Human Rhinovirus Infection in patients requiring intensive care unit admission

Abstract

Background: Human rhinovirus (HRV) usually causes self-limiting upper respiratory tract infections. However, HRV can also be associated with severe pneumonia requiring admission into the intensive care unit. The clinical significance of HRV among critically ill patients without pneumonia is not well defined. This study sought to investigate the clinical significance of HRV among critically ill patients with or without pneumonia. Methods: Archive nasopharyngeal aspirate (NPA) specimens of adult patients admitted to the intensive care unit between January 2011 and December 2013 were tested for HRV using reverse transcription-polymerase chain reaction. HRV genotyping was performed. Clinical data of patients with HRV infection were analyzed. Results: HRV was detected in 22 of 294 (7.5%) patients. NPA was collected within 2 days after hospital admission in 20 (90.9%) patients. Nineteen (86.4%) patients had chronic medical illnesses, with 8 (36.4%) patients having chronic pulmonary diseases. Eighteen (81.2%) patients required positive pressure ventilation. Twelve (54.5%) patients had pneumonia. The diagnoses of the 10 patients without pneumonia include exacerbation of chronic lung disease (4), acute pulmonary edema (3), diabetic ketoacidosis or hyperosmolar coma (2) and epilepsy (1). Four (18.2%) patients died within the same hospitalization. Genotyping was successful for 14 out of 22 patients. Nine (64%) patients had HRV-A, 2 patients had HRV-B (14%) and 3 patients had HRV-C (21%). No co-pathogens were identified for 10 patients. A single co-pathogen was identified for 10 patients, including Streptococcus pneumoniae (3 patients), Klebsiella spp. (3 patients), and patient with influenza A virus (1 patient), adenovirus type 6 (1 patient), cytomegalovirus (1 patient) and Mycobacterium avium-intracellulare complex (1 patient). Two immunocompromised patients had more than one co-pathogens identified. Conclusions: In addition to pneumonia, HRV can be identified in critically ill patients with severe exacerbation of underlying pulmonary or extrapulmonary diseases.