Use of a novel virus detection assay to identify coronavirus HKU1 in the lungs of a hematopoietic stem cell transplant recipient with fatal pneumonia

Abstract

A 38-year-old patient with systemic lupus erythematosus presented with pulmonary infiltrates and hypoxemia for several months following immunodepleting autologous hematopoietic stem cell transplantation. She was treated for influenza, which was isolated repeatedly from ororpharynx and bronchoalveolar lavage fluids, and later empirically for lupus pneumonitis, but expired 6 months after transplant. Autopsy findings failed to show influenza in the lungs or lupus pneumonitis. A novel generic PCR-based assay using degenerate primers identified human coronavirus HKU1 RNA in bronchoalveolar lavage fluid at autopsy. Coronavirus was confirmed by virus-specific PCRs of lung tissue at autopsy. Electron microscopy showed viral particles consistent with coronavirus HKU1 in lung tissue both at autopsy and from a previous biopsy. While human coronavirus HKU1 infection is not usually severe, in highly immunocompromised patients, it can be associated with fatal pneumonia.

Clinical Significance of Human Coronavirus in Bronchoalveolar Lavage Samples From Hematopoietic Cell Transplant Recipients and Patients With Hematologic Malignancies

“…Previous studies have demonstrated that HCoV is now the second most common virus identified from the upper respiratory tract in hematopoietic cell transplant (HCT) recipients [8]. Cases of fatal pneumonia related to HCoV without copathogens have also been reported mainly in HCT populations [9][10][11][12]. Two previous studies describe the possible role of HCoV in LRTD; however, these studies included only limited numbers of HCT recipients and patients with hematologic malignancy (HM), and outcome analyses could not be done [13,14].…”

Immunodepletion with Hypoxemia: A Potential High Risk Subtype of Coronavirus Disease 2019

“…Clinical studies have shown that coronavirus infection severity was linked to patient health status and an immunocompromised state carried an increased risk of death 6,7 . Clinical studies have shown that coronavirus infection severity was linked to patient health status and an immunocompromised state carried an increased risk of death 6,7 .…”

Recent advances and perspectives of nucleic acid detection for coronavirus

“…It is widely used to amplify minute quantities of biologic materials so as to provide adequate specimens for laboratory study. Owing to its large range of applications, high sensitivity and high sequence specificity, the PCR-based method has become a routine and reliable technique for detecting coronaviruses [6,7]. Generally, coronavirus RNA is transferred into cDNA by reverse transcription.…”