Novel clinical features of recurrent human respiratory syncytial virus infections.

Children and elderly individuals are often infected easily and repeatedly with human respiratory syncytial virus (HRSV); however, the features of recurrent infection in the same individual are defined poorly. To clarify the clinical significance of repeated HRSV infections in relation to subgroup epidemiology, this study performed prospective and longitudinal analyses in children with lower respiratory tract infections over 20 consecutive epidemics between 1985 and 2005 at a pediatric outpatient clinic in Kawasaki, Japan. HRSV infections were confirmed by 2 types of reverse-transcription PCR. Samples obtained from patients with repeated infections were subjected to sequence analysis and cloning analysis. A total of 1,312 lower respiratory tract infections observed in 1,010 patients were diagnosed as HRSV infections. Repeated HRSV infections occurred in 208 of the 1,010 patients. Analysis of the patients with repeated infections revealed that children were often infected multiple times even within a single short epidemic. Some patients were re-infected with strains having the same or virtually identical N gene sequences. In patients infected more than 4 times, cloning analysis revealed more frequent dual infections with both subgroups (23.8%). The HRSV-A subgroup caused subsequent homologous infections more frequently than did HRSV-B; furthermore, HRSV-A infections provided no protection from a second homologous infection. In contrast, HRSV-B infections offered significant protection against a second homologous infection. Statistical analysis revealed alleviation of symptoms with a reduced rate of dyspnoeic attacks only in the group re-infected with homologous HRSV-A strains. Thus, this study elucidates new clinical features of recurrent HRSV infection.

[Usefulness of a newly developed immunochromatographic assay kit for the detection of norovirus in stool specimens].

We evaluated the usefulness of ImmunoCatch-Noro (Eiken Chemical Co., Ltd.) (IC-A), a newly developed immunochromatography kit using Au colloid, for the detection of norovirus in stool specimens collected from patients with acute gastroenteritis during the three-year period from 2008-2011. When a total of 316 specimens were tested by RT-PCR and direct sequencing of the PCR products, norovirus was detected in 198 specimens (62.7%), including nine genotypes (GI/2, GI/4, GI/8, GII/1, GII/2, GII/3, GII/4, GII/6 and GII/ 13). The most frequently isolated genotypes were GII/3 (64), GII/2 (59) and GII/4 (58), accounting for about 90% of the positive specimens. As compared to RT-PCR, the sensitivity, specificity and concordance rate of IC-A were 87.4% (173/198), 100% (118/118) and 92.1% (291/316), respectively. Twenty-five positive specimens that were positive by RT-PCR were negative by IC-A, however there were no false-positive results of IC-A. On the other hand, the commercially available immunochromatography kit (IC-B), which was tested for comparison, had a sensitivity, specificity and concordance rate of 59.6% (118/198), 96.6% (114/118) and 73.4% (232/316), respectively, containing 80 false-negative and four false-positive specimens. All of the 118 specimens positive by both IC-B and RT-PCR were also interpreted as positive by IC-A. The detection rates of the predominant genotypes (GII/2, GII/3 and GII/4) by IC-A were 88.1%, 87.5% and 89.7%, respectively. In contrast, those by IC-B were only 32.2%, 67.2% and 81.0%, respectively. These results show that IC-A had adequate sensitivity and cross-reactivity for a wide range of GI and GII genotypes, and also had high specificity. In conclusion, IC-A is a useful rapid-diagnostic kit for the detection of norovirus, however, its current application is limited for stool specimens.

[Evaluation of the diagnostic reagents which detect group A Streptococcus with the immunochromatographical method].

Dipstick 'Eiken' Strep A was evaluated for this sensitivity and specificity. Dipstick 'Eiken' Strep A had a capacity to detect Group A Streptococcus in 1.5x10(5) cfu/swab. The sensitivity of Dipstick 'Eiken' Strep A was 4 times higher than the sensitivity of the latex agglutination test (Serodirect 'Eiken' Strep A) and was almost the same as the immunochromatography test (TESTPACK Plus STREP A, CLEARVIEW STREP A and ImmunoCard STAT! STREP A TEST). No cross reaction was observed among 27 strains of 25 species microorganisms with Dipstick 'Eiken' Strep A. Dipstick 'Eiken' Strep A was compared with TESTPACK Plus STREP A among throat swabs from 50 patients with pharyngitis. Dipstick 'Eiken' Strep A had a sensitivity of 92.9%, a specificity of 90.5% and an agreement of 91.8%. Dipstick 'Eiken' Strep A is found to be useful diagnostic assay in the clinical laboratories.

