More than just a common cold: endemic coronaviruses OC43, HKU1, NL63, and 229E associated with severe acute respiratory infection and fatality cases among healthy adults
J. med. virol; 92 (10), 2020
Publication year: 2020
Respiratory viral infection can cause severe disease and hospitalization, especially
among children, the elderly, and patients with comorbidities. In Brazil, the official
surveillance system of severe acute respiratory infection (SARI) investigates influenza
A (IAV) and B (IBV) viruses, respiratory syncytial virus (RSV), adenovirus
(HAdV), and parainfluenza viruses (hPIV 1–3). In Rio Grande do Sul (RS), Brazil, many
fatalities associated with SARI between 2013 and 2017 occurred among patients
without underlying diseases and for whom the causative agent had not been identified
using official protocols. This cross‐sectional study analyzed the presence of
coronaviruses (HCoV), bocavirus (HBoV), metapneumovirus (hMPV), and rhinovirus
in patients who died of SARI despite not having comorbidities, and that were negative
for IAV, IBV, RSV, HAdV, and hPIV. Nasopharyngeal aspirates/swabs from
patients were used for nucleic acid extraction. The presence of HCoVs OC43, HKU1,
NL63, and 229E; HBoV; hMPV; and rhinovirus was assessed by quantitative reverse
transcription‐polymerase chain reaction. Clinical data were also analyzed. Between
2013 and 2017, 16 225 cases of SARI were reported in RS; 9.8% of the patients died;
20% of all fatal cases were patients without comorbidities and for whom no pathogen
was detected using standard protocols. Analysis of 271 of these cases
identified HCoV in nine cases; HBoV, hMPV, and rhinovirus were detected in 3, 3,
and 10 cases, respectively. Of note, patients infected with HCoV were adults. Results
reinforce the importance of including coronaviruses in diagnostic panels used
by official surveillance systems because besides their pandemic potential, endemic
HCoVs are associated to severe disease in healthy adults.