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1、693online | memorias.ioc.fiocruz.brMem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 107(5): 693-694, August 2012Five human coronaviruses (HCoVs) have been iden-tified to date. HCoV-OC43 and HCoV-229E were first identified in the mid-1960s (Hamre & Procknow 1966) and were subsequently found to cause the c
2、ommon cold. These viruses were the only coronaviruses identified in humans until 2003, when HCoVs received worldwide at-tention with the emergence of severe acute respiratory syndrome (SARS), which is caused by a novel corona-virus (SARS-CoV). The increased research on these viruses led to the disco
3、very of two additional HCoVs: HCoV-NL63 in the Netherlands and HCoV-HKU1 in China (van der Hoek et al. 2004, Woo et al. 2005). HCoVs cause upper respiratory tract illness and occa-sionally cause lower respiratory tract disease in suscep-tible individuals. The incidence and clinical features of HCoV
4、infections in Brazilian patients with respiratory illness is not well known, especially among adults. There are few studies that describe HCoV infections among adults (Bellei et al. 2008, Gaunt et al. 2010). The aim of the present study was to investigate the occurrence of HCoVs among Brazilian outp
5、atients and hospitalised patients who received care at the Hospital of So Paulo Federal University, Brazil, during 2009 and 2010. A to-tal of 394 samples were collected with nasopharyngeal swabs. The final pool of subjects included 182 outpatient children from the general community and 212 hospita-l
6、ised patients; of these 212 patients, 136 were children and 76 were adults. Assays to identify HCoVs in patients were performed using a two-step process. First, an initial pancoronavirus reverse-transcription polymerase chain reaction (RT-PCR) screening assay was performed (Vi-jgen et al. 2008). Sec
7、ond, species-specific RT-PCR as-says were used to identify the specific HCoV species (Dare et al. 2007). Amplicons were further character-ised by sequencing. Epidemiological and clinical data from outpatients were obtained using a standardised questionnaire and data from hospitalised patients were o
8、btained from medical charts. The pancoronavirus assay detected five/394 (1.2%) coronavirus-positive samples. Within the outpatient group, which was comprised only children, one/182 (0.5%) patients was positive. Within the hospitalised patient group, four/212 (1.8%) patients were positive: two/136 we
9、re children (1.4%) and two/76 were adults (2.6%). HCoV-OC43 was documented in two samples from hospitalised patients, one of which was a nosocomial infection; three HCoV-NL63 positive sam-ples were identified, one of which was obtained from an outpatient and two of which were obtained from hospi-tal
10、ised patients. Sequencing confirmed the specificity of the species-specific RT-PCR assays. Coronavirus in-fections occurred during the spring, autumn and winter and more coronavirus-infected cases were documented in 2010 than in 2009. The median age of HCoV-infected patients was seven years (ranging
11、 from 11 months to 46 years). Eighty percent (4/5) of infected patients report-ed several underlying conditions, but no chronic lung disease was reported (Table). Fever and cough were the most common symptoms at presentation. Dyspnea was reported in two cases and bronchospasm was only re-ported in t
12、he three HCoV-NL63 cases. Three patients presented with lower respiratory tract infections. Two of the hospitalised patients were further admitted to the intensive care unit during their hospital stay. Eight days was the median length of the hospital stay for hospita-lised coronavirus-infected patie
13、nts (ranging from 5-30 days). HCoV-OC43-infected patients had longer hospital stays than HCoV-NL63-infected patients. Three of the four hospitalised patients had good outcomes, but the diabetic adult died of HCoV-NL63-associated pneumo-nia nine days after admission. The present study is the first Br
14、azilian report of HCoV infections in outpatients + Corresponding author: .brReceived 20 October 2011Accepted 11 January 2012Infections with human coronaviruses NL63 and OC43 among hospitalised and outpatient individuals in So Paulo, BrazilTatiane Karen Cabea1/+, Emerson Carraro1, Aripuan Watanabe1,
15、Celso Granato1, Nancy Bellei11Disciplina de Infectologia, Laboratrio de Virologia Clnica, Departamento de Medicina, Universidade Federal de So Paulo, So Paulo, SP, BrasilThe incidence and clinical features of human coronaviruses (HCoVs) among Brazilian patients with respiratory illness are not well