A phylogenetic study of human respiratory syncytial viruses group A and B strains isolated in two cities in Japan from 1980-2002.

The circulation pattern and genetic evolution of respiratory syncytial virus (RSV) in Japan were examined based on 109 RSV field strains isolated over 20 seasons (1980-2002) in two cities, Sapporo and Tokyo. The second hypervariable region of the large glycoprotein (G) gene was amplified by RT-PCR and the products sequenced directly. The nucleotide sequences were compared to those representatives of RSV genotypes identified previously. Japanese group A and B isolates clustered into five and four genotypes defined previously, respectively. Another one group A and one group B genotypes, which could not be assigned to previous genotypes, were also identified. Although different genotypes usually co-circulated in each season, the isolates in proximate seasons from two communities were usually located in the same branches. Moreover, the strains with genotypes defined previously were usually isolated at the same time as each reference strain of Western countries. Several mutant group B strains with 1-20 longer amino acid G proteins were newly identified in Sapporo. These findings suggest that Japanese RSV strains underwent geographical and also temporal clustering while participating in RSV genetic evolution in a global setting. In addition, Japanese strains, especially group B, might have evolved individually in each community, sometimes changing the length of the G protein.

Detection of respiratory syncytial virus genome by subgroups-A, B specific reverse transcription loop-mediated isothermal amplification (RT-LAMP).

Annual seasonal outbreaks of respiratory syncytial virus (RSV) infection occur every winter. Most patients are diagnosed clinically by a rapid detection kit for RSV protein(s) from nasopharyngeal secretion (NPS), but some problems have been reported on the specificity and sensitivity of such rapid detection kits. To ratify these issues, a sensitive, specific, simple, and rapid molecular based diagnostic method is expected to be introduced and we have developed a method to detect the RSV genome of subgroups A and B independently by reverse transcription loop-mediated isothermal amplification (RT-LAMP). We detected the genomic RNA corresponding approximately to 0.1 TCID 50 in the sample by RT-LAMP for both RSV subgroups under isothermal condition within 60 min after extraction of RNA. Specific DNA amplification was monitored by a real-time turbidimeter and the quantity of RNA was calculated. The RSV genome was detected in 47 of 50 NPS by RT-LAMP, and in 42 by nested RT-PCR, whereas virus isolation was positive for 29 and enzyme-linked immunoassay (EIA) for 34. RSV subgroup A was detected in 25 by RSV RT-LAMP A, RSV subgroup B in 23 by RSV RT-LAMP B, and dual infection with RSV subgroups A and B was identified in one case. They were confirmed with digestion with a specific restriction enzyme, Bgl II. The results showed the potential clinical feasibility of RT-LAMP as a useful diagnostic tool for the detection of RSV with high sensitivity similar to nested RT-PCR.

Detection of human respiratory syncytial virus sequences in peripheral blood mononuclear cells.

Peripheral blood mononuclear cells (PBMC) obtained from patients with lower respiratory infections were examined for the detection of human respiratory syncytial virus (RSV) sequences in the N region using the reverse transcription polymerase chain reaction (RT-PCR). RSV infection was confirmed by at least one method, i.e., virus isolation, enzyme immunoassay for viral antigen, and RT-PCR of nasopharyngeal secretions (NPS) samples. The detection rate for RSV RNA in PBMC obtained from RSV-infected patients was 40% (38/94), compared to 5% (1/20) in controls (P = 0.002). Between the groups positive (38) and negative (56) for RSV RNA in PBMC, there was no significant difference in clinical parameters. Seven patients had eight episodes of reinfection and RSV RNA was detected in 50% (4/8) during consecutive infections. Sequences of their PBMC samples were distinct from those of prototype strains of subgroup A and B. However, they were not always consistent with those of paired NPS samples. The findings suggested that RSV RNA could be detected in PBMC even during reinfection and as might have the possibility of quasispecies dynamics, reflecting the nature of RNA viruses.