Clinical and Molecular Epidemiological Features of Coronavirus HKU1–Associated Community-Acquired Pneumonia
Identifieur interne : 000393 ( Istex/Corpus ); précédent : 000392; suivant : 000394Clinical and Molecular Epidemiological Features of Coronavirus HKU1–Associated Community-Acquired Pneumonia
Auteurs : Patrick C. Y. Woo ; Susanna K. P. Lau ; Hoi-Wah Tsoi ; Yi Huang ; Rosana W. S. Poon ; Chung-Ming Chu ; Rodney A. Lee ; Wei-Kwang Luk ; Gilman K. M. Wong ; Beatrice H. L. Wong ; Vincent C. C. Cheng ; Bone S. F. Tang ; Alan K. L. Wu ; Raymond W. H. Yung ; Honglin Chen ; Yi Guan ; Kwok-Hung Chan ; Kwok-Yung YuenSource :
- The Journal of Infectious Diseases [ 0022-1899 ] ; 2005.
Abstract
BackgroundRecently, we described the discovery of a novel group 2 coronavirus, coronavirus HKU1 (CoV-HKU1), from a patient with pneumonia. However, the clinical and molecular epidemiological features of CoV-HKU1–associated pneumonia are unknown MethodsProspectively collected (during a 12-month period) nasopharyngeal aspirates (NPAs) from patients with community-acquired pneumonia from 4 hospitals were subjected to reverse-transcription polymerase chain reaction, for detection of CoV-HKU1. The epidemiological, clinical, and laboratory characteristics of patients with CoV-HKU1–associated pneumonia were analyzed. The pol spike (S), and nucleocapsid (N) genes were also sequenced ResultsNPAs from 10 (2.4%) of 418 patients with community-acquired pneumonia were found to be positive for CoV-HKU1. All 10 cases occurred in spring and winter. Nine of these patients were adults, and 4 had underlying diseases of the respiratory tract. In the 6 patients from whom serum samples were available, all had a 4-fold change in immunoglobulin (Ig) G titer and/or presence of IgM against CoV-HKU1. The 2 patients who died had significantly lower hemoglobin levels, monocyte counts, albumin levels, and oxygen saturation levels on admission and had more-extensive involvement visible on chest radiographs. Sequence analysis of the pol S, and N genes revealed 2 genotypes of CoV-HKU1 ConclusionsCoV-HKU1 accounts for 2.4% of community-acquired pneumonia, with 2 genotypes in the study population. Without performance of diagnostic tests, the illness was clinically indistinguishable from other community-acquired pneumonia illnesses
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DOI: 10.1086/497151
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Lau</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Tsoi, Hoi Wah" sort="Tsoi, Hoi Wah" uniqKey="Tsoi H" first="Hoi-Wah" last="Tsoi">Hoi-Wah Tsoi</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Huang, Yi" sort="Huang, Yi" uniqKey="Huang Y" first="Yi" last="Huang">Yi Huang</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Poon, Rosana W S" sort="Poon, Rosana W S" uniqKey="Poon R" first="Rosana W. S." last="Poon">Rosana W. S. Poon</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Chu, Chung Ming" sort="Chu, Chung Ming" uniqKey="Chu C" first="Chung-Ming" last="Chu">Chung-Ming Chu</name><affiliation><mods:affiliation>Division of Respiratory Medicine, Department of Medicine, United Christian Hospital,</mods:affiliation></affiliation></author><author><name sortKey="Lee, Rodney A" sort="Lee, Rodney A" uniqKey="Lee R" first="Rodney A." last="Lee">Rodney A. Lee</name><affiliation><mods:affiliation>Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, and</mods:affiliation></affiliation></author><author><name sortKey="Luk, Wei Kwang" sort="Luk, Wei Kwang" uniqKey="Luk W" first="Wei-Kwang" last="Luk">Wei-Kwang Luk</name><affiliation><mods:affiliation>Department of Pathology, Tseung Kwan O Hospital, Hong Kong, China</mods:affiliation></affiliation></author><author><name sortKey="Wong, Gilman K M" sort="Wong, Gilman K M" uniqKey="Wong G" first="Gilman K. M." last="Wong">Gilman K. M. Wong</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Wong, Beatrice H L" sort="Wong, Beatrice H L" uniqKey="Wong B" first="Beatrice H. L." last="Wong">Beatrice H. L. Wong</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Cheng, Vincent C C" sort="Cheng, Vincent C C" uniqKey="Cheng V" first="Vincent C. C." last="Cheng">Vincent C. C. Cheng</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Tang, Bone S F" sort="Tang, Bone S F" uniqKey="Tang B" first="Bone S. F." last="Tang">Bone S. F. Tang</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Wu, Alan K L" sort="Wu, Alan K L" uniqKey="Wu A" first="Alan K. L." last="Wu">Alan K. L. Wu</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Yung, Raymond W H" sort="Yung, Raymond W H" uniqKey="Yung R" first="Raymond W. H." last="Yung">Raymond W. H. Yung</name><affiliation><mods:affiliation>Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, and</mods:affiliation></affiliation></author><author><name sortKey="Chen, Honglin" sort="Chen, Honglin" uniqKey="Chen H" first="Honglin" last="Chen">Honglin Chen</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Guan, Yi" sort="Guan, Yi" uniqKey="Guan Y" first="Yi" last="Guan">Yi Guan</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Chan, Kwok Hung" sort="Chan, Kwok Hung" uniqKey="Chan K" first="Kwok-Hung" last="Chan">Kwok-Hung Chan</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Yuen, Kwok Yung" sort="Yuen, Kwok Yung" uniqKey="Yuen K" first="Kwok-Yung" last="Yuen">Kwok-Yung Yuen</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:F635127357C94B9B60E61F3A605ABC210BDF9E16</idno><date when="2005" year="2005">2005</date><idno type="doi">10.1086/497151</idno><idno type="url">https://api.istex.fr/ark:/67375/HXZ-5B17D7TW-C/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">000393</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000393</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main">Clinical and Molecular Epidemiological Features of Coronavirus HKU1–Associated Community-Acquired Pneumonia<ref type="fn" target="#fn1"></ref></title><author><name sortKey="Woo, Patrick C Y" sort="Woo, Patrick C Y" uniqKey="Woo P" first="Patrick C. Y." last="Woo">Patrick C. Y. Woo</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Lau, Susanna K P" sort="Lau, Susanna K P" uniqKey="Lau S" first="Susanna K. P." last="Lau">Susanna K. P. Lau</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Tsoi, Hoi Wah" sort="Tsoi, Hoi Wah" uniqKey="Tsoi H" first="Hoi-Wah" last="Tsoi">Hoi-Wah Tsoi</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Huang, Yi" sort="Huang, Yi" uniqKey="Huang Y" first="Yi" last="Huang">Yi Huang</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Poon, Rosana W S" sort="Poon, Rosana W S" uniqKey="Poon R" first="Rosana W. S." last="Poon">Rosana W. S. Poon</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Chu, Chung Ming" sort="Chu, Chung Ming" uniqKey="Chu C" first="Chung-Ming" last="Chu">Chung-Ming Chu</name><affiliation><mods:affiliation>Division of Respiratory Medicine, Department of Medicine, United Christian Hospital,</mods:affiliation></affiliation></author><author><name sortKey="Lee, Rodney A" sort="Lee, Rodney A" uniqKey="Lee R" first="Rodney A." last="Lee">Rodney A. Lee</name><affiliation><mods:affiliation>Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, and</mods:affiliation></affiliation></author><author><name sortKey="Luk, Wei Kwang" sort="Luk, Wei Kwang" uniqKey="Luk W" first="Wei-Kwang" last="Luk">Wei-Kwang Luk</name><affiliation><mods:affiliation>Department of Pathology, Tseung Kwan O Hospital, Hong Kong, China</mods:affiliation></affiliation></author><author><name sortKey="Wong, Gilman K M" sort="Wong, Gilman K M" uniqKey="Wong G" first="Gilman K. M." last="Wong">Gilman K. M. Wong</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Wong, Beatrice H L" sort="Wong, Beatrice H L" uniqKey="Wong B" first="Beatrice H. L." last="Wong">Beatrice H. L. Wong</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Cheng, Vincent C C" sort="Cheng, Vincent C C" uniqKey="Cheng V" first="Vincent C. C." last="Cheng">Vincent C. C. Cheng</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Tang, Bone S F" sort="Tang, Bone S F" uniqKey="Tang B" first="Bone S. F." last="Tang">Bone S. F. Tang</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Wu, Alan K L" sort="Wu, Alan K L" uniqKey="Wu A" first="Alan K. L." last="Wu">Alan K. L. Wu</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Yung, Raymond W H" sort="Yung, Raymond W H" uniqKey="Yung R" first="Raymond W. H." last="Yung">Raymond W. H. Yung</name><affiliation><mods:affiliation>Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, and</mods:affiliation></affiliation></author><author><name