 (SPSS Inc., USA). HRV was detected in 11% (22/202) of HSCT patients and in 31.3% (62/198) of SII patients (p < 0.001). The hospitalization length was longer for the HRV positive cases from the HSCT group than for those of the SII group (p < 0.001) but no significant differences were identified for ICU admission or mortality. A phylogenetic analysis was performed for 92% (77/84) of the samples and 54.6% (42/77) were HRV A, 11.7% (9/77) were HRV B, and 33.8% (26/77) were HRV C. HRV C was predominant among children but for adult patients' species distribution was similar. Indeed the clinical outcomes were similar (p > 0.05) for both patient groups regardless of the species (Table 1 ) and when each species was compared between the two groups. Some authors 12,13 did not observe any difference in the infection outcomes of HRV and influenza A (H1N1)pdm09 infections, as defined by intensive care unit admission and mortality, but species were not considered in their study. In the present study we attempted to identify differences in clinical outcomes in more detail using an HRV genotyping analysis. The severe outcomes previously linked to HRV C infection 1, 8, 9 and not the other two species should be reevaluated. Parameters such as age, immune status, and enrollment of community or hospitalized patients, may have differed between the studies. In this context, we reported elsewhere that younger ages may have a greater association with HRV C occurrence in both community and hospital settings. 10 In conclusion, HRV can play a role in severe respiratory infections, but the outcomes are not dependent on the viral agent or host factors, such as species diversity or immune status. Ellen Ricci Monteiro da Silva and Aripuana Watanabe authors contributed in study design, laboratory tests, data analysis, manuscript writing and revision. Emerson Carraro, Celso Granato and Nancy Bellei authors involved in study design, data analysis, manuscript writing and revision. Financial support of Fundaç ão de Amparo a Pesquisa do Estado de São Paulo (FAPESP Project number: 2010/09978-5) and Coordenaç ão de aperfeiç oamento de pessoal de nível superior (CAPES). None of the authors has declared competing interests. The present study was approved by the Ethics Committee of Sao Paulo Hospital and the Federal University of Sao Paulo (number: 0710/10). Clinical and molecular epidemiology of human rhinovirus C in children and adults in Hong Kong reveals a possible distinct human rhinovirus C subgroup Respiratory viral infections in adults A prospective hospital-based study of the clinical impact of non-severe acute respiratory syndrome (non-SARS)-related human coronavirus infection Rhinovirus genome variation during chronic upper and lower respiratory tract infections Respiratory viruses and exacerbations of asthma in adults Respiratory viruses, symptoms and inflammatory markers in acute exacerbations and stable chronic pulmonary disease Rhinovirus infections in hematopoietic stem cell transplant recipients with pneumonia A novel group of rhinoviruses is associated with asthma hospitalizations Human rhinovirus C associated with wheezing in hospitalised children in the Middle East Frequency of human rhinovirus species in outpatient children with acute respiratory infections at primary care level in Brazil Phylogenetic analysis of rhinovirus isolates collected during successive epidemic seasons Distinguishing characteristics between pandemic 2009-2010 influenza A (H1N1) and other virusesin patients hospitalized with respiratory illness Severity of human rhinovirus infection in immunocompromised adults is similar to that of 2009 H1N1 influenza Rua Pedro de Toledo, 781 -15 • andar -Vila Clementino, CEP: 04039-032, Brazil Celso Granato a,b Nancy Bellei a,b, * a Clinical Virology Laboratory CEP: 04039-032, Brazil. E-mail addresses: ellen virologia@yahoo