Human rhinoviruses and severe respiratory infections: is it possible to identify at-risk patients early?

Abstract

Molecular methods of viral screening have demonstrated that human rhinoviruses (HRVs) are associated with lower respiratory tract infections (LRTIs, including bronchiolitis and pneumonia), exacerbations of chronic pulmonary disease and the development of asthma. Patients with severe chronic diseases are at greater risk of developing major clinical problems when infected by HRVs, particularly if they are immunocompromised or have a chronic lung disease. Analysing the characteristics of HRVs does not provide any certainty concerning the risk of a poor prognosis and, although viremia seems to be associated with an increased risk of severe HRV infection, the available data are too scanty to be considered conclusive. However, a chest x-ray showing alveolar involvement suggests the potentially negative evolution of a bacterial superinfection. There is therefore an urgent need for more effective diagnostic, preventive and therapeutic measures in order to prevent HRV infection, and identify and treat the patients at highest risk.

Keywords::

• Enterovirus
• Picornaviridae
• respiratory infection
• rhinovirus
• viral infection

Financial & competing interests disclosure

The authors declare that they have no conflict of interest and have received no payment for preparing this manuscript. This review was supported by a grant from the Italian Ministry of Health (Bando Giovani Ricercatori 2009). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Human rhinoviruses (HRVs) have been associated with lower respiratory tract infections (including severe bronchiolitis and pneumonia), exacerbations of chronic pulmonary disease and the development of asthma.

• Patients with severe chronic diseases are at greater risk of developing major clinical problems when infected by HRVs, particularly if they are immunocompromised or have a chronic lung disease.

• Viremia seems to be associated with an increased risk of severe HRV infection, but the available data are too scanty to be considered conclusive.

• It is not clear whether the three HRV species differently condition the type of respiratory disease and its severity, and each species includes a number of types that could lead to possibly extensive recombinations.

• A chest x-ray showing alveolar involvement during the course of HRV infection suggests the potentially negative evolution of a bacterial superinfection.

• The real etiological role of HRVs remains uncertain: they are shed for several days after the clinical resolution of an acute episode of respiratory infection, can cause asymptomatic infections and are frequently identified together with other respiratory pathogens.

• Diagnostically, HRVs should be included in all of the highly multiplexed respiratory virus, and either the VP1 or VP4 gene should be amplified and sequenced; there is also a need for commercial quantitative molecular tests and standards for all types of HRVs.

• Substantial efforts should be made to prepare urgently needed prophylactic medications and vaccines.

• Various agents are being developed to treat HRV infection, and it is reasonable to think that the efficacy of some of them will be clarified in the next 5 years.