sortKey="Chen, Honglin" sort="Chen, Honglin" uniqKey="Chen H" first="Honglin" last="Chen">Honglin Chen</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Guan, Yi" sort="Guan, Yi" uniqKey="Guan Y" first="Yi" last="Guan">Yi Guan</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Chan, Kwok Hung" sort="Chan, Kwok Hung" uniqKey="Chan K" first="Kwok-Hung" last="Chan">Kwok-Hung Chan</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author><author><name sortKey="Yuen, Kwok Yung" sort="Yuen, Kwok Yung" uniqKey="Yuen K" first="Kwok-Yung" last="Yuen">Kwok-Yung Yuen</name><affiliation><mods:affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">The Journal of Infectious Diseases</title><title level="j" type="abbrev">The Journal of Infectious Diseases</title><idno type="ISSN">0022-1899</idno><idno type="eISSN">1537-6613</idno><imprint><publisher>The University of Chicago Press</publisher><date type="published">2005</date><biblScope unit="vol">192</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1898">1898</biblScope><biblScope unit="page" to="1907">1907</biblScope></imprint><idno type="ISSN">0022-1899</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-1899</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">BackgroundRecently, we described the discovery of a novel group 2 coronavirus, coronavirus HKU1 (CoV-HKU1), from a patient with pneumonia. However, the clinical and molecular epidemiological features of CoV-HKU1–associated pneumonia are unknown MethodsProspectively collected (during a 12-month period) nasopharyngeal aspirates (NPAs) from patients with community-acquired pneumonia from 4 hospitals were subjected to reverse-transcription polymerase chain reaction, for detection of CoV-HKU1. The epidemiological, clinical, and laboratory characteristics of patients with CoV-HKU1–associated pneumonia were analyzed. The pol spike (S), and nucleocapsid (N) genes were also sequenced ResultsNPAs from 10 (2.4%) of 418 patients with community-acquired pneumonia were found to be positive for CoV-HKU1. All 10 cases occurred in spring and winter. Nine of these patients were adults, and 4 had underlying diseases of the respiratory tract. In the 6 patients from whom serum samples were available, all had a 4-fold change in immunoglobulin (Ig) G titer and/or presence of IgM against CoV-HKU1. The 2 patients who died had significantly lower hemoglobin levels, monocyte counts, albumin levels, and oxygen saturation levels on admission and had more-extensive involvement visible on chest radiographs. Sequence analysis of the pol S, and N genes revealed 2 genotypes of CoV-HKU1 ConclusionsCoV-HKU1 accounts for 2.4% of community-acquired pneumonia, with 2 genotypes in the study population. Without performance of diagnostic tests, the illness was clinically indistinguishable from other community-acquired pneumonia illnesses</div></front></TEI><istex><corpusName>oup</corpusName><keywords><teeft><json:string>coronavirus</json:string><json:string>npa</json:string><json:string>airspace</json:string><json:string>figu</json:string><json:string>primer</json:string><json:string>human coronavirus</json:string><json:string>pneumonia</json:string><json:string>mutation</json:string><json:string>nonsynonymous mutation</json:string><json:string>genotype</json:string><json:string>viral</json:string><json:string>phylogenetic</json:string><json:string>nonsynonymous</json:string><json:string>radiological</json:string><json:string>coronaviruses</json:string><json:string>sars</json:string><json:string>hku1</json:string><json:string>radiograph</json:string><json:string>hong kong</json:string><json:string>december</json:string><json:string>sequencing</json:string><json:string>oxygen saturation 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disease</json:string><json:string>viral replication</json:string><json:string>other hand</json:string><json:string>immune system</json:string><json:string>prospective study</json:string><json:string>disease onset history</json:string><json:string>young child</json:string><json:string>rapid diagnosis</json:string><json:string>potassium concentration</json:string></teeft></keywords><author><json:item><name>Patrick C. Y. Woo</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Susanna K. P. Lau</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Hoi-wah Tsoi</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Yi Huang</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Rosana W. S. Poon</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Chung-ming Chu</name><affiliations><json:string>Division of Respiratory Medicine, Department of Medicine, United Christian Hospital,</json:string></affiliations></json:item><json:item><name>Rodney A. Lee</name><affiliations><json:string>Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, and</json:string></affiliations></json:item><json:item><name>Wei-kwang Luk</name><affiliations><json:string>Department of Pathology, Tseung Kwan O Hospital, Hong Kong, China</json:string></affiliations></json:item><json:item><name>Gilman K. M. Wong</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Beatrice H. L. Wong</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Vincent C. C. Cheng</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Bone S. F. Tang</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Alan K. L. Wu</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Raymond W. H. Yung</name><affiliations><json:string>Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, and</json:string></affiliations></json:item><json:item><name>Honglin Chen</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Yi Guan</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Kwok-hung Chan</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item><json:item><name>Kwok-yung Yuen</name><affiliations><json:string>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</json:string></affiliations></json:item></author><arkIstex>ark:/67375/HXZ-5B17D7TW-C</arkIstex><language><json:string>unknown</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>BackgroundRecently, we described the discovery of a novel group 2 coronavirus, coronavirus HKU1 (CoV-HKU1), from a patient with pneumonia. However, the clinical and molecular epidemiological features of CoV-HKU1–associated pneumonia are unknown MethodsProspectively collected (during a 12-month period) nasopharyngeal aspirates (NPAs) from patients with community-acquired pneumonia from 4 hospitals were subjected to reverse-transcription polymerase chain reaction, for detection of CoV-HKU1. The epidemiological, clinical, and laboratory characteristics of patients with CoV-HKU1–associated pneumonia were analyzed. The pol spike (S), and nucleocapsid (N) genes were also sequenced ResultsNPAs from 10 (2.4%) of 418 patients with community-acquired pneumonia were found to be positive for CoV-HKU1. All 10 cases occurred in spring and winter. Nine of these patients were adults, and 4 had underlying diseases of the respiratory tract. In the 6 patients from whom serum samples were available, all had a 4-fold change in immunoglobulin (Ig) G titer and/or presence of IgM against CoV-HKU1. The 2 patients who died had significantly lower hemoglobin levels, monocyte counts, albumin levels, and oxygen saturation levels on admission and had more-extensive involvement visible on chest radiographs. Sequence analysis of the pol S, and N genes revealed 2 genotypes of CoV-HKU1 ConclusionsCoV-HKU1 accounts for 2.4% of community-acquired pneumonia, with 2 genotypes in the study population. Without performance of diagnostic tests, the illness was clinically indistinguishable from other community-acquired pneumonia illnesses</abstract><qualityIndicators><score>7.76</score><pdfWordCount>4453</pdfWordCount><pdfCharCount>30344</pdfCharCount><pdfVersion>1.4</pdfVersion><pdfPageCount>10</pdfPageCount><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><pdfWordsPerPage>445</pdfWordsPerPage><pdfText>true</pdfText><refBibsNative>true</refBibsNative><abstractWordCount>220</abstractWordCount><abstractCharCount>1623</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Clinical and Molecular Epidemiological Features of Coronavirus HKU1–Associated Community-Acquired Pneumonia</title><pmid><json:string>16267760</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>The Journal of Infectious Diseases</title><language><json:string>unknown</json:string></language><issn><json:string>0022-1899</json:string></issn><eissn><json:string>1537-6613</json:string></eissn><publisherId><json:string>jid</json:string></publisherId><volume>192</volume><issue>11</issue><pages><first>1898</first><last>1907</last></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>2005</json:string><json:string>1000</json:string><json:string>2002</json:string><json:string>2003</json:string><json:string>2784</json:string></date><geogName></geogName><orgName><json:string>Department