We analyzed viral nucleic acids in stool samples collected from 35 South Asian children with nonpolio acute flaccid paralysis (AFP). Sequence-independent reverse transcription and PCR amplification of capsid-protected, nuclease-resistant viral nucleic acids were followed by DNA sequencing and sequence similarity searches. Limited Sanger sequencing (35 to 240 subclones per sample) identified an average of 1.4 distinct eukaryotic viruses per sample, while pyrosequencing yielded 2.6 viruses per sample. In addition to bacteriophage and plant viruses, we detected known enteric viruses, including rotavirus, adenovirus, picobirnavirus, and human enterovirus species A (HEV-A) to HEV-C, as well as numerous other members of the Picornaviridae family, including parechovirus, Aichi virus, rhinovirus, and human cardiovirus. The viruses with the most divergent sequences relative to those of previously reported viruses included members of a novel Picornaviridae genus and four new viral species (members of the Dicistroviridae, Nodaviridae, and Circoviridae families and the Bocavirus genus). Samples from six healthy contacts of AFP patients were similarly analyzed and also contained numerous viruses, particularly HEV-C, including a potentially novel Enterovirus genotype. Determining the prevalences and pathogenicities of the novel genotypes, species, genera, and potential new viral families identified in this study in different demographic groups will require further studies with different demographic and patient groups, now facilitated by knowledge of these viral genomes.

Using viral metagenomics we identified a novel parvovirus species in human stool whose closest phylogenetic relative is the human bocavirus (HBoV). HBoV2 has an identical genomic organization to HBoV but share only 78%, 67%, and 80% identity to its NS1, NP1 and VP1/VP2 proteins. Using PCR we detected HBoV2 sequences in 5/98 Pakistani children stool samples and 3/699 stool samples from the UK. Near full genome sequencing showed the presence of three divergent genotypes and evidence of recombination. Further studies are required to determine sites of replication of HBoV2 and potential associations with clinical symptoms or disease.

Viral metagenomics focused on particle-protected nucleic acids was used on the stools of South Asian children with nonpolio acute flaccid paralysis (AFP). We identified sequences distantly related to Seneca Valley virus and cardioviruses that were then used as genetic footholds to characterize multiple viral species within a previously unreported genus of the Picornaviridae family. The picornaviruses were detected in the stools of >40% of AFP and healthy Pakistani children. A genetically diverse and highly prevalent enteric viral infection, characteristics similar to the Enterovirus genus, was therefore identified substantially expanding the genetic diversity of the RNA viral flora commonly found in children.Cardiovirus ͉ Cosavirus ͉ metagenomics ͉ Picornavirus ͉ polio M etagenomics analyses have revealed a high degree of microbial genetic diversity in environmental and human samples. Human stool, containing numerous bacteriophages and plant viruses (1, 2), also appears to be a readily accessible source of novel eukaryotic viruses (3). Stools from children with acute flaccid paralysis (AFP) are being systematically analyzed by using cell cultures to identify and control remaining foci of poliovirus in 4 endemic countries (www.who.int/ immunizationmonitoring/laboratorypolio/en/index.html and www.polioeradication.org/content/general/infectedistricts.pdf). Inoculated cell cultures from nonpolio AFP cases show the presence of other, nonpoliovirus, human enteroviruses (HEVs) (4, 5), some serotypes of which have been associated with neurological symptoms. Because HEVs are detected in less than half of the nonpolio AFP cases a majority of these cases remain without a potential etiological agent. To characterize the viruses circulating in this population we used viral particle nucleic acid purification and limited shotgun sequencing, a method initially reported for animal viruses by Allander et al. (6) and extensively used for environmental viral metagenomics (7-9). We genetically characterized multiple picornavirus species (themselves diversified into serotypes) belonging to a previously unreported genus of the Picornaviridae family. Members of this genus were detected in the stools of nearly half of the AFP and healthy children. This high level of viral genetic diversity and prevalence, reminiscent of that observed for HEV infections, indicate that this genus of picornaviruses has the potential to be involved in a variety of diseases. Results Metagenomic Identification and Sequencing of a Highly DivergentPicornavirus. Stool samples from cases of nonpolio AFP were analyzed by using a simple viral particle nucleic acid purification method involving filtration at 450 nm and DNA and RNA nuclease treatment to reduce contamination from bacteria, eukaryotic cells, and nonviral capsid protected nucleic acids. Extracted viral nucleic acids where then amplified in a sequenceindependent manner by using 3Ј randomized oligonucleotides for reverse transcription, Klenow fragment DNA polymerase extension, and PCR. Amplified DNA libr...

