Shih Hsin-I, Wang Hsuan-Chen, Su Ih-Jen, Hsu Hsiang-Chin, Wang Jen-Ren, Sun Hsiao Fang Sunny, Chou Chien-Hsuan, Ko Wen-Chien, Hsieh Ming-I, Wu Chi-Jung
From the Departments of Emergency Medicine (H-IS, H-CH); Public Health (H-IS); Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University (C-HC, W-CK, C-JW); National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes (H-CW, I-JS, J-RW, M-IH, C-JW); Department of Medical Laboratory Science and Biotechnology (J-RW); and Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (HSS).
Medicine (Baltimore). 2015 Sep;94(38):e1545. doi: 10.1097/MD.0000000000001545.
Viral etiologies of respiratory tract infections (RTIs) have been less studied in adult than in pediatric populations. Furthermore, the ability of PCR/electrospray ionization mass spectrometry (PCR/ESI-MS) to detect enteroviruses and rhinoviruses in respiratory samples has not been well evaluated. We sought to use PCR/ESI-MS to comprehensively investigate the viral epidemiology of adult RTIs, including testing for rhinoviruses and enteroviruses. Nasopharyngeal or throat swabs from 267 adults with acute RTIs (212 upper RTIs and 55 lower RTIs) who visited a local clinic or the outpatient or emergency departments of a medical center in Taiwan between October 2012 and June 2013 were tested for respiratory viruses by both virus isolation and PCR/ESI-MS. Throat swabs from 15 patients with bacterial infections and 27 individuals without active infections were included as control samples. Respiratory viruses were found in 23.6%, 47.2%, and 47.9% of the 267 cases by virus isolation, PCR/ESI-MS, and both methods, respectively. When both methods were used, the influenza A virus (24.3%) and rhinoviruses (9.4%) were the most frequently identified viruses, whereas human coronaviruses, human metapneumovirus (hMPV), enteroviruses, adenoviruses, respiratory syncytial virus, and parainfluenza viruses were identified in small proportions of cases (<5% of cases for each type of virus). Coinfection was observed in 4.1% of cases. In the control group, only 1 (2.4%) sample tested positive for a respiratory virus by PCR/ESI-MS. Patients who were undergoing steroid treatment, had an active malignancy, or suffered from chronic obstructive pulmonary disease (COPD) were at risk for rhinovirus, hMPV, or parainfluenza infections, respectively. Overall, immunocompromised patients, patients with COPD, and patients receiving dialysis were at risk for noninfluenza respiratory virus infection. Rhinoviruses (12.7%), influenza A virus (10.9%), and parainfluenza viruses (7.3%) were the most common viruses involved in the 55 cases of lower RTIs. The factors of parainfluenza infection, old age, and immunosuppression were independently associated with lower RTIs. In conclusion, PCR/ESI-MS improved the diagnostic yield for viral RTIs. Non-influenza respiratory virus infections were associated with patients with comorbidities and with lower RTIs. Additional studies that delineate the clinical need for including non-influenza respiratory viruses in the diagnostic work-up in these populations are warranted.
与儿科人群相比，呼吸道感染（RTIs）的病毒病因在成人中研究较少。此外，PCR/电喷雾电离质谱法（PCR/ESI-MS）检测呼吸道样本中肠道病毒和鼻病毒的能力尚未得到充分评估。我们试图使用PCR/ESI-MS全面调查成人RTIs的病毒流行病学，包括检测鼻病毒和肠道病毒。对2012年10月至2013年6月期间前往台湾当地诊所或医疗中心门诊或急诊科就诊的267例急性RTIs成人患者（212例上呼吸道感染和55例下呼吸道感染）的鼻咽或咽拭子进行病毒分离和PCR/ESI-MS检测呼吸道病毒。将15例细菌感染患者和27例无活动性感染个体的咽拭子作为对照样本。通过病毒分离、PCR/ESI-MS和两种方法，分别在267例病例中的23.6%、47.2%和47.9%中检测到呼吸道病毒。当同时使用两种方法时，甲型流感病毒（24.3%）和鼻病毒（9.4%）是最常检测到的病毒，而人类冠状病毒、人偏肺病毒（hMPV）、肠道病毒、腺病毒、呼吸道合胞病毒和副流感病毒在少数病例中被检测到（每种病毒类型<5%的病例）。4.1%的病例观察到合并感染。在对照组中，仅1份（2.4%）样本通过PCR/ESI-MS检测呼吸道病毒呈阳性。正在接受类固醇治疗、患有活动性恶性肿瘤或患有慢性阻塞性肺疾病（COPD）的患者分别有感染鼻病毒、hMPV或副流感病毒的风险。总体而言，免疫功能低下患者、COPD患者和接受透析的患者有感染非流感呼吸道病毒的风险。鼻病毒（12.7%）、甲型流感病毒（10.9%）和副流感病毒（7.3%）是55例下呼吸道感染中最常见的病毒。副流感病毒感染、老年和免疫抑制因素与下呼吸道感染独立相关。总之，PCR/ESI-MS提高了病毒RTIs的诊断率。非流感呼吸道病毒感染与合并症患者和下呼吸道感染有关。有必要进行更多研究，以明确在这些人群的诊断检查中纳入非流感呼吸道病毒的临床必要性。