of Medicine, United Christian Hospital</json:string><json:string>University of Hong Kong</json:string><json:string>Suen Chi Sun Charitable Foundation</json:string><json:string>Research Grant Council</json:string><json:string>Queen Mary Hospital, Hong Kong</json:string><json:string>Division of Respiratory Medicine</json:string><json:string>Department of Microbiology, The University of Hong Kong</json:string><json:string>Special Research Achievement Award</json:string><json:string>Department of Pathology, Tseung Kwan O Hospital, Hong Kong, China Background</json:string><json:string>Research Fund for the Control of Infectious Diseases of the Health, Welfare, and Food Bureau of the Hong Kong SAR Government</json:string><json:string>China Survived</json:string><json:string>Department of Microbiology, Pamela Youde Nethersole Eastern Hospital</json:string><json:string>China Hypertension Chinese</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Yi Huang</json:string><json:string>H. L. Wong</json:string><json:string>Yi Guan</json:string><json:string>W. H. Yung</json:string><json:string>Mortality</json:string><json:string>Chronic</json:string><json:string>K. P. Lau</json:string><json:string>C. C. Cheng</json:string><json:string>K. L. Wu</json:string><json:string>Rodney A. Lee</json:string><json:string>W. S. Poon</json:string><json:string>S. F. Tang</json:string><json:string>Kwok</json:string><json:string>K. M. Wong</json:string><json:string>Radio</json:string></persName><placeName><json:string>Hong Kong</json:string><json:string>Shenzhen</json:string><json:string>China</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>[4]</json:string><json:string>January 2004</json:string><json:string>[12]</json:string><json:string>[22]</json:string><json:string>[8]</json:string><json:string>[4, 12]</json:string><json:string>[21]</json:string><json:string>[3]</json:string><json:string>[20]</json:string><json:string>[5, 6]</json:string><json:string>Woo et al.</json:string><json:string>[7]</json:string><json:string>[19]</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/HXZ-5B17D7TW-C</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - microbiology</json:string><json:string>2 - infectious diseases</json:string><json:string>2 - immunology</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - biomedical research</json:string><json:string>3 - microbiology</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Infectious Diseases</json:string><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Immunology and Allergy</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>2005</publicationDate><copyrightDate>2005</copyrightDate><doi><json:string>10.1086/497151</json:string></doi><id>F635127357C94B9B60E61F3A605ABC210BDF9E16</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/ark:/67375/HXZ-5B17D7TW-C/fulltext.pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/ark:/67375/HXZ-5B17D7TW-C/bundle.zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/ark:/67375/HXZ-5B17D7TW-C/fulltext.tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main">Clinical and Molecular Epidemiological Features of Coronavirus HKU1–Associated Community-Acquired Pneumonia<ref type="fn" target="#fn1"></ref></title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>The University of Chicago Press</publisher><availability><licence>© 2005 by the Infectious Diseases Society of America</licence></availability><date type="Copyright" when="2005">2005</date><date type="published">2005</date></publicationStmt><notesStmt><note type="content-type" source="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="publication-type" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="article"><analytic><title level="a" type="main">Clinical and Molecular Epidemiological Features of Coronavirus HKU1–Associated Community-Acquired Pneumonia<ref type="fn" target="#fn1"></ref></title><author xml:id="author-0000"><persName><surname>Woo</surname><forename type="first">Patrick C. Y.</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0001"><persName><surname>Lau</surname><forename type="first">Susanna K. P.</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0002"><persName><surname>Tsoi</surname><forename type="first">Hoi-wah</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0003"><persName><surname>Huang</surname><forename type="first">Yi</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0004"><persName><surname>Poon</surname><forename type="first">Rosana W. S.</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0005"><persName><surname>Chu</surname><forename type="first">Chung-ming</forename></persName><affiliation><orgName type="division">Division of Respiratory Medicine</orgName><orgName type="division">Department of Medicine</orgName><orgName type="institution">United Christian Hospital</orgName></affiliation></author><author xml:id="author-0006"><persName><surname>Lee</surname><forename type="first">Rodney A.</forename></persName><affiliation><orgName type="department">Department of Microbiology</orgName><orgName type="institution">Pamela Youde Nethersole Eastern Hospital</orgName><address><addrLine>and</addrLine></address></affiliation></author><author xml:id="author-0007"><persName><surname>Luk</surname><forename type="first">Wei-kwang</forename></persName><affiliation><orgName type="department">Department of Pathology</orgName><orgName type="institution">Tseung Kwan O Hospital</orgName><address><addrLine>Hong Kong</addrLine><country key="CN" xml:lang="en">CHINA</country></address></affiliation></author><author xml:id="author-0008"><persName><surname>Wong</surname><forename type="first">Gilman K. M.</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0009"><persName><surname>Wong</surname><forename type="first">Beatrice H. L.</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0010"><persName><surname>Cheng</surname><forename type="first">Vincent C. C.</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0011"><persName><surname>Tang</surname><forename type="first">Bone S. F.</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0012"><persName><surname>Wu</surname><forename type="first">Alan K. L.</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0013"><persName><surname>Yung</surname><forename type="first">Raymond W. H.</forename></persName><affiliation><orgName type="department">Department of Microbiology</orgName><orgName type="institution">Pamela Youde Nethersole Eastern Hospital</orgName><address><addrLine>and</addrLine></address></affiliation></author><author xml:id="author-0014"><persName><surname>Chen</surname><forename type="first">Honglin</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0015"><persName><surname>Guan</surname><forename type="first">Yi</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0016"><persName><surname>Chan</surname><forename type="first">Kwok-hung</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><author xml:id="author-0017"><persName><surname>Yuen</surname><forename type="first">Kwok-yung</forename></persName><affiliation><orgName type="division">Division of Infectious Disease</orgName><orgName type="department">Department of Microbiology</orgName><orgName type="institution">The University of Hong Kong</orgName></affiliation></author><idno type="istex">F635127357C94B9B60E61F3A605ABC210BDF9E16</idno><idno type="ark">ark:/67375/HXZ-5B17D7TW-C</idno><idno type="DOI">10.1086/497151</idno></analytic><monogr><title level="j" type="main">The Journal of Infectious Diseases</title><title level="j" type="abbrev">The Journal of Infectious Diseases</title><idno type="hwp">jinfdis</idno><idno type="publisher-id">jid</idno><idno type="pISSN">0022-1899</idno><idno type="eISSN">1537-6613</idno><imprint><publisher>The University of Chicago Press</publisher><date type="published">2005</date><biblScope unit="vol">192</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1898">1898</biblScope><biblScope unit="page" to="1907">1907</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><encodingDesc><schemaRef type="ODD" url="https://xml-schema.delivery.istex.fr/tei-istex.odd"></schemaRef><appInfo><application ident="pub2tei" version="1.0.41" when="2020-04-06"><label>pub2TEI-ISTEX</label><desc>A set of style sheets for converting XML documents encoded in various scientific publisher formats into a common TEI format.
