title: Pulmonary and extrapulmonary complications of human rhinovirus infection in critically ill patients.
abstract: BACKGROUND
  Human rhinovirus (HRV) is frequently detected in patients with respiratory tract infection. However, the full clinical spectrum of HRV infection in critically ill patients is not well characterized.
  
  
  OBJECTIVE
  To evaluate the clinical and virological characteristics of critically ill patients with HRV infection.
  
  
  METHODS
  HRV-specific reverse transcription-polymerase chain reaction (RT-PCR) was performed on nasopharyngeal aspirate (NPA) specimens from 294 adult patients who required admission into the intensive care unit (ICU). Clinical characteristics were analyzed. HRV genotyping using the 5'UTR-VP4-VP2 region was performed.
  
  
  RESULTS
  HRV was detected in NPA specimens of 22 patients (7.5%) by RT-PCR. Dyspnea was the most common presenting symptom (16/22; 72.7%), but seizure also occurred in 5 (22.7%) patients. Exacerbation of underlying disease occurred in 12 (54.5%) patients. Four (18.2%) patients died, and HRV was considered to play a role as the cause of death in 3 patients. Thirteen (59.1%) patients had pneumonia, and the most common radiological finding was consolidation (6/13; 46.2%). Streptococcus pneumoniae was the most common co-pathogen among patients with pneumonia. Among the 9 patients without pneumonia, 3 patients had exacerbation of underlying lung diseases, 3 patients had acute pulmonary edema, 2 patients with diabetes mellitus had acute complications from poor glycemic control, and 1 patient had status epilepticus. HRV-A was the most common species (64.3%), but there was no clear relationship between HRV species and clinical presentation.
  
  
  CONCLUSIONS
  Both pulmonary and extrapulmonary complications of HRV were common in critically ill patients.
authors.affiliation: State Key Laboratory for Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region; Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Kelvin K W
authors.initials: KK
authors.lastname: To
authors.affiliation: State Key Laboratory for Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region; Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Susanna K P
authors.initials: SK
authors.lastname: Lau
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Kwok-Hei
authors.initials: KH
authors.lastname: Chan
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Ka-Yi
authors.initials: KY
authors.lastname: Mok
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Hayes K H
authors.initials: HK
authors.lastname: Luk
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Cyril C Y
authors.initials: CC
authors.lastname: Yip
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Yat-Kwan
authors.initials: YK
authors.lastname: Ma
authors.affiliation: Department of Radiology, Queen Mary Hospital, Hong Kong Special Administrative Region.
authors.forename: Lorraine H Y
authors.initials: LH
authors.lastname: Sinn
authors.affiliation: Department of Radiology, Queen Mary Hospital, Hong Kong Special Administrative Region.
authors.forename: Sonia H Y
authors.initials: SH
authors.lastname: Lam
authors.affiliation: Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong Special Administrative Region.
authors.forename: Chun-Wai
authors.initials: CW
authors.lastname: Ngai
authors.affiliation: State Key Laboratory for Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region; Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Ivan F N
authors.initials: IF
authors.lastname: Hung
authors.affiliation: State Key Laboratory for Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region; Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Chan
authors.affiliation: State Key Laboratory for Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region; Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region. Electronic address: kyyuen@hku.hk.
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060085:Coinfection; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D005838:Genotype; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010850:Picornaviridae Infections / Q000150:complications* / Q000821:virology*; D011024:Pneumonia, Viral / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies; D012229:Rhinovirus / Q000145:classification / Q000235:genetics; D012640:Seizures / Q000175:diagnosis / Q000209:etiology; D055815:Young Adult
keywords: Genotype; Human rhinovirus; Intensive care unit; Pneumonia; Seasonality; Seizure