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Both AFP patients and healthy children in Pakistan were found to be excreting SAFV at high frequencies of 9 and 12%, respectively. Further studies are needed to examine the roles of these highly common and diverse SAFV genotypes in nonpolio AFP and other human diseases.

Background In COVID-19 patients, undetected co-infections may have severe clinical implications associated with increased hospitalization, varied treatment approaches and mortality. Therefore, we investigated the implications of viral and bacterial co-infection in COVID-19 clinical outcomes. Methods Nasopharyngeal samples were obtained from 48 COVID-19 patients (29% ICU and 71% non-ICU) and screened for the presence of 24 respiratory pathogens using six multiplex PCR panels. Results We found evidence of co-infection in 34 COVID-19 patients (71%). Influenza A H1N1 (n = 17), Chlamydia pneumoniae (n = 13) and human adenovirus (n = 10) were the most commonly detected pathogens. Viral co-infection was associated with increased ICU admission (r = 0.1) and higher mortality (OR 1.78, CI = 0.38–8.28) compared to bacterial co-infections (OR 0.44, CI = 0.08–2.45). Two thirds of COVID-19 critically ill patients who died, had a co-infection; and Influenza A H1N1 was the only pathogen for which a direct relationship with mortality was seen (r = 0.2). Conclusions Our study highlights the importance of screening for co-infecting viruses in COVID-19 patients, that could be the leading cause of disease severity and death. Given the high prevalence of Influenza co-infection in our study, increased coverage of flu vaccination is encouraged to mitigate the transmission of influenza virus during the on-going COVID-19 pandemic and reduce the risk of severe outcome and mortality.

A B S T R A C TMERS-CoV, a highly pathogenic virus in humans, is associated with high morbidity and case fatality. Inflammatory responses have a significant impact on MERS-CoV pathogenesis and disease outcome. However, CD4 + T-cell induced immune responses during acute MERS-CoV infection are barely detectable, with potent inhibition of effector T cells and downregulation of antigen presentation. The local pulmonary immune response, particularly the Th1 and Th2-related immune response during acute severe MERS-CoV infection is not fully understood. In this study, we offer the first insights into the pulmonary gene expression profile of Th1 and Th2related cytokines/chemokines (Th1 & Th2 responses) during acute MERS-CoV infection using RT 2 Profiler PCR Arrays. We also quantified the expression level of primary inflammatory cytokines/chemokines. Our results showed a downregulation of Th2, inadequate (partial) Th1 immune response and high expression levels of inflammatory cytokines IL-1α and IL-1β and the neutrophil chemoattractant chemokine IL-8 (CXCL8) in the lower respiratory tract of MERS-CoV infected patients. Moreover, we identified a high viral load in all included patients. We also observed a correlation between inflammatory cytokines, Th1, and Th2 downregulation and the case fatality rate. Th1 and Th2 response downregulation, high expression of inflammatory cytokines, and high viral load may contribute to lung inflammation, severe infection, the evolution of pneumonia and ARDS, and a higher case fatality rate. Further study of the molecular mechanisms underlying the Th1 and Th2 regulatory pathways will be vital for active vaccine development and the identification of novel therapeutic strategies.

Using a simple metagenomic approach, we identified a divergent human parechovirus (HPeV) in the stool of a child in Pakistan. Genomic characterization showed this virus was distinct enough from reported HPeV types to qualify as candidate prototype for the seventh HPeV type.