Sang Woo Kim

Bocavirus infection in hospitalized children, South Korea.

This study presents the first evidence of human bocavirus infection in South Korean children. The virus was detected in 27 (8.0%) of 336 tested specimens, including 17 (7.5%) of 225 virus-negative specimens, collected from children with acute lower respiratory tract infection.

WU Polyomavirus in Children with Acute Lower Respiratory Tract Infections, South Korea

In South Korea, WU polyomavirus (WUPyV) was detected in 34 (7%) of 486 children with acute lower respiratory tract infections, 3 (4.2%) of 72 asymptomatic children, and as coinfection with other respiratory viruses in 23 (67.6%) children. Although WUPyV was frequently detected, its clinical role has not been distinguished from that of coinfecting viruses.

Detection of viruses identified recently in children with acute wheezing

The etiologic role of recently identified respiratory viruses for acute wheezing in children is not yet clear. The purpose of this study was to investigate the prevalence of recently identified viruses, including human metapneumovirus (hMPV), human bocavirus (hBoV), human coronavirus NL63 (hCoV‐NL63), and human coronavirus HKU1 (hCoV‐HKU1) in children with acute wheezing. Viral etiology was identified in 231 children hospitalized with acute wheezing, aged from 1 month to 5 years. Viral antigens for common respiratory viruses were detected by IFA or multiplex PCR. RT‐PCR was used to detect respiratory rhinoviruses, hCoV‐NL63, hCoV‐HKU1, and hMPV. PCR assays for hBoV DNA were performed using the primer sets for noncapsid protein (NP1) and nonstructural protein (NS1) genes. Viruses were found in 61.5% (142/231) of the study population and a single virus was detected in 45.5% (105/231) of the study population. Rhinovirus (33.3%), human respiratory syncytial virus (hRSV; 13.8%), and hBoV (13.8%) were the most frequently detected viruses. hMPV and hCoV‐NL63 were detected in 7.8% and 1.3% of wheezing children, respectively. HCoV‐HKU1 was not detected. In 16.0% of the study population, more than one virus was detected. In children with acute wheezing, rhinovirus, hRSV, and hBoV were most frequently detected. Further studies including healthy control subjects are needed to define the clinical significance of hBoV in acute wheezing. J. Med. Virol. 79: 1238–1243, 2007.

Human Coronavirus-NL63 infections in Korean children, 2004–2006

Abstract Background Human coronavirus-NL63 (HCoV-NL63) has been isolated from children with respiratory tract infections and its prevalence in Korea has not been reported. Objectives This study was designed to investigate the presence and the clinical features of HCoV-NL63 during two winter seasons. Study design During April 2004–April 2006, nasopharyngeal specimens from children hospitalized with acute respiratory disease were tested for common respiratory viruses, including RSV, influenza A, influenza B, parainfluenza viruses, and adenovirus by IFA. hMPV infection was excluded by nested RT-PCR using primers for F-gene. To detect HCoV-NL63, previously described nested PCR assays for 1a and 1b were used. PCR products of the 1a gene for HCoV-NL63 were sequenced. Results Out of 872 nasopharyngeal aspirate from children aged under 16 years, 14 (1.7%) were positive for HCoV-NL63. Most of the patients had croup (64.2%) or bronchiolitis (21.4%). The peak prevalence was found in November (28.5%). Most were collected between November 2004 and February 2005. Conclusions HCoV-NL63 may be one of the causative agents of acute respiratory tract infection, especially croup.

Detection of GII-4/2006b Variant and Recombinant Noroviruses in Children With Acute Gastroenteritis, South Korea

