title: Clinical and molecular epidemiology of human rhinovirus infections in patients with hematologic malignancy.
abstract: BACKGROUND
  Human rhinoviruses (HRVs) are common causes of upper respiratory tract infection (URTI) in hematologic malignancy (HM) patients. Predictors of lower respiratory tract infection (LRTI) including the impact of HRV species and types are poorly understood.
  
  
  OBJECTIVE
  This study aims to describe the clinical and molecular epidemiology of HRV infections among HM patients.
  
  
  METHODS
  From April 2012-March 2013, HRV-positive respiratory specimens from symptomatic HM patients were molecularly characterized by analysis of partial viral protein 1 (VP1) or VP4 gene sequence. HRV LRTI risk-factors and outcomes were analyzed using multivariable logistic regression.
  
  
  RESULTS
  One hundred and ten HM patients presented with HRV URTI (n=78) and HRV LRTI (n=32). Hypoalbuminemia (OR 3.0; 95% CI, 1.0-9.2; p=0.05) was independently associated with LRTI, but other clinical and laboratory markers of host immunity did not differ between patients with URTI versus LRTI. Detection of bacterial co-pathogens was common in LRTI cases (25%). Among 92 typeable respiratory specimens, there were 58 (64%) HRV-As, 12 (13%) HRV-Bs, and 21 (23%) HRV-Cs, and one Enterovirus 68. LRTI rates among HRV-A (29%), HRV-B (17%), and HRV-C (29%) were similar. HRV-A infections occurred year-round while HRV-B and HRV-C infections clustered in the late fall and winter.
  
  
  CONCLUSIONS
  HRVs are associated with LRTI in HM patients. Illness severity is not attributable to specific HRV species or types. The frequent detection of bacterial co-pathogens in HRV LRTIs further substantiates the hypothesis that HRVs predispose to bacterial superinfection of the lower airways, similar to that of other community-acquired respiratory viruses.
authors.affiliation: Division of Infectious Diseases, Weill Cornell Medical Center, New York, NY, USA. Electronic address: sej9006@med.cornell.edu.
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Jacobs
authors.affiliation: Virology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA.
authors.forename: Daryl M
authors.initials: DM
authors.lastname: Lamson
authors.affiliation: Division of Infectious Diseases, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Soave
authors.affiliation: Division of Infectious Diseases, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Brigitte Huertas
authors.initials: BH
authors.lastname: Guzman
authors.affiliation: Division of Hematology and Medical Oncology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Tsiporah B
authors.initials: TB
authors.lastname: Shore
authors.affiliation: Division of Hematology and Medical Oncology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Ritchie
authors.affiliation: Division of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital/ Weill Cornell Medical College, New York, NY, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Zappetti
authors.affiliation: Division of Infectious Diseases, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Satlin
authors.affiliation: Division of Hematology and Medical Oncology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Leonard
authors.affiliation: Division of Hematology and Medical Oncology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Koen
authors.initials: K
authors.lastname: van Besien
authors.affiliation: Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Audrey N
authors.initials: AN
authors.lastname: Schuetz
authors.affiliation: Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Jenkins
authors.affiliation: Virology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA.
authors.forename: Kirsten St
authors.initials: KS
authors.lastname: George
authors.affiliation: Division of Infectious Diseases, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D010802:Phylogeny; D010850:Picornaviridae Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D012229:Rhinovirus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D017422:Sequence Analysis, DNA; D017385:Sequence Homology; D015678:Viral Structural Proteins / Q000235:genetics; D055815:Young Adult
chemical_list: D015678:Viral Structural Proteins
keywords: Hematologic malignancy; Human rhinovirus; Immunocompromised hosts; Rhinovirus species; Viral pneumonia