1750. Severity and Viral Etiologies of Upper Respiratory Infections in Chronically Ill Older Adults and Young Healthy Adults
Session: Poster Abstract Session: Viral Infections; Pathogenesis and Epidemiology
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Gorse Illness Pstr_44x88_FIN.pdf (420.3 kB)
  • Background: Human coronaviruses (HCoV) and other respiratory viruses are associated with a range of upper respiratory illnesses (URI) in chronically ill older adults.  Severity, seasonal incidence and etiology are important to characterize. 

    Methods: A prospective, observational trial conducted in 2009 – 2012 assessed URIs in patients ≥60 y old with chronic lung (65%) and heart (78%) diseases (Group 1) and a comparator group of young healthy adults aged 18 – 40 y (Group 2).  Subjects were assessed for qualifying respiratory illnesses soon after onset and again 3-4 weeks later.  Respiratory secretions were tested for 15 respiratory viruses by multiplex RT-PCR (xTAG RVP Fast, Luminex) and serum antibodies were detected by enzyme linked immunosorbent assay for 4 HCoV strains.

    Results: We enrolled 100 chronically ill patients in Group 1 (mean age 66.6±20.3 y) and 101 subjects in Group 2 (mean age 30.6±6.4 y) between 11/2009 and 8/2011 in St. Louis, MO.  Prospective follow-up that continued through 12/2012 is reported.  192 qualifying illnesses were evaluated that occurred in 38 Group 1 (74 illnesses) and 60 Group 2 subjects (118 illnesses) (p<0.01).  Virus-associated illnesses were detected in all calendar quarters.  Group 1 patients were more likely to experience 9 to 11 total symptoms of respiratory infection in association with an illness than were Group 2 patients (17 [23.0%] vs. 14 [11.9%] illnesses; p<0.05).  There were 29 (39.2%) illnesses in Group 1 and 58 (49.2%) illnesses in Group 2 that were virus-associated illnesses, of which 14 (48.3%) in Group 1 and 24 (41.3%) in Group 2 were associated with HCoV.  The preponderance of RT-PCR (+) specimens for HCoV was for the -OC43 strain.  Infections with -229E, -NL63 and -HKU1 occurred, as well.  The most commonly identified non-HCoV virus by RT-PCR was entero/rhinovirus in 14 (18.9%) illnesses in Group 1 and 38 (31.4%) illnesses in Group 2. Co-infections with more than one virus occurred. Three severity of illness scores indicated more severe disease in Group 1 patients than in Group 2 at the acute illness and/or follow-up visits 3-4 weeks later.  

    Conclusion: HCoV was associated with about 20% of upper respiratory illnesses and occurred in both age groups.   URIs were more severe and prolonged in the older age group with chronic illnesses.

    Geoffrey J. Gorse, MD1,2, Mary M. Donovan, MSN1,2, Sumitra Balasubramanian, MS1,3, Gira B. Patel, MS1,2 and Rodney H. Lusk, MD1,2, (1)VA St. Louis Health Care System, St. Louis, MO, (2)Saint Louis University School of Medicine, St. Louis, MO, (3)Washington University School of Medicine, St. Louis, MO


    G. J. Gorse, None

    M. M. Donovan, None

    S. Balasubramanian, None

    G. B. Patel, None

    R. H. Lusk, None

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