<ref target="http://www.tei-c.org/">We use TEI</ref></desc></application></appInfo></encodingDesc><profileDesc><abstract><p><hi rend="bold">Background</hi>Recently, we described the discovery of a novel group 2 coronavirus, coronavirus HKU1 (CoV-HKU1), from a patient with pneumonia. However, the clinical and molecular epidemiological features of CoV-HKU1–associated pneumonia are unknown</p><p><hi rend="bold">Methods</hi>Prospectively collected (during a 12-month period) nasopharyngeal aspirates (NPAs) from patients with community-acquired pneumonia from 4 hospitals were subjected to reverse-transcription polymerase chain reaction, for detection of CoV-HKU1. The epidemiological, clinical, and laboratory characteristics of patients with CoV-HKU1–associated pneumonia were analyzed. The <hi rend="italic">pol</hi> spike (S), and nucleocapsid (N) genes were also sequenced</p><p><hi rend="bold">Results</hi>NPAs from 10 (2.4%) of 418 patients with community-acquired pneumonia were found to be positive for CoV-HKU1. All 10 cases occurred in spring and winter. Nine of these patients were adults, and 4 had underlying diseases of the respiratory tract. In the 6 patients from whom serum samples were available, all had a 4-fold change in immunoglobulin (Ig) G titer and/or presence of IgM against CoV-HKU1. The 2 patients who died had significantly lower hemoglobin levels, monocyte counts, albumin levels, and oxygen saturation levels on admission and had more-extensive involvement visible on chest radiographs. Sequence analysis of the <hi rend="italic">pol</hi> S, and N genes revealed 2 genotypes of CoV-HKU1</p><p><hi rend="bold">Conclusions</hi>CoV-HKU1 accounts for 2.4% of community-acquired pneumonia, with 2 genotypes in the study population. Without performance of diagnostic tests, the illness was clinically indistinguishable from other community-acquired pneumonia illnesses</p></abstract><textClass ana="subject"><keywords scheme="heading"><term>Major Article</term></keywords></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc><revisionDesc><change when="2020-04-06" who="#istex" xml:id="pub2tei">formatting</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/HXZ-5B17D7TW-C/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup, element #text not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article">
<front>
<journal-meta>
<journal-id journal-id-type="hwp">jinfdis</journal-id>
<journal-id journal-id-type="publisher-id">jid</journal-id>
<journal-title>The Journal of Infectious Diseases</journal-title>
<abbrev-journal-title>The Journal of Infectious Diseases</abbrev-journal-title>
<issn pub-type="ppub">0022-1899</issn>
<issn pub-type="epub">1537-6613</issn>
<publisher>
<publisher-name>The University of Chicago Press</publisher-name>
</publisher>
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<article-meta>
<article-id pub-id-type="doi">10.1086/497151</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Major Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Clinical and Molecular Epidemiological Features of Coronavirus HKU1–Associated Community-Acquired Pneumonia<xref ref-type="fn" rid="fn1"></xref></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Woo</surname>
<given-names>Patrick C. Y.</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="fn" rid="fn2">a</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Lau</surname>
<given-names>Susanna K. P.</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="fn" rid="fn2">a</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Tsoi</surname>
<given-names>Hoi-wah</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Huang</surname>
<given-names>Yi</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Poon</surname>
<given-names>Rosana W. S.</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Chu</surname>
<given-names>Chung-ming</given-names></name>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Lee</surname>
<given-names>Rodney A.</given-names></name>
<xref ref-type="aff" rid="aff3">3</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Luk</surname>
<given-names>Wei-kwang</given-names></name>
<xref ref-type="aff" rid="aff4">4</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Wong</surname>
<given-names>Gilman K. M.</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Wong</surname>
<given-names>Beatrice H. L.</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Cheng</surname>
<given-names>Vincent C. C.</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Tang</surname>
<given-names>Bone S. F.</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Wu</surname>
<given-names>Alan K. L.</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Yung</surname>
<given-names>Raymond W. H.</given-names></name>
<xref ref-type="aff" rid="aff3">3</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Chen</surname>
<given-names>Honglin</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Guan</surname>
<given-names>Yi</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Chan</surname>
<given-names>Kwok-hung</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Yuen</surname>
<given-names>Kwok-yung</given-names></name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<aff id="aff1">
<label>1</label>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong, </aff>
<aff id="aff2">
<label>2</label>Division of Respiratory Medicine, Department of Medicine, United Christian Hospital, </aff>
<aff id="aff3">
<label>3</label>Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, and</aff>
<aff id="aff4">
<label>4</label>Department of Pathology, Tseung Kwan O Hospital, Hong Kong, China</aff>
</contrib-group>
<author-notes>
<corresp id="cor1">Reprints or correspondence: Dr Kwok-yung Yuen, Div. of Infectious Disease, Dept. of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong (<email>hkumicro@hkucc.hku.hk</email>)</corresp>
</author-notes>
<pub-date pub-type="ppub">
<day>1</day>
<month>12</month>
<year>2005</year>
</pub-date>
<volume>192</volume>
<issue>11</issue>
<fpage>1898</fpage>
<lpage>1907</lpage>
<history>
<date date-type="received">
<day>7</day>
<month>4</month>
<year>2005</year></date>
<date date-type="rev-recd">
<day>30</day>
<month>5</month>
<year>2005</year></date>
<date date-type="accepted">
<day>7</day>
<month>6</month>
<year>2005</year></date>
</history>
<copyright-statement>© 2005 by the Infectious Diseases Society of America</copyright-statement>
<copyright-year>2005</copyright-year>
<abstract>
<p><bold>Background</bold>Recently, we described the discovery of a novel group 2 coronavirus, coronavirus HKU1 (CoV-HKU1), from a patient with pneumonia. However, the clinical and molecular epidemiological features of CoV-HKU1–associated pneumonia are unknown</p>
<p><bold>Methods</bold>Prospectively collected (during a 12-month period) nasopharyngeal aspirates (NPAs) from patients with community-acquired pneumonia from 4 hospitals were subjected to reverse-transcription polymerase chain reaction, for detection of CoV-HKU1. The epidemiological, clinical, and laboratory characteristics of patients with CoV-HKU1–associated pneumonia were analyzed. The <italic>pol</italic> spike (S), and nucleocapsid (N) genes were also sequenced</p>
<p><bold>Results</bold>NPAs from 10 (2.4%) of 418 patients with community-acquired pneumonia were found to be positive for CoV-HKU1. All 10 cases occurred in spring and winter. Nine of these patients were adults, and 4 had underlying diseases of the respiratory tract. In the 6 patients from whom serum samples were available, all had a 4-fold change in immunoglobulin (Ig) G titer and/or presence of IgM against CoV-HKU1. The 2 patients who died had significantly lower hemoglobin levels, monocyte counts, albumin levels, and oxygen saturation levels on admission and had more-extensive involvement visible on chest radiographs. Sequence analysis of the <italic>pol</italic> S, and N genes revealed 2 genotypes of CoV-HKU1</p>
<p><bold>Conclusions</bold>CoV-HKU1 accounts for 2.4% of community-acquired pneumonia, with 2 genotypes in the study population. Without performance of diagnostic tests, the illness was clinically indistinguishable from other community-acquired pneumonia illnesses</p>
</abstract>
</article-meta>
</front>
<body>
