title: Role of picornaviruses in flu-like illnesses of adults enrolled in an oseltamivir treatment study who had no evidence of influenza virus infection.
abstract: The primary objective of this study was to determine the role of picornavirus in flu-like episodes (temperature of > or =38.0 degrees C plus one respiratory and one constitutional symptom) among otherwise healthy adults enrolled in a placebo-controlled, double-blind, randomized oseltamivir treatment study. Combined nasal and pharyngeal swabs were collected at baseline for influenza cultures and picornavirus reverse transcription (RT)-PCR. In addition, acute- and convalescent-serum samples were obtained for serological studies of common respiratory pathogens. From a total of 719 subjects enrolled in the clinical trial within 36 h of the onset of symptoms, 475 (66%) had evidence of recent influenza A or B virus infections by means of culture and/or serological testing. Of the 244 remaining patients, 36 (15%) presented a seroconversion for at least one of the common respiratory viruses or atypical pathogens. An RT-PCR assay for the picornavirus 5" noncoding region (NCR) was positive in a subset of 15 (19%) of 78 patients with flu-like illnesses of undetermined etiology. Sequence analysis of the picornavirus 5" NCR amplicons revealed that 14 (93%) of them had greater homology to rhinoviruses, whereas 1 (7%) was related to enteroviruses. Interestingly, median total symptom scores and oral temperatures of picornavirus-positive patients (n = 15) and placebo-treated influenza virus-positive patients (n = 161) were similar over a 3-week period. We conclude that, among the influenza virus-negative preselected cases of this study, rhinoviruses were relatively frequent pathogens associated with important respiratory and systemic symptoms.
authors.affiliation: Infectious Disease Research Center of the Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada. Guy.Boivin@crchul.ulaval.ca
authors.forename: Guy
authors.initials: G
authors.lastname: Boivin
authors.forename: Albert D
authors.initials: AD
authors.lastname: Osterhaus
authors.forename: Annie
authors.initials: A
authors.lastname: Gaudreau
authors.forename: Helen C
authors.initials: HC
authors.lastname: Jackson
authors.forename: Jan
authors.initials: J
authors.lastname: Groen
authors.forename: Penelope
authors.initials: P
authors.lastname: Ward
mesh_terms: D000081:Acetamides / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D004770:Enterovirus / Q000145:classification / Q000302:isolation & purification*; D006801:Humans; D009980:Influenza A virus / Q000302:isolation & purification; D009981:Influenza B virus / Q000302:isolation & purification; D007251:Influenza, Human / Q000188:drug therapy* / Q000821:virology*; D008875:Middle Aged; D009305:Nasopharynx / Q000821:virology; D053139:Oseltamivir; D010850:Picornaviridae Infections / Q000821:virology*; D012367:RNA, Viral / Q000097:blood; D012229:Rhinovirus / Q000145:classification / Q000302:isolation & purification*
chemical_list: D000081:Acetamides; D000998:Antiviral Agents; D012367:RNA, Viral; D053139:Oseltamivir