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204 Pulmonary Disease Human Coronavirus and Acute Respiratory Illness in Older Adults with Chronic Obstructive Pulmonary Disease Gorse GJ O Connor TZ Hall SL et al Dept of Veterans Affairs Med Ctr and Saint Louis Univ Missouri Dept of Veterans Affairs Cooperative Studies Program Coordinating Ctr West Haven Connecticut et al J Infect Dis 199 847 857 2009 Background The clinical features and incidence of human corona virus HCoV infections in chronically ill older adults need better definition Methods HCoV infection was determined on the basis of a 4 fold increase in serum antibody and the detection of HCoV by reverse transcription polymerase chain reaction Laboratory documented influ enza LDI was detected by serologic assay and culture HCoV illnesses were compared with other acute respiratory illnesses identified by active surveillance during the 1998 99 winter respiratory virus season of 2215 patients with chronic obstructive pulmonary disease who were 50 years old and who received influenza vaccines Results HCoV 229E and HCoV OC43 were associated with 90 14 of 665 illnesses HCoV 229E in 22 HCoV OC43 in 67 and both in 1 LDI with 107 16 of 678 illnesses In multivariate logistic regression analysis myalgia was less likely with HCoV infection than with LDI OR 0 27 95 confidence limit 0 13 0 58 A majority of these HCoV and LDI illnesses exhibited each of 11 symptoms and signs of acute respiratory illness Spirometric results worsened most often with LDI and many acute respiratory illnesses regardless of etiology were associated with hospitalization A total of 8 illnesses were associated with HCoV NL63 1 with HCoV HKU1 Conclusions The frequencies of HCoVand LDI illnesses were similar HCoV illness was less severe than LDI illness was accompanied by multiple respiratory and systemic symptoms and was associated with hospitalization In late 2002 and early 2003 a deadly sudden respiratory illness was reported initially from Asia and then from multiple other countries This frightening illness termed sudden acute respiratory syndrome SARS was soon found to be caused by a coronavirus and respect for this virus often considered a common cold virus rose to a whole new level In fact there are many strains of coronavirus and the outbreak of SARS prompted significant increased research into this RNA virus and its potential role in human respiratory prob lems The authors studied acute respiratory illness exacerbations in more than 2200 chronic obstructive pulmonary disease COPD patients in one winter flu season In this population that had received influenza vaccination almost a third of the respiratory illnesses that winter were caused by either coro navirus or influenza virus as measured by serologic evidence of infections culture or polymerase chain reaction Coronaviral infections were associated with most of the same symptoms as influenza infections and resulted in Chapter 5 Community Acquired Pneumonia 205 clinically severe enough infections to warrant hospitalization In both groups about one fourth of the infected patients required hospitalization Clearly coro navirus strains present a spectrum of human respiratory ranging all the way from colds to often lethal SARS It also causes a substantial number of exacerbations in COPD patients and needs to be kept in mind when assessing and managing these patients J R Maurer MD MBA Rhinovirus Disrupts the Barrier Function of Polarized Airway Epithelial Cells Sajjan U Wang Q Zhao Y et al Univ of Michigan Ann Arbor et al Am J Respir Crit Care Med 178 1271 1281 2008 Rationale Secondary bacterial infection following rhinovirus RV infection has been recognized in chronic obstructive pulmonary disease Objectives We sought to understand mechanisms by which RV infec tion facilitates secondary bacterial infection Methods Primary human airway epithelial cells grown at air liquid interface and human bronchial epithelial 16HBE14o cells grown as polarized monolayers were infected apically with RV Transmigration of bacteria nontypeable Haemophilus influenzae and others was assessed by colony counting and transmission electron microscopy Transepithelial resistance R T was measured by using a voltmeter The distribution of zona occludins ZO 1 was determined by immunohistochemistry and immunoblotting Measurements and Main Results Epithelial cells infected with RV showed 2 log more bound bacteria than sham infected cultures and bacteria were recovered from the basolateral media of RV but not sham infected cells Infection of polarized airway epithelial cell cultures with RV for 24 hours caused a significant decrease in R T without causing cell death or apoptosis Ultraviolet treated RV did not decrease R T sug gesting a requirement for viral replication Reduced R T was associated with increased paracellular permeability as determined by flux of fluores cein isothiocyanate FITC inulin Neutralizing antibodies to tumor necrosis factor TNF a IFN g and IL 1b reversed corresponding cyto kine induced reductions in R T but not that induced by RV indicating that the RV effect is independent of these proinflammatory cytokines Confocal microscopy and immunoblotting revealed the loss of ZO 1 from tight junction complexes in RV infected cells Intranasal inoculation of mice with RV1B also caused the loss of ZO 1 from the bronchial epithe lium tight junctions in vivo Conclusions RV facilitates binding translocation and persistence of bacteria by disrupting airway epithelial barrier function Rhinovirus which is probably the most common virus causing the common cold does not typically cause lower respiratory tract infection and does not significantly destroy the respiratory epithelium 1 However other respiratory