<p>Since no microbiological cause can be identified in a significant proportion of patients with respiratory tract infections [<xref ref-type="bibr" rid="ref1">1</xref>, <xref ref-type="bibr" rid="ref2">2</xref>], research has been conducted to identify novel agents. Of the 3 novel agents identified in the last 3 years—including human metapneumovirus [<xref ref-type="bibr" rid="ref3">3</xref>], severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) [<xref ref-type="bibr" rid="ref4">4</xref>], and human coronavirus NL63 (HCoV-NL63) [<xref ref-type="bibr" rid="ref5">5</xref>, <xref ref-type="bibr" rid="ref6">6</xref>]—2 are coronaviruses. On the basis of serological and phylogenetic characterization, coronaviruses were divided into 3 distinct groups: human coronavirus 229E (HCoV-229E) and HCoV-NL63 are group 1 coronaviruses, and human coronavirus OC43 (HCoV-OC43) is a group 2 coronavirus [<xref ref-type="bibr" rid="ref7">7</xref>]. HCoV-229E and HCoV-OC43 account for 5%–30% of human respiratory tract infections [<xref ref-type="bibr" rid="ref8">8</xref>], whereas, in a few recent studies, HCoV-NL63 was found to be present in 2%–3.6% of respiratory specimens [<xref ref-type="bibr" rid="ref9">9</xref><xref ref-type="bibr" rid="ref10"></xref>–<xref ref-type="bibr" rid="ref11">11</xref>]. In 2002 and 2003, the epidemic caused by SARS-CoV affected >8000 people, with 750 deaths [<xref ref-type="bibr" rid="ref4">4</xref>, <xref ref-type="bibr" rid="ref12">12</xref><xref ref-type="bibr" rid="ref13"></xref><xref ref-type="bibr" rid="ref14"></xref><xref ref-type="bibr" rid="ref15"></xref><xref ref-type="bibr" rid="ref16"></xref><xref ref-type="bibr" rid="ref17"></xref>–<xref ref-type="bibr" rid="ref18">18</xref>]</p>
<p>Recently, we have described the discovery of a novel group 2 coronavirus, coronavirus HKU1 (CoV-HKU1), from a patient with pneumonia [<xref ref-type="bibr" rid="ref19">19</xref>]. Complete genome sequencing and phylogenetic analysis revealed that CoV-HKU1 is a distinct group 2 coronavirus, with G + C content of 32%, the lowest among all known coronaviruses. Although preliminary screening also identified an additional patient with pneumonia with CoV-HKU1 in her nasopharyngeal aspirate (NPA), the epidemiological and clinical features of CoV-HKU1–associated pneumonia remain to be determined. In the present study, using prospectively collected NPAs, we examined the prevalence of CoV-HKU1 in patients with community-acquired pneumonia during a 12-month period. The clinical, laboratory, and radiological characteristics of patients with CoV-HKU1–associated pneumonia were described. The molecular epidemiological profile of CoV-HKU1 was also analyzed</p>
<sec id="S1">
<title>Patients and Methods</title>
<p><bold><italic>Patients and microbiological methods</italic></bold>All prospectively collected NPAs from patients with community-acquired pneumonia that were sent to the clinical microbiology laboratories of 4 hospitals in Hong Kong during a 12-month period (22 March 2003 [the beginning of the SARS epidemic in Hong Kong] to 21 March 2004) for detection of SARS-CoV and were found to be negative for SARS-CoV RNA, by reverse-transcription polymerase chain reaction (RT-PCR) [<xref ref-type="bibr" rid="ref20">20</xref>], were included in the study. Community-acquired pneumonia is defined as symptoms and signs, consistent with an acute lower respiratory tract infection and associated with new radiographic finding for which there is no other explanation, that develop before or within 48 h after presentation to the hospital. Once CoV-HKU1 was detected in NPAs, hospital records, laboratory results (including direct antigen detection, by immunofluorescence, of influenza A and B viruses, parainfluenza viruses 1–3, respiratory syncytial virus [RSV], and adenovirus [<xref ref-type="bibr" rid="ref21">21</xref>]), and chest radiographs of the corresponding patients were analyzed by 2 infectious-disease physicians. The RNA extracted from the NPAs was subjected to RT-PCR, for detection of influenza A virus and human metapneumovirus [<xref ref-type="bibr" rid="ref4">4</xref>]. Available stored serum samples were subjected to serological assays, for detection of antibodies against <italic>Mycoplasma</italic>, <italic>Chlamydia</italic>, and <italic>Legionella</italic> species and SARS-CoV, by SERODIA-MYCO II (Fujirebio), <italic>Chlamydia pneumoniae</italic> MIF IgG (Focus Technologies), indirect immunofluorescence (MRL), and our recently developed ELISA, respectively [<xref ref-type="bibr" rid="ref16">16</xref>]</p>
<p>To determine possible risk factors associated with CoV-HKU1–associated pneumonia, 2 age- and sex-matched controls per patient with CoV-HKU1–associated pneumonia were randomly selected from patients with community-acquired pneumonia whose NPAs were found to be negative for CoV-HKU1. Controls were within 5 years in age (older or younger) of the corresponding patients with CoV-HKU1–associated pneumonia and were admitted within 15 days before or after admission of the corresponding patients with CoV-HKU1–associated pneumonia. The hospital records, laboratory results, and chest radiographs of the controls were examined by 2 infectious disease physicians</p>
<p><bold><italic>RNA extraction</italic></bold>Viral RNA was extracted from NPAs using the QIAamp Viral RNA Mini Kit (QIAgen) within 10 h of receipt of specimens. The eluted RNA (template for RT-PCR) was stored immediately at −70°C until use</p>
<p><bold><italic>RT-PCR of the</italic></bold><bold> pol</bold><bold><italic> gene of CoV-HKU1 using CoV-HKU1–specific primers and DNA sequencing</italic></bold>A 453-bp fragment of the <italic>pol</italic> gene of CoV-HKU1 was amplified by RT-PCR using CoV-HKU1–specific primers (LPW1926 [5′-AAAGGATGTTGACAACCCTGTT-3′] and LPW1927 [5′-ATCATCATACTAAAATGCTTACA-3′]) designed by multiple alignment of the nucleotide sequences of the <italic>pol</italic> genes of CoV-HKU1 [<xref ref-type="bibr" rid="ref19">19</xref>] and those of other coronaviruses. RT was performed using the SuperScript II kit (Invitrogen). The PCR mixture (50 μL) contained cDNA, PCR buffer, 200 μmol/L each dNTP, and 1.0 U of <italic>Taq</italic> polymerase (Boehringer). The mixtures were amplified in 40 cycles of 94°C for 1 min, 48°C for 1 min, and 72°C for 1 min and a final extension at 72°C for 10 min. To ensure the high specificity of the CoV-HKU1–specific primers, RNA extracted from 200 NPAs positive for influenza A and B viruses, parainfluenza viruses 1–3, RSV, or adenovirus antigens and RNA from 12 NPAs positive for HCoV-229E, HCoV-OC43, HCoV-NL63, or SARS-CoV RNA (3 samples/coronavirus) were also subjected to RT-PCR using the 2 CoV-HKU1–specific primers. The amplified products were detected by agarose gel electrophoresis, as described elsewhere [<xref ref-type="bibr" rid="ref19">19</xref>]</p>
<p>Both strands of the PCR products were sequenced twice by use of an ABI Prism 3700 DNA Analyzer (Applied Biosystems), using the 2 PCR primers. The sequences of the PCR products were compared with the sequences of the <italic>pol</italic> genes of CoV-HKU1 [<xref ref-type="bibr" rid="ref19">19</xref>] and those of other coronaviruses in the GenBank database</p>
<p><bold><italic>ELISA using recombinant nucleocapsid (N) protein of CoV-HKU1</italic></bold>The ELISA-based IgG and IgM antibody tests were performed in accordance with our published protocol [<xref ref-type="bibr" rid="ref19">19</xref>]. Each sample was tested in duplicate, and the mean absorbance for each serum sample was calculated</p>
<p><bold><italic>RT-PCR and sequencing of the complete</italic></bold><bold> pol, </bold><bold><italic> spike (S), and N genes of CoV-HKU1 and phylogenetic analysis</italic></bold>The complete <italic>pol</italic> S, and N genes of CoV-HKU1 from NPAs from 9 of the 10 patients from whom adequate amounts of RNA were available were amplified and sequenced using the strategy described in our previous study [<xref ref-type="bibr" rid="ref19">19</xref>] and the primers listed in <xref ref-type="fig" rid="tb1">table 1</xref>. The nucleotide and deduced amino acid sequences of the <italic>pol</italic> S, and N genes were compared with those of CoV-HKU1 [<xref ref-type="bibr" rid="ref19">19</xref>] and other group 2 coronaviruses. Phylogenetic tree construction was performed using the PileUp method with GrowTree (Genetics Computer Group)</p>
