MICROBIOLOGY

  • Positive single-strand, enveloped RNA virus belonging to the family Coronaviridae.
  • Name derived from the Latin corona, meaning crown. Viral envelope under electron microscopy appears crown-like due to small bulbar projections formed by the viral spike (S) peplomers.
  • Virus common infection of birds and mammals causing gastroenteritis and respiratory infections.
  • Important structural proteins include spike (S), envelope (E), membrane (M) and nucleocapsid (N).
  • In humans, six coronaviruses identified as causing human disease [gamma and delta coronaviruses are other subgroupings that don’t cause known human disease]
    • May cause severe disease
      • SARS (see separate module for additional details)
        • SARS-associated coronavirus felt to be an animal virus, likely of bat origin.
        • Presumed hosts include civets, wild boars, muntjac deer, hares and pheasants.
        • Animal traders in China shown to have a high prevalence of IgG antibodies to the SARS-CoV.
      • MERS-CoV (see separate module for additional details)
        • Middle East Respiratory Syndrome--Coronavirus, originally called Human coronavirus EMC (hCoV-EMC), discovered in 2012 as a cause of severe illness in the Middle East.
        • Infections to date of respiratory nature acquired in countries in or neighboring the Arabian Peninsula.
    • Usually mild to moderate human illness
      • Alpha coronaviruses 229E and NL63
      • Beta coronaviruses OC43 and HKU1

CLINICAL

  • This module pertains to routine coronavirus infections.
    • See MERS-CoV or SARS module for specific information on these viral infections.
  • A common cause of mild-to-moderate upper respiratory tract infection (URI) in humans.
    • Most commonly occurring in winter and early spring.
      • Some studies suggest it is a more common cause of URI infection than rhinovirus[3].
    • Incubation period ~3d.
    • Shedding may occur longer or also occur in asymptomatic individuals.
  • Wuhan City, China, novel coronavirus (2020): check the CDC website for the latest updates.
    • Cause of upper respiratory tract symptoms and pneumonia. Most cases not severe.
      • Exported cases described in Japan, Thailand.
      • Some deaths in patients with comorbidities.
      • Screening for illness/fever instituted in three U.S. airports (Los Angeles, San Francisco, New York City [JFK]) in Jan 2020.
        • Difficulty sorting other causes of respiratory illness from the novel coronavirus, especially during influenza season.
  • An occasional cause of viral pneumonia.
  • Cause of wheezing in persons with reactive airway disease.
  • An occasional cause of gastroenteritis in babies.
  • Most people have anti-coronavirus antibodies, reflecting universal exposure, but reinfection appears common, suggestive that there are many circulating serotypes of the virus in the human population.
  • Dx: coronavirus infection usually not diagnosed specifically for routine infections causing GI or respiratory illness, therefore none of the below are routinely performed.
    • RT-PCR or other molecular assays: most sensitive and specific diagnostic approach on respiratory specimens.
      • Coronavirus HKU1, NL63, 229E and OC43 part of BioFire® FilmArray®, for example, FDA-approved.
    • Serology (IFA, ELISA) with acute/convalescent samples is sensitive
    • Immuno-electron microscopy (not commercially available)
    • Viral culture (interestingly often unsuccessful from human samples as opposed to animals).
    • Other coronaviruses:
      • MERS-CoV: see module for diagnostic details. RT-PCR method of choice.
      • SARS: see module for specifics.
      • Wuhan novel coronavirus: contact the local health department for shipping specimens to CDC.
        • Recommendation to not perform viral culture.
        • Additional details and specimen procurement on CDC site.

SITES OF INFECTION

TREATMENT

Coronavirus (common cold or bronchitis)

  • Supportive care
  • No specific therapy exists

OTHER INFORMATION

  • Infections occur more commonly in winter and spring.
  • It is not feasible to reliably distinguish one cause of viral URI from another clinically.
    • Most infections are undiagnosed and self-limiting.
    • Most efforts to securely diagnosis this infection are part of research or epidemiological studies.
  • Coronavirus are difficult to grow in the laboratory.
  • In the U.S., the two predominant coronavirus strains causing infection appear to cause epidemics at 3-year intervals.
  • No vaccine available for the prevention of human coronavirus infection, although vaccines do exist for common veterinary coronavirus infections that can cause significant infection in younger animals.

Basis for recommendation

  1. Author opinion;

    Comment: No specific guidelines exist for non-SARS coronavirus infections.

References

  1. Heimdal I, Moe N, Krokstad S, et al. Human Coronavirus in Hospitalized Children With Respiratory Tract Infections: A 9-Year Population-Based Study From Norway. J Infect Dis. 2019;219(8):1198-1206.  [PMID:30418633]

    Comment: A Norwegian study found that human coronavirus infection was found in 10% of hospitalized patients, with high viral loads correlating with the presence of respiratory tract infection.

  2. Davis BM, Foxman B, Monto AS, et al. Human coronaviruses and other respiratory infections in young adults on a university campus: Prevalence, symptoms, and shedding. Influenza Other Respir Viruses. 2018.  [PMID:29660826]

    Comment: In this young adult population, 30% of viral URTIs had HCoV while rhinovirus was second at 7.6%.

