704. Coinfections with Epstein-Barr Virus, Adenovirus, and Novel H1N1 Among Military Trainees
Session: Abstracts: Virology
Friday, October 22, 2010
Background: Upper respiratory infection (URI) is a major cause of morbidity among military trainees, and multiple pathogens often circulate concurrently.  Whether clinical presentations differ or excess morbidity result from coinfections is unclear.  It has been postulated that Epstein-Barr Virus (EBV) infection may contribute to excess morbidity in trainees with adenovirus (AD) infection.

Methods: The Advanced Diagnostics Laboratory was established in 2003 to prospectively evaluate epidemiology and rapid diagnostics of respiratory pathogens in trainees with URI.  From 5/1/2009 to 3/30/2010, demographic, clinical and PCR data from throat and nasal specimens for EBV, AD, and novel H1N1 influenza were collected.  Clinical laboratory data obtained during clinical care were retrospectively obtained.

Results: 664 trainees with URI enrolled (median age 20; 90% male); predominant symptoms were fever (98%; mean 101.40F), cough (89%) and sore throat (87%); 3% were diagnosed with pneumonia and 1% were hospitalized.  AD PCR was positive in 61% (97.5% serotype 4); novel H1N1 in 18.6%, and EBV in 41.8%.  EBV shedding was associated with non-white ethnicity (50.5% vs. 38.1%, p < .01), higher BMI (23.8 vs. 23.0, p < .01), and lack of smoking history (32.0% vs. 68.0%, p = .03).  2/10 tested subjects had positive monospots; both were shedding EBV, and one had confirmatory serology positive.  Among those with AD, EBV shedding (n=205) was not associated with differences in clinical signs or symptoms, except decreased likelihood of lymphadenopathy (52.3% vs. 42.3%, p = .04), and lower aspartate aminotransferase (mean 38.7 vs. 21.8, p=.03).  Among those with H1N1, EBV shedding (n=25) was associated with a slight decrease in respiratory rate (20.6 vs. 16.8, p = .03) and increased report of vomiting (24% vs. 6%, p = .05).  Neither hospitalization nor pneumonia rates differed by EBV shedding status with either AD (2.0% vs. 0.7%; 3.9% vs. 2.5%, respectively) or H1N1 (0 vs. 0, 0 vs. 2.0%).

Conclusion: A large proportion of trainees with URI shed EBV while infected with other respiratory pathogens.  Shedding EBV does not appear to increase morbidity or substantially change clinical presentation in those concurrently infected with AD or H1N1. 


Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Speakers:
Heather C. Yun, MD , Brooke Army Medical Center, Fort Sam Houston, TX
William H. Fugate, BS, MBA , Eagle Applied Sciences Advanced Diagnostics Laboratory, Lackland AFB, TX
Clinton Murray, MD, FIDSA , Brooke Army Medical Center, Fort Sam Houston, TX
Francine F. Stotler, BS , Eagle Applied Sciences Advanced Diagnostics Laboratory, Lackland AFB, TX
Thomas L. Cropper, DVM , Trainee Health Surveillance, Lackland AFB, TX
Lisa M. Lott, PhD , Eagle Applied Sciences Advanced Diagnostics Laboratory, Lackland AFB, TX
J. Matthew McDonald, PhD , Eagle Applied Sciences Advanced Diagnostics Laboratory, Lackland AFB, TX

Disclosures:

H. C. Yun, None

W. H. Fugate, None

C. Murray, None

F. F. Stotler, Yes
Eagle Applied Sciences: Employee,

T. L. Cropper, None

L. M. Lott, Yes
Eagle Applied Sciences: Employee,

J. M. McDonald, Yes
Eagle Applied Sciences: Employee,

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