<p><bold><italic>Statistical analysis</italic></bold>A comparison of characteristics was made between patients with CoV-HKU1–associated pneumonia and those with non–CoV-HKU1–associated pneumonia and between patients who died of and those who survived CoV-HKU1–associated pneumonia. Fisher’s exact test was used for categorical variables, and the Mann-Whitney <italic>U</italic> test was used for continuous variables. P<.05 was regarded as statistically significant</p></sec>
<sec id="S2">
<title>Results</title>
<p><bold><italic>Clinical and laboratory characteristics</italic></bold>During the 12-month period, NPAs from 418 patients (men:women, 198:220; mean ± SD age, 49±26 years) in 4 hospitals with community-acquired pneumonia were found to be negative for SARS-CoV RNA by RT-PCR. A 453-bp fragment of the <italic>pol</italic> gene of CoV-HKU1 was amplified and sequenced for 10 patients (2.4%). Sequence analysis revealed 0%–2% nucleotide differences between the sequences of the fragments and the sequence of the <italic>pol</italic> gene from the CoV-HKU1 in the NPAs from the reported index patient (patient 5) [<xref ref-type="bibr" rid="ref19">19</xref>] (<xref ref-type="fig" rid="Fig1">figure 1</xref>). In contrast, by use of our CoV-HKU1–specific primers, none of the 200 NPAs positive for influenza A and B viruses, parainfluenza viruses 1–3, RSV, or adenovirus antigens and none of the 12 NPAs positive for HCoV-229E, HCoV-OC43, HCoV-NL63, and SARS-CoV RNA were RT-PCR positive</p>
<p>The epidemiological, clinical, and radiological characteristics of the 10 patients with CoV-HKU1–associated community-acquired pneumonia are summarized in <xref ref-type="fig" rid="tb2">table 2</xref>. No epidemiological linkage was identified among the 10 cases. All cases occurred during either spring or winter (January–May). The median age of these patients was 71.5 years (range, 13–96 years). Seven were men, and 3 were women. Eight had underlying diseases, of whom 4 had underlying diseases of the respiratory tract. Four had recently traveled to southern China. Five were smokers. Clinically, the illness was not distinguishable from other community-acquired pneumonia illnesses. Fever, productive cough, and dyspnea were common symptoms at presentation. Upper respiratory tract symptoms were present in only 2 patients (patients 1 and 5). One patient (patient 7) had loose-stool diarrhea. Oxygen saturation levels on room air on admission were <95% in 2 patients. Airspace shadows were observed in the right lungs of 6 patients and in the left lungs of 6 patients. The upper, middle, and lower zones were affected in 2, 4, and 9 patients, respectively. All patients, except patient 10, had normal platelet counts and normal results of liver and renal function tests. Bacterial or mycobacterial pathogens were not detected in any of the sputum samples from the patients. Results of direct antigen testing for influenza A and B viruses, parainfluenza viruses 1–3, RSV, and adenovirus and of RT-PCR for influenza A virus and metapneumovirus were negative for all NPAs. Results of testing for antibodies against <italic>Mycoplasma pneumoniae, C. pneumoniae, Chlamydia psittaci, Legionella pneumophila</italic> and SARS-CoV were negative for all 6 patients (patients 1, 4, 5, 6, 8, and 9) from whom serum samples were available. Of these 6 patients, all had a 4-fold increase in IgG titer (patients 4, 5, and 6) and/or the presence of IgM against CoV-HKU1 (patients 1, 5, 8, and 9). Compared with age- and sex-matched controls with non–CoV-HKU1–associated pneumonia, patients with CoV-HKU1–associated pneumonia had no epidemiological, clinical, hematological, serum biochemical, or radiological risk factors identified (<xref ref-type="fig" rid="tb3">table 3</xref>). None of the 10 patients in this control group from whom serum samples were available had a 4-fold increase in IgG titer or the presence of IgM against CoV-HKU1</p>
<p>Two of the 10 patients died of CoV-HKU1–associated pneumonia. The first patient (patient 2) was a 66-year-old man who had presented with dyspnea for 1 day. He had type 2 diabetes mellitus, old myocardial infarction, and gastric lymphoma with total gastrectomy in 2002 and was treated with chemotherapy. He had severe lymphopenia (0.2×10<sup>9</sup> lymphocytes/L) and an oxygen saturation level of only 83% on admission. Chest radiographic examination revealed patchy airspace shadows in both lungs, with predominant involvement of the lower zones (<xref ref-type="fig" rid="Fig2">figure 2<italic>A</italic></xref>). He died 11 days after admission. The other patient (patient 10) was a 72-year-old man who had presented with fever and productive cough for 1 week. He had type 2 diabetes mellitus, cerebrovascular accident, and prostatic carcinoma with bone metastasis complicated by spinal cord compression; laminectomy and Luque instrumentation were performed. He had lymphopenia (0.9×10<sup>9</sup> lymphocytes/L), thrombocytopenia (33×10<sup>9</sup> thrombocytes/L), deranged liver and renal function test results, and an oxygen saturation level of only 88% on admission. Chest radiographic examination revealed extensive airspace shadows in both lungs, with the middle zones more severely involved (<xref ref-type="fig" rid="Fig2">figure 2<italic>B</italic></xref>). He died 5 days after admission</p>
<p>The clinical, laboratory, and radiological characteristics of patients who survived and those who died of CoV-HKU1–associated community-acquired pneumonia were compared (<xref ref-type="fig" rid="tb4">table 4</xref>). Patients who died had lower hemoglobin concentrations (<italic>P</italic> = .04), monocyte counts (<italic>P</italic> = .04), serum albumin levels (<italic>P</italic> = .04), and oxygen saturation levels on admission (<italic>P</italic> = .03) and had bilateral involvement (P=.003) and more zones involved (P=.01) on chest radiographs</p>
<p><bold><italic>RT-PCR and sequencing of the complete</italic></bold><bold> pol, </bold><bold><italic> S, and N genes of CoV-HKU1 and phylogenetic analysis</italic></bold>The complete <italic>pol</italic>, S, and N genes of CoV-HKU1 from NPAs from 9 of the 10 patients from whom adequate amounts of RNA were available were amplified and sequenced. The phylogenetic trees and nonsynonymous mutations and the corresponding amino acid changes are shown in <xref ref-type="fig" rid="Fig3">figure 3</xref>. For the S gene, there were 317 and 306 nt positions with synonymous and nonsynonymous mutations, respectively (<xref ref-type="fig" rid="Fig3">figure 3<italic>B</italic></xref>); 72% and 28% of the nonsynonymous mutations were in the putative S1 and S2, respectively (<xref ref-type="fig" rid="Fig4">figure 4</xref>). For the N gene, there were 42 and 53 nt positions with synonymous and nonsynonymous mutations, respectively (<xref ref-type="fig" rid="Fig3">figure 3</xref>C). The nucleotide sequences of 7 of the 9 S or N genes showed similar sequences (genotype A), and those of the other 2 genes also showed similar sequences (genotype B) (<xref ref-type="fig" rid="Fig3">figure 3<italic>B</italic></xref> and <xref ref-type="fig" rid="Fig3">3<italic>C</italic></xref>). For the CoV-HKU1 specimen from patient 1, 2 peaks (T and C) were consistently observed at nt 1300 of the N gene, suggesting the presence of a quasi species (<xref ref-type="fig" rid="Fig3">figure 3<italic>C</italic></xref>). For the <italic>pol</italic> gene, there were 95 and 13 nt positions with synonymous and nonsynonymous mutations, respectively (<xref ref-type="fig" rid="Fig3">figure 3</xref>A). The nucleotide sequences of the <italic>pol</italic> genes in the 7 CoV-HKU1 specimens of genotype A were also clustered together (<xref ref-type="fig" rid="Fig3">figure 3<italic>A</italic></xref>). Interestingly, the 7 CoV-HKU1 specimens of genotype A were from 7 patients with underlying diseases, and the 2 specimens of genotype B were from the 2 patients without underlying diseases (<xref ref-type="fig" rid="tb2">table 2</xref>). Furthermore, multiple alignments of the nucleotide sequences of the <italic>pol</italic> genes from the 9 CoV-HKU1 specimens and those from the HCoV-OC43, HCoV-229E, HCoV-NL63, and SARS-CoV supported the notion that the primers used in the present study were specific for CoV-HKU1</p></sec>
