Nonrespiratory Clinical Findings
To date, one group has reported an association between HCoV-NL63 and Kawasaki disease, a form of early childhood systemic vasculitis that presents as prolonged fever, polymorphic exanthem, oropharyngeal erythema and bilateral conjuctivitis. In view of this paper, the editorial by McIntosh made a compelling argument for a possible association between respiratory HCoVs and Kawasaki disease, motivating further study using broader epidemiological and nonepidemiological criteria. All subsequent reports, however, have conclusively demonstrated that no statistical significant link between HCoV-NL63 and Kawasaki disease exists.[8,58–64]
HCoV-NL63 infections have previously been associated with gastrointestinal findings.[21,25,29,65–67] However, this is not unique to HCoV-NL63 infections, as coronavirus-like particles, as well as SARS-CoV and HCoV-HKU1 RNA[68,69] have been previously detected in patient diarrheic samples. These manifestations appear to be a direct consequence of viral invasion of the intestinal mucosa. In one study, 4 out of 878 stool samples from children with acute gastroenteritis tested positive for HCoV-NL63, and these samples are usually positive for other gastroenteritis viruses as well. Another study using stool samples collected from 479 patients, reported the absence of HCoV-NL63. However, this study had several shortcomings, including a short study period, the absence of a control group without gastrointestinal disease, and specimen selection that might be biased towards individuals with more severe disease. Also, the majority of patients included were adults (older than 18 years of age); this is a problem since it has previously been shown that young children are more susceptible to HCoV-NL63 infections. Therefore, the findings of this study cannot exclude the role of HCoV-NL63 in gastrointestinal disease. Thus far, data show that HCoV-NL63 may, at most, have a minor etiological role in acute gastroenteritis in children, but since other viruses are frequently associated with gastroenteritis in HCoV-NL63 infected individuals, the exact role of HCoV-NL63 is not clear.
Future Microbiol. 2011;6(2):153-159. © 2011 Future Medicine Ltd.
Cite this: Human Coronavirus NL63 - Medscape - Feb 01, 2011.