Page 102 - 2020 JSOM Winter

Human Bocavirus as a Possible Contributor
to Respiratory Disease in the Georgian Military Population

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Nino Akhvlediani, MD ; Shannon Walls, MS ; Nabil H. Latif, DVM ;
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Nino Markhvashvili, MD ; Neli Javakhishvili, MD ; Nino Mitaishvili, PhD ;
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David Barliani, MD ; Kalei Hering ; Michael A. Washington, PhD *
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ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has gastrointestinal illness in humans, just as bovine parvovirus
demonstrated that new and devastating respiratory pathogens and canine minute virus are involved in the pathogenesis of
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can emerge without warning. It is therefore imperative that gastrointestinal illness in domestic animals. HBoV is distrib-
Special Operations medical personnel be aware of the pres- uted worldwide, and it has been detected in clinical material
ence of emerging pathogens within their area of operation. derived from both children and adults in Europe, Asia, the
Human bocavirus (HBoV) is a newly described member of a Americas, Africa, and Australia. The transmission of HBoV
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family of viruses known as the Parvovirinae that are often as- infection is seasonal; it has been found to occur at a constant
sociated with acute respiratory illness. The presence of HBoV low level throughout the year, but detections tend to peak
in the country of Georgia has not been previously reported. during late winter and early spring. 5
Nasal and throat swabs were collected from 95 symptomatic
members of the Georgian military. HBoV was detected in 11 The mechanism of HBoV pathogenesis has not been fully elu-
of them (12%). To our knowledge, this is the first report of cidated, and it is not known whether the various disease states
HBoV infection in the country of Georgia. This finding may that have been associated with this virus result from the virus
have a significant impact on members of the Special Opera- itself or from coinfection with other pathogens. Indeed, it is un-
tions community who train in Georgia as more data concern- clear whether HBoV functions as a pathogen or a passenger in
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ing the transmission, pathogenesis, and treatment of HBoV most of the cases in which it has been detected. This lack of
are accumulated and the role of HBoV in human disease is granularity regarding the role of this virus in the pathogenicity
more clearly defined. of infectious disease is because an appropriate animal model
capable of sustaining the growth of HBoV has not been de-
Keywords: coronavirus disease 2019; COVID-19; respiratory veloped, and the virus is notoriously difficult to culture in the
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pathogens; bocavirus; human bocavirus laboratory environment. Furthermore, HBoV infection is often
accompanied by coinfection with bacteria and other viruses.
Notably, coinfection has been detected in up to 83% of respira-
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tory samples in which HBoV was present. It is possible that the
Introduction virus may be a passenger in some cases and a pathogen in other
HBoV was discovered in 2005. The name bocavirus comes cases, but there are currently no methods available to distin-
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from the combination of the first two letters of “bovine par- guish between these two possibilities. Further research will be
vovirus” with the first two letters of “canine minute virus.” required to resolve these issues, and the development of robust
These viruses primarily infect domestic animals, resulting in animal and cell culture models will be a prerequisite for the de-
acute gastrointestinal dysfunction and stillbirth. The name termination of the role of HBoV in the development of disease.
bocavirus was chosen because of similarities in the genetic se-
quence and genomic organization between the newly described Despite the current limitations, a variety of signs and symp-
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HBoV and these two close relatives. To date, HBoV has pri- toms has been described in patients with HBoV infection, and
marily been detected as the cause of respiratory infection in these have been used to generate a standardized description
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young children. However, it has also been detected in adults of the results of infection with this virus. The symptoms of
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as a component of multipathogen synergistic infections. HBoV HBoV infection include rhinitis, pharyngitis, cough, dyspnea,
is most often found in nasopharyngeal secretions, in whole wheezing, pneumonia, acute otitis media, fever, nausea, vom-
blood, and in the serum of patients with upper and lower re- iting, and diarrhea. Many of these potential manifestations
spiratory tract infections. However, it has also been detected have not been systematically explored, and many have been
in fecal specimens derived from patients presenting with acute questioned because of the detection of high levels of coinfec-
gastroenteritis. Although the exact cause of the gastroenteri- tion in symptomatic subjects and high HBoV detection rates
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tis in these patients has not been determined, this finding in asymptomatic subjects. It is important to note that se-
indicates that HBoV may be involved in the pathogenesis of vere cases of HBoV infection without coinfection have also
*Correspondence to michael.washington@westpoint.edu
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1 Dr Akhvlediani, Mr Walls, and Dr Latif are affiliated with the United States Army Medical Research Directorate–Georgia, Tbilisi, Georgia.
4 Dr Mitaishvili is affiliated with the United States Army Medical Research Directorate–Georgia, Tbilisi, Georgia, and with the Military Hospital
of the Ministry of Defense of Georgia, Gori, Georgia. Dr Javakhishvili and Dr Barliani are affiliated with the Military Hospital of the Ministry
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of Defense of Georgia, Gori, Georgia. Ms Hering and Dr Washington are affiliated with the Department of Chemistry and Life Science, United
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States Military Academy, West Point, NY.
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