Norovirus (NoV), a single‐stranded, positive RNA virus, is an important etiologic agent of acute gastroenteritis in children worldwide. In this study, a total of 434 fecal samples collected from 434 children with acute gastroenteritis in Seoul, between September 2007 and July 2008 were tested to determine the molecular epidemiology of NoVs and characterize recombinant strains by using RT‐PCR followed by sequencing. Of the 434 specimens, NoV, rotavirus, and adenovirus were detected in 155 (35.8%), 72 (16.6%), and 19 specimens (4.3%), respectively. NoV GI was detected in 7 specimens (1.6%) and GII in 148 (34.1%) specimens. Phylogenetic analysis of capsid sequences in the GII‐positive specimens revealed the presence of the following strains: GII‐4, 111 (75.0%); GII‐3, 35 cases (23.6%); GII‐6b, 1 case; and GII‐16, 1 case. Most of the GII‐4 strains were grouped with the GII‐4/2006b variant with 98–100% nucleotide identity. Eleven strains were identified as recombinant (GII‐4/GII‐3 in 10 cases and GII‐b polymerase/GII‐16 capsid in 1 case) by sequencing based on the RdRP and capsid genes. The putative recombination point in the recombinant strains was the ORF‐1/ORF2 overlap, located at nucleotide 5,046 with reference to Lordsdale. In conclusion, GII‐4/2006b variants were detected predominantly and a new recombinant strain (GII‐4/GII‐3) was found in the Korean children with gastroenteritis. Continuous monitoring of the genetic diversity of NoVs is important to determine the trend of the predominant genotype and new recombinant strain. J. Med. Virol. 82:146–152, 2010.

Respiratory picornavirus infections in Korean children with lower respiratory tract infections

Recently, human rhinoviruses (RVs) and enteroviruses have been suggested as important etiological agents in young children with lower respiratory tract infections (LRTIs). We investigated the role of respiratory picornaviruses in hospitalized children with LRTI. A total of 233 nasopharyngeal samples were collected from hospitalized children with LRTIs from July 2004 to January 2006. All specimens were tested for the presence of human respiratory syncytial virus (hRSV), influenza virus A, influenza B, parainfluenzavirus, and adenovirus using direct immunofluorescent assay, and for human metapneumovirus (HMPV) by RT-PCR. Detection of RV was performed in nasopharyngeal samples by a RT-PCR assay that incorporated a BglI restriction enzyme digestion of the picornavirus RT-PCR amplicon, and detection of enterovirus was accomplished by hemi-nested RT-PCR using specific primers. Viral agents were detected in 70.4% (164/233) of the study population. The most frequently detected viruses were RV (64/233, 27.4%), hRSV (48/233, 20.6%), and enterovirus (43/233, 18.4%). Picornaviruses were detected as the sole viral agents in 27.0% (63/233) of children, whereas mixed viral infection was detected in 12.0%. These results suggest that picronavirus infection is an important etiological cause of LRTIs in Korean children.

Th1 and Th2 cytokine levels in nasopharyngeal aspirates from children with human bocavirus bronchiolitis.

BACKGROUND Human bocavirus (hBoV) is regarded as one of the possible etiologic agents in lower respiratory tract infection and bronchial asthma exacerbation in children despite frequent co-detection with other respiratory viruses. The immunologic response in children with hBoV infection is still not clear. OBJECTIVES To investigate the profiles of T helper-1 (Th1)/T helper-2 (Th2) cytokines in children with hBoV-associated bronchiolitis. STUDY DESIGN This study utilized of 59 nasopharyngeal aspirates from 59 infants aged 24 months or younger, including 29 from children with hBoV-related bronchiolitis and 30 with respiratory syncytial virus (RSV)-related bronchiolitis. Eighteen infants hospitalized for elective surgeries were included as controls. Nasopharyngeal aspirates were tested simultaneously for cytokines interleukin (IL)-2, IL-4, IL-5, IL-10, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha using the Cytometric Bead Array. RESULTS Significantly higher concentrations of IFN-gamma (p=0.0001), IL-2 (0.006), and IL-4 (p=0.0002) were observed in hBoV positive specimens than in controls. The concentration of IL-10 (p=0.04) and TNF-alpha (p=0.006) in the RSV-positive group was significantly higher than in the hBoV-positive group, while there was no difference in other cytokines concentration between the two groups. CONCLUSIONS These results showed that both of Th1 and Th2 cytokines were increased in children with hBoV-related bronchiolitis compared to normal controls, but Th2-polarized responses were not observed.

