Pstgraduate Medical Jurnal (Nvember 1973) 49, 802-806. Rhinvirus infectins P. G. HGGNS Virus Reference Labratry, Central Public Health Labratry, Clindale Avenue, Lndn NW9 5HT Sunmary One hundred and seventy-five rhinviruses were islated frm 4 4 % f patients in the general practice survey and 44 frm 1-8% f children in the hspital survey. slatins were made at all times f the year and althugh islated mst frequently frm cases f cmmn cld rhinviruses were als fund in assciatin with ther respiratry syndrmes. The rhinviruses were the mst recently described agents t be sught in the MRC/PHLS studies. Nt until 1960 was a practical rutine methd fr their detectin described (Tyrrell & Parsns, 1960) with the result that, at the cmmencement f the studies in Octber 1964, few reprts were available based n a substantial number f islates. Hwever, rhinviruses had been shwn t be assciated with naturally ccurring respiratry infectins (e.g. Kendall, Byne & Tyrrell, 1962) and there was evidence suggesting they might be the cmmnest agents t be islated frm such illnesses in the general ppulatin (Higgins, Bstn & Ellis, 1964). During a cllabrative survey f acute infectins f the respiratry tract (MRC, 1965) which immediately preceded the present studies, seventyeight rhinviruses were islated and nly enterviruses (ninety-three) and adenviruses (eighty-six) were encuntered with greater frequency.the rhinviruses were shwn t be present at all seasns and, while cmmnly being islated frm patients with a cmmn cld, they were als fund in a small prprtin f patients diagnsed as suffering frm ther frms f respiratry illness. Results f MRC/PHLS surveys Rhinviruses were islated frm 175 f 3966 patients (4 4 %) sampled in the general practice study and nly parainfluenza virus infectins (190) were mre cmmnly diagnsed. Frty-fur strains were detected in specimens frm 2418 (1-8 %) children admitted t hspital and prven rhinvirus infectins were seen less ften than infectins with any ther grup f viruses in these patients. Rhinviruses were islated frm tw f 280 children (0 7%) withut respiratry symptms at the same time as eleven strains were recvered frm 648 patients (1 7 %) with respiratry illness-a difference that is nt significant at the 5 % level. Seasn Rhinviruses were islated at all seasns in bth surveys (see Figs. 1 & 2, Ple & Tbin, this sympsium). Althugh there were fluctuatins, frm mnth t mnth, in the frequency with which these viruses were detected in individual practices the numbers islated were t small t determine if this variatin was significant. Age Rhinviruses were islated infrequently frm children admitted t hspital under 1 year ld (1-6 Y.) r thse between l and 4 years f age (1 *6 %) but were assciated with a greater prprtin (3 5%) f respiratry illness in lder children (Fig. 1). n general practice (Fig.- 2) the islatin rates were higher fr children under 5 years (4-1 %) and adults (5 8 %) than fr schl children (23 %). Diagnsis Figs. 1 and 2 als shw, by age grup, the prprtin f cases within each f the varius diagnstic categries which was shwn t be rhinvirus infectins. n the general practice survey a rhinvirus was islated frm at least ne in every frty cases sampled irrespective f the diagnsis but f children admitted t hspital nly thse with clds gave as high an islatin rate. Hwever, f children 5-14 years ld in hspital, between 4 and 6 % with clds, crup, brnchitis and pneumnia were fund t be excreting rhinviruses. n general practice higher islatin rates were fund in patients aged 5-15 years with crup (8-3%), and in lder patients suffering frm clds (8 7%), laryngitis and crup (6 2 %) and tracheitis (8 3%). Rhinviruses accunted fr apprximately half the viruses islated frm adult patients with clds and laryngitis and ver a third f thse with tracheitis and brnchitis.