16、known. We investigated the prevalence of HCoVs among Brazilian outpatients and hospitalised patients with respiratory illnesses during 2009 and 2010. To identify the HCoVs, pancoronavirus and species-spe-cific reverse-transcriptase polymerase chain reaction assays were performed. Five of 394 samples
17、 were positive for HCoVs (1.2%): 1/182 (0.5%) outpatients and 4/212 (1.8%) hospitalised patients. The OC43 and NL63 HCoVs were identified. Two patients were admitted to the intensive care unit. Underlying chronic disease was reported in cases and one diabetic adult died. HCoVs can cause lower respir
18、atory infections and hospitalisation. Patients with pre-existing conditions and respiratory infections should be evaluated for HCoV infections. Key words: human coronavirus OC43 - human coronavirus NL63 - respiratory tract infectionsCoronaviruses among Brazilian patients Tatiane Karen Cabea et al.69
19、4and hospitalised patients to describe NL63 infection in an adult patient. Because the subjects of our study in-cluded both outpatients and hospitalised patients, the majority of the patients included in this study were be-lieved to have a common cold. The composition of our subject pool could be a
20、limitation of our study and might explain the small number of coronavirus-positive cases. Gaunt et al. (2010) detected 0.3-0.85% coronavirus-pos-itive samples across all ages and we hypothesised that the H1N1 2009 influenza pandemic wave might have influenced the dynamics of the other respiratory vi
21、rus-es, mainly in 2009. The coronavirus-positive rate found among adults revealed that HCoVs may be representa-tive causal agents of respiratory disease among adults as well as children. This study is one of the few studies to record a fatal case of HCoV-NL63 infection (Bastien et al. 2005, Cabea &
22、Bellei 2012). In conclusion, our data demonstrate that HCoVs can cause more than just the common cold and mild respiratory tract disease. There-fore, at-risk patients presenting with severe respiratory infections should be evaluated for HCoV infections. Ac-cording to the data presented herein, the N
23、L63 HCoV represents an important pathogen that is involved in un-explained respiratory illnesses.REFERENCESBastien N, Anderson K, Hart L, Van Caeseele P, Brandt K, Milley D, Hatchette T, Weiss EC, Li Y 2005. Human coronavirus NL63 infection in Canada. J Infect Dis 191: 503-506. Bellei N, Carraro E,
24、Perosa A, Watanabe A, Arruda E, Granato C 2008. Acute respiratory infection and Influenza-like illness viral etiologies in Brazilian adults. J Med Virol 80: 1824-1827.Cabea TK, Bellei N 2012. Human coronavirus NL-63 infection in a Brazilian patient suspected of H1N1 2009 influenza infection: descrip
25、tion of a fatal case. J Clin Virol 53: 82-84. Dare RK, Fry AM, Chittaganpitch M, Sawanpanyalert P, Olsen SJ, Erd-man DD 2007. Human coronavirus infections in rural Thailand: a comprehensive study using real-time reverse-transcription poly-merase chain reaction assays. J Infect Dis 196: 1321-1328.Gau
26、nt ER, Hardie A, Claas EC, Simmonds P, Templeton KE 2010. Epidemiology and clinical presentations of the four human coro-naviruses 229E, HKU1, NL63 and OC43 detected over 3 years using a novel multiplex real-time PCR method. J Clin Microbiol 48: 2940-2947.Hamre D, Procknow JJ 1966. A new virus isola
27、ted from the human respiratory tract. Proc Soc Exp Biol Med 121: 190-193.van der Hoek L, Pyrc K, Jebbink MF, Vermeulen-Oost W, Berkhout RJ, Wolthers KC, Wertheim-van Dillen PM, Kaandorp J, Spaar-garen J, Berkhout B 2004. Identification of a new human corona-virus. Nat Med 10: 368-373. Vijgen L, Mos
28、E, Keyaerts E, Li S, Van Ranst M 2008. A pancoro-navirus RT-PCR assay for detection of all known coronaviruses. Methods. Mol Biol 454: 3-12.Woo PC, Lau SK, Chu CM, Chan KH, Tsoi HW, Huang Y, Wong BH, Poon RW, Cai JJ, Luk WK, Poon LL, Wong SS, Guan Y, Peiris JS, Yuen KY 2005. Characterization and com
29、plete genome sequence of a novel coronavirus, coronavirus HKU1, from patients with pneumonia. J Virol 79: 884-895.TABLEDemographic and clinical data of coronavirus-infected patients during 2009-2010Patients12345CharacteristicsHCoV speciesHCoV-OC43HCoV-NL63HCoV-OC43HCoV-NL63HCoV-NL63Sample dateSeptem
30、ber/09May/10April/10June/10June/10Age2 years5 years43 years46 years11 monthsGenderFemaleFemaleMaleFemaleFemaleUnderlyingMegacolonNoneHIVDiabetesLiverDiseasePrematurity-MellitusTransplantHistory of smoking-+-Clinical featuresFever+Cough+Myalgia-+-Headache-+-Diarrhoea-+-Rhinorrhoea-+-+-Sore throat-+-Bronchospasm-+-Dyspnea-+-LRTI+-+-Hospitalization+-+OutcomeSurvivedSurvivedSurvivedDiedSurvivedHCoV: human coronaviruses; LRTI: lower respiratory tract illness; HIV: human immunodeficiency virus infected; +: present; -: absent.