<sec id="S3">
<title>Discussion</title>
<p>CoV-HKU1, a novel group 2 coronavirus, is associated with community-acquired pneumonia. Since the SARS epidemic in 2003, we have started to prospectively collect NPAs from patients with community-acquired pneumonia and store the extracted RNA, so that, when a novel virus is discovered, the epidemiological and, hence, the clinical, laboratory, and radiological features of the disease can be studied in a timely manner. In January 2004, we discovered a novel coronavirus, CoV-HKU1, from a patient with community-acquired pneumonia [<xref ref-type="bibr" rid="ref19">19</xref>]. The RNA extracted from prospectively collected NPAs was immediately retrieved, and the presence of CoV-HKU1 was investigated. Ten of the 418 NPAs were positive for CoV-HKU1, giving an incidence of 2.4%. The presence of CoV-HKU1 in these specimens was genuine—that is, it was not due to contamination—since amplification and sequencing of multiple genes (<italic>pol</italic> S, and N) of CoV-HKU1 indicated the presence of CoV-HKU1 with different nucleotide sequences from the different patients. Moreover, the clinical significance of CoV-HKU1 was confirmed by the presence of a specific antibody response in all 6 patients from whom serum samples were available. The antibody response in these patients was unlikely to be the result of cross-reaction with other known human coronaviruses, since none of the 20 serum samples obtained from patients with HCoV-OC43 infections or SARS-CoV pneumonia had positive results in the recombinant N ELISA (authors’ unpublished data). Further studies on detection of CoV-HKU1 in NPAs from healthy individuals will determine whether asymptomatic shedding of CoV-HKU1 occurs</p>
<p>Similar to HCoV-229E, HCoV-OC43, and HCoV-NL63, CoV-HKU1 is a human coronavirus that is endemic in humans. Similar to other human coronavirus infections, cases of CoV-HKU1–associated pneumonia occurred during winter and spring. Most patients with CoV-HKU1–associated pneumonia were old (80% were >65 years old) and had major underlying diseases, especially those of the respiratory and cardiovascular systems. To study the phylogeny and relationships among the 10 CoV-HKU1 specimens, we sequenced the <italic>pol</italic> S, and N genes from the 9 CoV-HKU1 specimens that contained adequate amounts of RNA. Combined with the data on partial sequencing of the <italic>pol</italic> genes from the 10 CoV-HKU1 specimens (<xref ref-type="fig" rid="Fig1">figure 1</xref>), results showed that, unlike the epidemiological profile of SARS-CoV, the 10 CoV-HKU1 specimens were not clonal, and the topology of the phylogenetic trees did not follow the pattern of a clonal outbreak (<xref ref-type="fig" rid="Fig3">figure 3</xref>). Interestingly, the phylogenetic trees constructed using the sequences of both the S and N genes showed that CoV-HKU1 of genotype B was detected in NPAs from with 2 patients without underlying diseases, but CoV-HKU1 of genotype A was detected in NPAs from patients with underlying diseases (<xref ref-type="fig" rid="Fig3">figure 3<italic>B</italic></xref> and <xref ref-type="fig" rid="Fig3">3<italic>C</italic></xref>). Sequencing of more CoV-HKU1 specimens may reveal the presence of genotypes or clades of CoV-HKU1 with differential virulence</p>
<p>Compared with SARS-CoV pneumonia, CoV-HKU1–associated pneumonia is a monophasic disease, and most patients had relatively mild symptoms that were localized to the respiratory tract and were, therefore, hospitalized only briefly. SARS-CoV pneumonia is often described as a biphasic disease, with the first phase due to cell lysis as a result of viral replication and the second phase due to immunopathological damage [<xref ref-type="bibr" rid="ref4">4</xref>, <xref ref-type="bibr" rid="ref12">12</xref>]. On the other hand, all 10 patients with CoV-HKU1–associated pneumonia showed the pattern of a monophasic disease. Although dyspnea was present in one-half of the patients with CoV-HKU1–associated pneumonia at presentation, compared with only ∼20% of patients with SARS-CoV pneumonia at presentation [<xref ref-type="bibr" rid="ref4">4</xref>], patients with CoV-HKU1–associated pneumonia often recovered quickly, but patients with SARS-CoV pneumonia deteriorated after 7–10 days [<xref ref-type="bibr" rid="ref4">4</xref>, <xref ref-type="bibr" rid="ref12">12</xref>]. For the 8 patients who recovered, the median duration of hospitalization was only 5.5 days. This rapid recovery of patients with CoV-HKU1–associated pneumonia could be related to the rapid control of the virus by the immune system. This is in line with the results of our previous study, which showed that the index patient with CoV-HKU1–associated pneumonia had his peak viral load at around day 3 after the onset of illness [<xref ref-type="bibr" rid="ref19">19</xref>]. Moreover, only 1 of the patients had extrapulmonary symptoms, and all available extrapulmonary specimens (stool, urine, and serum) were negative, by RT-PCR, for CoV-HKU1 (authors’ unpublished data). On the other hand, for SARS-CoV pneumonia, patients usually had their peak viral loads 7–10 days after onset of illness [<xref ref-type="bibr" rid="ref12">12</xref>]. Furthermore, the virus can be readily detected in extrapulmonary specimens, in which the viral loads correlated with the manifestations in the corresponding systems [<xref ref-type="bibr" rid="ref22">22</xref>]. These findings imply that the virus was not well controlled by the immune system during the initial phase of the illness</p>
<p>Despite the relatively mild course of disease in most patients, CoV-HKU1–associated pneumonia is associated with mortality in a minority of patients who have lower hemoglobin concentrations, monocyte counts, serum albumin levels, and oxygen saturation levels on admission and more-extensive involvement on chest radiographs. As in most cases of pneumonia, extensive involvement in the lungs will result in poor gaseous exchange and, hence, hypoxia and eventually death. The lower hemoglobin concentrations, monocyte counts, and serum albumin levels could represent poorer premorbid states and narrower margins to fight against infections. Both patients who died had underlying diabetes mellitus, malignancy (gastric lymphoma in one and prostate carcinoma in the other), and cardiovascular disease (old myocardial infarction in one and cerebrovascular accident in the other)</p></sec>
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<sec sec-type="display-objects">
<title>Figures and Tables</title>
<fig id="Fig1" position="float">
<label>Figure 1</label>
<caption>
<p>Phylogenetic tree of <italic>pol</italic> gene sequences of the 10 coronavirus HKU1 (CoV-HKU1) specimens from patients with community-acquired pneumonia. The tree was inferred from <italic>pol</italic> gene data by the neighbor-joining method, and bootstrap values were calculated from 1000 trees. The tree was rooted using the <italic>pol</italic> gene sequence of human coronavirus 229E (HCoV-229E), and 393 nt positions (primer sequences excluded) in each <italic>pol</italic> gene were included in the analysis. The scale bar indicates the estimated no. of substitutions per 50 bases using the Jukes-Cantor correction. BCoV, bovine coronavirus; HCoV-OC43, human coronavirus OC43; MHV, murine hepatitis virus; PHEV, porcine hemagglutinating encephalomyelitis virus</p>
</caption>
<graphic mimetype="image" xlink:href="192-11-1898-fig001.tif"></graphic>
</fig>
<fig id="Fig2" position="float">
<label>Figure 2</label>
<caption>
<p>Chest radiographs of the 2 patients who died of coronavirus HKU1–associated community-acquired pneumonia. The chest radiograph of the first patient (<italic>A</italic>) (patient 2 in <xref ref-type="fig" rid="tb2">table 2</xref>) showed patchy airspace shadows in both lungs, with predominant involvement of the lower zones. The chest radiograph of the second patient (<italic>B</italic>) (patient 10 in <xref ref-type="fig" rid="tb2">table 2</xref>), with Luque instrumentation in situ, showed extensive airspace shadows in both lungs, with the middle zones more severely involved</p>