C n c EQ) C w Za) 1 10 Cmmn cld 103 '9 Primary titis 58 N"\\\\\\B media 7 M\\\\\\\\\,m\\\\OS N f Pharyngitis 100 im and 320 tnsillitis 81 1056 All l nesses 1075 287 Rhinvirus infectins M m// Other ~~~~~~~~~~~~~~~~~~ Rhinviruses viruses Streptccci -~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0?~~kkk ktk - xsssss N' ] i\x\x\x\x\x\x\x\x\x\x\xm 49 Crup 144 37.,XkNONX'lq 232 Brnchitis 177 44 268 Brnchilitis 31 4 \\\\\\\\\\\\\\\\\\\\\\\\\\\\x\\x\xex\x\x\xex\m 240 N Pneumnia 2 1 6 87 4 nfluenza 6 4 0 -l mnths - 4 years 5-14 years 10 20 30 40 50 &G~Ei 7 "t83 3 FG. 1. The distributin f rhinviruses by age and clinical illness. Hspital survey. Clinical features The fur cmmnest clinical features f the 232 rhinvirus infectins seen in the tw surveys cmbined were: cryza, cugh, red r sre thrat and fever (Figs. 3 and 4). Headache, general aches and harseness were mre cmmn in adults (between 30 and 40 % f cases) than in children and the cnverse was true fr vmiting and dyspnea. Labratry findings Thse tissue cultures purpsely included in the survey t detect rhinviruses did s in apprximately 3 % f the specimens examined, varying frm 2 9 % in human embry kidney cells t 3-5 % in cultures f HEL7. Rhinviruses were islated frm twentynine (0 4%) f the specimens examined in mnkey kidney cells but ther cultures were f n practical 803 use fr this purpse (see Ple & Tbin, Table 3 this sympsium). The duratin f the illness at the time f swabbing had n influence n the ability t islate rhinviruses frm the specimens taken (see Ple & Tbin, Table 4, this sympsium). Discussin Rhinvirus infectins were fund t be cmmn in the general ppulatin and t ccur at all seasns f the year. The increased prevalence f these viruses during the autumn r early winter reprted by ther wrkers (Hamre, Cnnlly & Prcknw, 1966; Higgins, 1967) was nt bserved, prbably because f the small number f strains islated in any ne labratry. The lwer islatin rate fr rhinviruses in the hspital study can be attributed t the mild nature
804 c- a) ~U ) LO a,) C O Q) E a,1 x 3 Z Cmmn cld 343 and 171 sinusitis 471, '- Primary tit is 58 media 5 Pharyngitis Laryngitis and crup Trachei tis Brnchitis Brnchil itis arid pneumnia n fluenza Al nesses qrn jju ev 667 P. G. Higgins 58 36 _ W,/ 97_// 812 93 i80 MU11111111 04 _ /////////// 58 g/%///// 26 g%////x 5i _ 08 300 i/ / f mst infectins while the increasing imprtance f these viruses with age, is mst likely the result f a build up f immunity t a number f the ther respiratry pathgens. Althugh rhinviruses were the cmmnest diagnsed cause f the cmmn cld a significant prprtin f all ther respiratry tract infectins was fund t be assciated with rhinviruses, especially crup, laryngitis, brnchitis and tracheitis. The fur cmmnest clinical features f rhinvirus infectin-cryza, cugh, sre thrat and feverare nt diagnstic and als ccur with greater frequency than the ther features sught in a number f cnditins, e.g. bth influenza virus A and adenvirus infectins in children in hspital. Rhinviruses Other viruses }Streptccci 98 c Sgfi//////m 0-4> years 106,605 5-14 ) years 1 921 _7 15 +! years 0 10 20 30-1- - /- 40 50 r\ 60 FG. 2. The distributin f rhinviruses by age and clinical illness. General practice survey. t was realized at the utset that, because f the difficulty in btaining human embrynic kidney few specimens wuld be examined in bth this tissue and a sensitive strain f diplid fibrblasts. This prved t be s and tgether with the failure t examine 730 specimens (11-1 %) in either cell system culd accunt, in part, fr the relatively small number f islatins made (Higgins, 1966a). Mre recently it has been shwn that many rhinviruses will nly grw in tissue culture after passage in rgan culture f human embrynic ciliated respiratry epithelium (Tyrrell & Byne, 1966; Higgins, Ellis & Wlley, 1969) and the number f islatins reprted in this study must be an underestimate f the rhinvirus infectins sampled. Sme
