936. Acute Exacerbations of COPD: Role of viruses and significance of Human Rhinovirus C
Session: Poster Abstract Session: Biomarkers and Risk Factors for Viral Infections
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Acute Exacerbations of Chronic obstructive pulmonary disease (AE-COPD), are frequently associated with viral infections. Human Rhinovirus (HRV) has been associated with AE-COPD.  Rhinovirus C is a newly identified genotype thought to cause more severe disease than other genotypes and is largely unexplored in patients with COPD.

Methods: Nasal and sputum samples from COPD patients were collected every 2 months during well visits and all respiratory illnesses over 1 year. Illness samples and a representative subset of asymptomatic samples from well visits were tested for Rhinovirus using RT-PCR. Other respiratory viruses were identified using serology and RT-PCR. Phylogenetic analysis was performed on HRV illness samples to identify genotypes (A,B,C) by sequencing the 5’ untranslated region. Illness characteristics of HRV genotypes and other viruses were compared.  

Results: Over 1 year, 127 patients were enrolled and 102 illnesses evaluated. HRV was detected in 20 illnesses and 4 asymptomatic subjects (9 HRV-A, 3 HRV-B and 8 HRV-C). HRV diagnostic yield was greater in sputum (89%) vs. nasal (75%) and in illness vs. routine samples (nasal: 15/102 (14.7%) vs. 3/125 (2.4%), p=.0008 and sputum: 14/72 (19.7%) vs. 2/97 (2%), p=.0002). HRV was more frequently identified compared to other viruses; 15 respiratory syncytial virus, 17 coronavirus, 4 metapneumovirus, 4 parainfluenza, 9 influenza A and 1 influenza B, but in general caused milder illness. HRV infected subjects were found to have greater exposure to children compared to those not infected (86% vs. 57%, p=.01). HRV circulated throughout the year although,  HRV-C was only found during winter. HRV-A was the most common genotype and accounted for all subjects seeking medical care (7 office visits and 2 hospitalizations). Clinical features of HRV-C were not significantly different than other genotypes.

Conclusion: Viral respiratory infections are common among COPD patients of which HRV is most frequent. Illness is generally symptomatic but relatively mild compared to other viruses.  HRV-C does not appear to be severe or more frequent than other genotypes. Given the association of exposure to children and HRV infection, good hand hygiene may be prudent in this population visiting young children.


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

Anurag Gandhi, MBBS1, Edward Walsh, MD2,3, Maria Formica3 and Ann Falsey, MD2, (1)Infectious Diseases, University of Rochester Medical Center, Rochester, NY, (2)University of Rochester School of Medicine, Rochester, NY, (3)Rochester General Hospital, Rochester, NY

Disclosures:

A. Gandhi, None

E. Walsh, Novartis: Consultant, Consulting fee
Alnylam: Consultant, Consulting fee
Astra Zeneca: Consultant, Consulting fee
Medimmune: Consultant, Consulting fee
Boehringer Ingelheim: Consultant, Consulting fee

M. Formica, None

A. Falsey, Sanofipasteur: Consultant, Consulting fee and Research grant
GSK Biologics: Consultant, Consulting fee and Research grant
Medimmune: Consultant, Consulting fee
Astra Zeneca: Consultant, Consulting fee
Novartis: Consultant, Consulting fee

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.