</caption>
<graphic mimetype="image" xlink:href="192-11-1898-fig002.tif"></graphic>
</fig>
<fig id="Fig3" position="float">
<label>Figure 3</label>
<caption>
<p>Phylogenetic trees and nonsynonymous mutations and corresponding amino acid changes of complete <italic>pol</italic> spike (S), and nucleocapsid (N) gene sequences of coronavirus HKU1 (CoV-HKU1) specimens from 9 patients with community-acquired pneumonia. The trees were inferred from <italic>pol</italic> (3A), S (3B), and N (3C) gene data by the neighbor-joining method, and bootstrap values were calculated from 1000 trees. The trees were rooted using <italic>pol</italic> S, and N gene sequences of human coronavirus OC43 (HCoV-OC43). A total of 2784 nt positions in each <italic>pol</italic> gene, 4071 nt positions in each S gene, and 1326 nt positions in each N gene were included in the analysis. The scale bar indicates the estimated no. of substitutions per 100 <italic>(A)</italic> and 50 <italic>(B</italic> and <italic>C)</italic> bases, using the Jukes-Cantor correction. The shaded nucleotides are those that differ from the majority at the corresponding location. Because of the large no. of nonsynonymous mutations in the S gene, only the NH<sub>2</sub> terminal 45, of a total of 306 nonsynonymous mutations, is shown</p>
</caption>
<graphic mimetype="image" xlink:href="192-11-1898-fig003.tif"></graphic>
</fig>
<fig id="Fig4" position="float">
<label>Figure 4</label>
<caption>
<p>Distribution of nonsynonymous mutations in the spike (S) gene of coronavirus HKU1 (CoV-HKU1). The S protein (1356 aa) of CoV-HKU1 is depicted by the horizontal bar, and the positions of the nonsynonymous mutations are depicted by vertical lines in the bar. HR1, heptad repeat 1 (aa 982–1083); HR2, heptad repeat 2 (aa 1250–1297); SS, N terminal signal sequence (aa 1–13); TM, transmembrane domain (aa 1301–1323)</p>
</caption>
<graphic mimetype="image" xlink:href="192-11-1898-fig004.tif"></graphic>
</fig>
<fig id="tb1" position="float">
<label>Table 1</label>
<caption>
<p>Primers used for amplification and sequencing of the pol, spike (S), and nucleocapsid (N) genes</p>
</caption>
<graphic mimetype="image" xlink:href="192-11-1898-tab001.tif"></graphic>
</fig>
<fig id="tb2" position="float">
<label>Table 2</label>
<caption>
<p>Epidemiological, clinical, and radiological characteristics of patients with community-acquired pneumonia associated with coronavirus HKU1</p>
</caption>
<graphic mimetype="image" xlink:href="192-11-1898-tab002.tif"></graphic>
</fig>
<fig id="tb3" position="float">
<label>Table 3</label>
<caption>
<p>Comparison of clinical, laboratory, and radiological characteristics of patients with coronavirus HKU1 (CoV-HKU1)–associated pneumonia and those of age- and sex-matched controls with non–CoV-HKU1–associated pneumonia</p>
</caption>
<graphic mimetype="image" xlink:href="192-11-1898-tab003.tif"></graphic>
</fig>
<fig id="tb4" position="float">
<label>Table 4</label>
<caption>
<p>Comparison of clinical, laboratory, and radiological characteristics of patients who survived and those who died of coronavirus HKU1–associated pneumonia</p>
</caption>
<graphic mimetype="image" xlink:href="192-11-1898-tab004.tif"></graphic>
</fig></sec>
<fn-group>
<fn id="fn1">
<p>Potential conflicts of interest: none reported</p>
<p>Financial support: Research Grant Council (7616/05M); Research Fund for the Control of Infectious Diseases of the Health, Welfare, and Food Bureau of the Hong Kong SAR Government; The University of Hong Kong (Outstanding Researcher Award 2002–2003 and Special Research Achievement Award); Commercial Radio’s Fund; Suen Chi Sun Charitable Foundation; William Benter Infectious Disease Fund</p></fn>
<fn id="fn2">
<p>P.C.Y.W. and S.K.P.L. contributed equally to this work</p></fn>
</fn-group>
</back>
</article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Clinical and Molecular Epidemiological Features of Coronavirus HKU1–Associated Community-Acquired Pneumonia</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Clinical and Molecular Epidemiological Features of Coronavirus HKU1–Associated Community-Acquired Pneumonia</title></titleInfo><name type="personal"><namePart type="given">Patrick C. Y.</namePart><namePart type="family">Woo</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Susanna K. P.</namePart><namePart type="family">Lau</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hoi-wah</namePart><namePart type="family">Tsoi</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Yi</namePart><namePart type="family">Huang</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rosana W. S.</namePart><namePart type="family">Poon</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chung-ming</namePart><namePart type="family">Chu</namePart><affiliation>Division of Respiratory Medicine, Department of Medicine, United Christian Hospital,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rodney A.</namePart><namePart type="family">Lee</namePart><affiliation>Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Wei-kwang</namePart><namePart type="family">Luk</namePart><affiliation>Department of Pathology, Tseung Kwan O Hospital, Hong Kong, China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gilman K. M.</namePart><namePart type="family">Wong</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Beatrice H. L.</namePart><namePart type="family">Wong</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Vincent C. C.</namePart><namePart type="family">Cheng</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bone S. F.</namePart><namePart type="family">Tang</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alan K. L.</namePart><namePart type="family">Wu</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Raymond W. H.</namePart><namePart type="family">Yung</namePart><affiliation>Department of Microbiology, Pamela Youde Nethersole Eastern Hospital, and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Honglin</namePart><namePart type="family">Chen</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Yi</namePart><namePart type="family">Guan</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kwok-hung</namePart><namePart type="family">Chan</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kwok-yung</namePart><namePart type="family">Yuen</namePart><affiliation>Division of Infectious Disease, Department of Microbiology, The University of Hong Kong,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>The University of Chicago Press</publisher><dateIssued encoding="w3cdtf">2005-12-01</dateIssued><dateCreated encoding="w3cdtf">2005-06-07</dateCreated><copyrightDate encoding="w3cdtf">2005</copyrightDate></originInfo><abstract>BackgroundRecently, we described the discovery of a novel group 2 coronavirus, coronavirus HKU1 (CoV-HKU1), from a patient with pneumonia. However, the clinical and molecular epidemiological features of CoV-HKU1–associated pneumonia are unknown MethodsProspectively collected (during a 12-month period) nasopharyngeal aspirates (NPAs) from patients with community-acquired pneumonia from 4 hospitals were subjected to reverse-transcription polymerase chain reaction, for detection of CoV-HKU1. The epidemiological, clinical, and laboratory characteristics of patients with CoV-HKU1–associated pneumonia were analyzed. The pol spike (S), and nucleocapsid (N) genes were also sequenced ResultsNPAs from 10 (2.4%) of 418 patients with community-acquired pneumonia were found to be positive for CoV-HKU1. All 10 cases occurred in spring and winter. Nine of these patients were adults, and 4 had underlying diseases of the respiratory tract. In the 6 patients from whom serum samples were available, all had a 4-fold change in immunoglobulin (Ig) G titer and/or presence of IgM against CoV-HKU1. The 2 patients who died had significantly lower hemoglobin levels, monocyte counts, albumin levels, and oxygen saturation levels on admission and had more-extensive involvement visible on chest radiographs. Sequence analysis of the pol S, and N genes revealed 2 genotypes of CoV-HKU1 ConclusionsCoV-HKU1 accounts for 2.4% of community-acquired pneumonia, with 2 genotypes in the study population. 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