  3. Killerby ME, Biggs HM, Haynes A, et al. Human coronavirus circulation in the United States 2014-2017. J Clin Virol. 2018;101:52-56.  [PMID:29427907]

    Comment: Study of 854,575 HCoV tests from 117 labs in the U.S. found peak incidence during December to March. Of these tests performed, 2.2% were positive for HCoV-OC43, 1.0% for HCoV-NL63, 0.8% for HCoV-229E, and 0.6% for HCoV-HKU1.

  4. Ogimi C, Greninger AL, Waghmare AA, et al. Prolonged Shedding of Human Coronavirus in Hematopoietic Cell Transplant Recipients: Risk Factors and Viral Genome Evolution. J Infect Dis. 2017;216(2):203-209.  [PMID:28838146]

    Comment: Unsurprisingly, HCoV was often shed > 21 days in the HSCT population.

  5. Sanchez JL, Cooper MJ, Myers CA, et al. Respiratory Infections in the U.S. Military: Recent Experience and Control. Clin Microbiol Rev. 2015;28(3):743-800.  [PMID:26085551]

    Comment: Review of respiratory tract infections potentially affecting military recruits. Limited human coronavirus studies exist. Authors review one study involving U.S. military recruits in October 2011 through March 2013, investigators found that 35 (6%) of 615 recruits with FRI were infected with strains OC43 (67%), 229E (21%), and NL63 (12%). In the other involving Marine Corps recruits in Parris Island, SC, in the early 1970s, strain OC43 was identified in one winter, with 1% to 2% of such recruits sustaining infections and some of them being hospitalized for characteristic ARD. HCoV infections are an uncommon cause of ILI among patients seen at U.S. military MTFs (∼1%) (USAFSAM, unpublished data, 30 March 2015).

  6. Berkley JA, Munywoki P, Ngama M, et al. Viral etiology of severe pneumonia among Kenyan infants and children. JAMA. 2010;303(20):2051-7.  [PMID:20501927]

    Comment: After RSV, human coronavirus infection was the leading cause of infection-causing hospitalization among this population in Kenya. Pneumonia caused by coronavirus was not as severe as RSV.

  7. Johnstone J, Majumdar SR, Fox JD, et al. Viral infection in adults hospitalized with community-acquired pneumonia: prevalence, pathogens, and presentation. Chest. 2008;134(6):1141-1148.  [PMID:18689592]

    Comment: Canadian pneumonia study isolated coronavirus in 4 out of 193 total patients. The overall study found 15% of patients admitted with pneumonia had viral infections including influenza, hMPV and RSV.

  8. 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):e929-37.  [PMID:17875651]

    Comment: An Australian study looked for the newly described human coronavirus NL63 among others in schoolchildren with acute respiratory illness. Both the coronavirus and hMPV infections were identified in 3.3% and 6.1% of specimens respectively. These viruses were also associated with children attending daycare.

  9. Dominguez SR, Anderson MS, Glodé MP, et al. Blinded case-control study of the relationship between human coronavirus NL63 and Kawasaki syndrome. J Infect Dis. 2006;194(12):1697-701.  [PMID:17109341]

    Comment: Study refutes association with Kawasaki's disease suggested by Esper, et al.

  10. Esper F, Shapiro ED, Weibel C, et al. Association between a novel human coronavirus and Kawasaki disease. J Infect Dis. 2005;191(4):499-502.  [PMID:15655771]

    Comment: Possible association with Kawasaki disease, although other studies have not confirmed this link [see Dominguez ref].

  11. Woo PC, Lau SK, Tsoi HW, et al. Relative rates of non-pneumonic SARS coronavirus infection and SARS coronavirus pneumonia. Lancet. 2004;363(9412):841-5.  [PMID:15031027]

    Comment: Findings indicate that non-pneumonic cases of SARS co-V infection do occur and were found in 0.48% of the population studied. Such infections may account for cases of SARS in patients with no obvious clinical exposure to symptomatic patients.
    Rating: Important

  12. Marin J, Jeler-Kacar D, Levstek V, et al. Persistence of viruses in upper respiratory tract of children with asthma. J Infect. 2000;41(1):69-72.  [PMID:10942643]

    Comment: Nasopharyngeal swabs obtained from 50 children with asthma and were processed for PCR screening for viral infection. Adenovirus DNA was found in 78%, rhinovirus in 32% and coronavirus RNA in 2.7%. Similar viral genetic material was found in only 1 of the 20 healthy controls. The authors suggest that persistent viral infection may be associated with on-going asthma in these children.
    Rating: Important

  13. El-Sahly HM, Atmar RL, Glezen WP, et al. Spectrum of clinical illness in hospitalized patients with "common cold" virus infections. Clin Infect Dis. 2000;31(1):96-100.  [PMID:10913403]

    Comment: Of 1198 patients admitted to a hospital in Houston, Texas with respiratory illness, evidence for infection with either rhinovirus or coronavirus was found in 61 (5.1%). The clinical expression of these infections included acute asthma, pneumonia, exacerbation of COPD and congestive heart failure. The vast majority of these patients had an underlying "cardiopulmonary" disease. All age groups were affected.
    Rating: Important

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Last updated: January 21, 2020