Nasal Radilgical Chest C ugh Red pharynx Fever Red tnsils discharge Dyspnea Vmiting Rhnchi Rles shadws recessin Red drum Stridr Pulmnary distensin Cyansis Cnvulsins Z 10 20 30 40 50 60 70 80 90 FG. 3. Clinical features f frty-nine rhinvirus infectins in children. Hspital survey. idea f this deficiency can be judged by cmparing the islatin rate in the general practice study (4 4 %) with the recently reprted finding that 15 % f similar specimens, which were negative n examinatin in tissue culture, yielded viruses after passage in rgan cultures; 80 % f these were rhinviruses (Higgins & Ellis, 1973). t will be appreciated that it was nt pssible t justify the expenditure f labur and materials invlved in any attempt t sertype thse rhinviruses which were islated. What evidence there is suggests that the rhinviruses islated by rgan culture are generally f the same sertype as thse detected in tissue culture and their distributin amng the varius clinical diagnses is similar (Higgins, 1966b). t is reasnable, therefre, t assume that the prprtin f the ttal rhinvirus infectins fund in each f the clinical categries in these surveys is substantially crrect althugh their relative imprtance cmpared t the ther respiratry viruses has been underestimated. Similarly, the frequency with which certain clinical features were fund in assciatin with rhinvirus infectins in these studies is prbably true and unlikely t have been mdified had a larger number f rhinviruses been islated by the use f additinal methds. Rhinvirus infectins 805 Sre General Cugh thrat Feve r Headache aches Harseness Glands Nausea /vmiting Wheeze Earache Cnjunctivitis i Under 15 years Pleural pain 15 years and ver 10 20 30 40 50 60 70 80 FG. 4. Clinical features f sixty-six rhinvirus infectins in children and 117 infectins in adults. General practice survey. Althugh these surveys have added little t ur knwledge f the behaviur f the rhinviruses they have succeeded in cnfirming sme f the bservatins which have been reprted since the cmmencement f these studies. References HAMRE, D., CONNELLY, A.P. & PROCKNOW, J.J. (1966) Virlgical studies f acute respiratry disease in yung adults. V. Virus islatins during fur years f surveillance. American Jurnal f Epidemilgy, 83, 253. HGGNS, P.G. (1966a) The islatin f viruses frm acute respiratry infectins. Part V. A cmparative study f the use f human embry kidney and human embry diplid fibrblasts (W138). Mnthly Bulletin f the Ministry f Health and the Public Health Labratry Service, 25, 223. HGGNS, P.G. (1966b) The islatin f viruses frm acute respiratry infectins. Part V. The use f rgan cultures f human embrynic nasal and tracheal ciliated epithelium. Mnthly Bulletin f the Ministry f Health and the Public Health Labratry Service, 25, 283.
806 P. G. Higgins HGGNS, P.G. (1967) The rhinviruses. The Practitiner, 199, 633. HGGNS, P.G., BOSTON, D.G. & ELLS, E.M. (1964) The islatin f viruses frm acute respiratry infectins.. A study f the islates made frm cases ccurring in a general practice in 1963. Mnthly Bulletin f the Ministry f Health and the Public Health Labratry Service, 23, 93. HGGNS, P.G. & ELLS, E.M. (1973) Further bservatins n the use f rgan cultures in the study f acute respiratry infectins. Jurnal f Medical Micrbilgy, 6, 177. HGGNS, P.G., ELLS, E.M. & WOOLLEY, D.A. (1969) A cmparative study f standard methds and rgan culture fr the islatin f respiratry viruses. Jurnal f Medical Micrbilgy, 2, 109. KENDALL, E.J., BYNOE, M.L. & TYRRELL, D.A.J. (1962). Virus islatins frm cmmn clds ccurring in a residential schl. British Medical Jurnal, 2, 82. MEDCAL RESEARCH COUNCL WORKNG PARTY ON ACUTE RESPRATORY NFECTONS (1965) A cllabrative study f the aetilgy f acute respiratry infectins in Great Britain 1961-4. British Medical Jurnal, 2, 319. TYRRELL, D.A.J. & BYNOE, M.L. (1966) Cultivatin f viruses frm a high prprtin f patients with clds. Lancet, i, 76. TYRRELL, D.A.J. & PARSONS, R. (1960) Sme virus islatins frm cmmn clds.. Cytpathic effects in tissue culture. Lancet, i, 239. Pstgrad Med J: first published as 10.1136/pgmj.49.577.802 n 1 Nvember 1973. Dwnladed frm http://pmj.bmj.cm/ n 7 April 2019 by guest. Prtected by