Primary and Secondary Human Bocavirus 1 Infections in a Family, Finland

Alma Jula, Matti Waris, Kalle Kantola, Ville Peltola, Maria Söderlund-Venermo, Klaus Hedman, and Olli Ruuskanen

Author affiliations: Turku University Hospital, Turku, Finland (A. Jula, V. Peltola, O. Ruuskanen); University of Turku, Turku (M. Waris); University of Helsinki, Helsinki, Finland (K. Kantola, M. Söderlund-Venermo, K. Hedman)

Abstract

Human bocavirus 1 (HBoV1) was detected in a young child hospitalized for pneumonia and subsequently in his twin brother and other family members. The mother’s nasopharyngeal samples intermittently showed HBoV1 DNA; the grandmother had HBoV1 reinfection. Findings in this family lead to consideration of HBoV virulence, latency, and reactivation.

Human bocavirus 1 (HBoV1) is a frequent cause of common cold, bronchiolitis, acute wheezing, and pneumonia in children worldwide. The causative role of HBoV1 has been questioned because of HBoV1 DNA presence after primary infection and common co-infection with other respiratory viruses (1–5). We report life-threatening HBoV1 pneumonia in a child and transmission within his family.

The Cases

Figure

Thumbnail of Chest radiograph of the index patient, a 16-month-old boy in Finland with human bocavirus 1 pneumonia, on day 2 of hospitalization. Bilateral pulmonary infiltrations and atelectasis of the upper right lobe can be seen.

Figure. . Chest radiograph of the index patient, a 16-month-old boy in Finland with human bocavirus 1 pneumonia, on day 2 of hospitalization. Bilateral pulmonary infiltrations and atelectasis of the upper right...

The index patient was a male twin who was born prematurely at 26 weeks’ gestation. He weighed 1,540 g at birth and had severe bronchopulmonary dysplasia. He was not administered pneumococcal vaccine. At the age of 16 months, he was admitted to the hospital for evaluation and treatment of wheezing. Rhinorrhea and cough had been present for 12 days. No fever was recorded at admission. The child had a heart rate of 170 beats/min (reference range 75–130 beats/min) and a respiratory rate of 50 breaths/min (reference range 25–30 breaths/min). He experienced severe respiratory distress and was transferred to the intensive care unit. A chest radiograph showed bilateral pulmonary infiltrations and atelectasis of the upper right lobe (Figure). His serum C-reactive protein level was 1 mg/L, and his leukocyte count was 19.6 ×10⁹/L. He was treated with intravenous cefuroxime, clarithromycin, and methylprednisolone. Tracheal intubation and bronchoalveolar lavage (BAL) were performed. Cultures of blood and BAL sample did not grow bacteria.