Human Metapneumovirus Infection in Hospitalized Children with Acute Respiratory Disease in Korea

Human metapneumovirus (hMPV) is a recently isolated virus, mostly associated with acute lower respiratory infection in children, of which symptoms are similar to those of respiratory syncytial virus (RSV) infection. The aim of our study was to determine the frequency of hMPV in hospitalized children with acute respiratory tract disease in Korea. Nasal aspirates from hospitalized children with respiratory infections under 15 yr old between December 2003 and February 2005 were included in the study. Each sample was analyzed for RSV, adenovirus, influenza virus A and B, and parainfluenza virus by indirect fluorescent assay (IFA). F-gene sequences were used for PCR for the detection and sequencing of hMPV. In total 381 samples, negative samples in which any viral pathogen could not be identified by IFA were 231 cases. hMPV was detected using reverse transcriptase-PCR (RT-PCR) in 28 of 231 (12.1%) children who were not infected with another respiratory viruses. The hMPV-infected children were diagnosed as having pneumonia, bronchiolitis, bronchial asthma exacerbation, croup, and upper respiratory tract infection. Most of the RT-PCR positive samples for hMPV were collected in winter season. These results suggest that hMPV may be a responsible pathogen causing acute respiratory tract infection in Korean children.

Detection of the Bartonella henselae Gene Sequence in Lymph Nodes of Children With Kikuchi's Disease

I thank Baptista et al for their interest in my research. In the article, my co-workers and I1 hypothesized that brain-type natriuretic peptide (BNP) levels would be elevated in any pathologic condition that resulted in abnormal stress on the ventricles. This would be true of some, but not all, forms of congenital heart disease. It seems from the preliminary data that the doctors are on their way to confirming that hypothesis. We excluded infants with congenital heart disease from our study because of potential limitations of using the BNP assay in this setting that occurred to us while planning for this project. First, BNP is a marker for ventricular stress. It is not specific to any particular disease state. Although BNP is elevated in infants with persistent pulmonary hypertension (PPHN), it can also be expected to be elevated in any infant with congenital heart disease that results in a state of ventricular stress. Second, low levels of BNP, while suggestive of no ventricular stress, do not rule out serious (potentially life-threatening) cardiac or respiratory diseases. As we concluded in the article, “the results of this study should not be interpreted as showing that BNP levels are diagnostic of PPHN or that measuring BNP levels can be used in place of echocardiography.” It is unfortunate that not all practicing pediatricians or neonatologists have access to 24-hour/7-day-a-week echocardiography services. Serum BNP level is a useful adjuvant diagnostic tool that can be used in conjunction with a thorough physical examination, blood gas analysis, and other information to help physicians determine the proper treatment for the patient. Again, we emphasize that “[p]hysicians should have increased suspicion of PPHN, or other states of ventricular stress, when caring for a term or near-term newborn with RD [respiratory distress] and an elevated BNP level.” We feel that any infant with respiratory distress and an elevated BNP level should receive a thorough evaluation, likely including echocardiography, to determine the proper course of treatment. We are glad that preliminary data from Baptista et al support our hypothesis and that they agree with the conclusions we put forth in our article. We look forward to their final manuscript.

Genotype variability of human metapneumovirus, South Korea

Human metapneumovirus (hMPV), a virus causing lower respiratory tract infections in children, is classified two major groups or genotypes of hMPV and recently existence of multiple lineages has been suggested. The purpose of this study was to examine the extent of genetic variation and circulation pattern of hMPV in Korea. Between January 2005 and April 2007, nasopharyngeal aspirates were collected from 1,214 children <16 years of age hospitalized with acute respiratory tract infection at Sanggyepaik Hospital. Nasopharyngeal aspirates were tested for common respiratory pathogens using immunofluorescence or multiplex RT‐PCR. RT‐PCR was used to detect hMPV. The PCR products were purified and subsequently sequenced directly on both strands. hMPV was detected in 8.4% (102/1,214) of nasopharyngeal aspirates from children with acute respiratory tract infection. The 102 hMPV strains detected in this study were classified into two distinct F lineages, 87 strains belonged to genogroup A2 (A2a in 42, A2b in 45) and 15 strains to genogroup B. All hMPV subtypes except A1 co‐circulated in Korean population. Although alternating predominance of hMPV subtypes from year to year could not be found, the changing predominance of sublineage A2a and A2b was demonstrated. J. Med. Virol. 80:902–905, 2008.