Published online February 1, 2008
PEDIATRICS Vol. 121 No. 2 February 2008, pp. 445-446 (doi:10.1542/peds.2007-3356)

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LETTER TO THE EDITOR

Human Metapneumovirus and Human Coronavirus NL63

Diogo André Pilger, MSc
Serviço de Genética Médica
Hospital de Clínicas de Porto Alegre
90035-005, Porto Alegre, RS, Brazil

Vlademir Vicente Cantarelli, PhD
Instituto de Ciências da Saúde
Centro Universitário Feevale
90035-005, Porto Alegre, RS, Brazil

To the Editor.—

We read with great interest the article by Lambert et al that studied the role of 2 new respiratory viruses (human metapneumovirus [hMPV] and human coronavirus NL63 [hCoV-NL63]) in healthy preschool-aged children using parent-collected specimens with molecular techniques.¹ The study showed that these viruses circulated in Melbourne, Australia, during 2003, and an association between child care and acute respiratory illness was proposed.¹ We believe that some methodologic aspects of this study may have impaired the accuracy of the assessment of the role of these 2 viruses in such a population. Current literature shows that there are differences between respiratory samples collected by nose/throat swabs and nasopharyngeal aspirates regarding their potential to detect and identify respiratory pathogens.² Tracheal secretion is less suitable for detection of respiratory viruses than nasopharyngeal washes and bronchoalveolar lavage.² Another important point is the classification of symptoms, based entirely on parental experience. There are many subjective signs that, for an inexperienced person, would be difficult to recognize. All conclusions of an association between acute respiratory illness and virus incidence are based on symptom classifications (A and B), which may be incorrect.

Finally, different methods were used to determine the incidence of several respiratory viruses. It has been shown that the sensitivity and specificity of real-time polymerase chain reaction (PCR), conventional PCR, and nested PCR may be completely different. In this case, hMPV and hCoV-NL63 were identified by using the most sensitive techniques (real-time and nested PCR), which might lead to an overestimation of the role of hMPV and hCoV-NL63 in community-acquired infections. However, there are no gold standards for detection of respiratory viruses to which both conventional tests and real-time PCR can be compared.³

REFERENCES

1. Lambert SB, Allen KM, Druce JD, et al. Community epidemiology of human metapneumovirus, human coronavirus NL63, and other respiratory viruses in healthy preschool-aged children using parent-collected specimens. Pediatrics. 2007;120 (4). Available at: www.pediatrics.org/cgi/content/full/120/4/e929
2. Kleines M, Scheithauer S, Rackowitz A, Ritter K, Häusler M. High prevalence of human bocavirus detected in young children with severe acute lower respiratory tract disease by use of a standard PCR protocol and a novel real-time PCR protocol. J Clin Microbiol. 2007;45 (3):1032 –1034[Abstract/Free Full Text]
3. van de Pol AC, van Loon AM, Wolfs TMF, et al. Increased detection of respiratory syncytial virus, influenza viruses, parainfluenza viruses, and adenoviruses with real-time PCR in samples from patients with respiratory symptoms. J Clin Microbiol. 2007;45 (7):2260 –2262[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Pilger, D. A. Articles by Cantarelli, V. V. Search for Related Content PubMed PubMed Citation Articles by Pilger, D. A. Articles by Cantarelli, V. V. Related Collections Infectious Disease & Immunity Related AAP Red Book topics: Coronaviruses, Including SARS Social Bookmarking                         What's this?