LETTERS

2. Jouanguy E, Altare F, Lamhamedi S, Revy Human Bocavirus ed product size was 354 bp. In each P, Emilie J-F, Levin M, et al. Interferon- experiment, a negative control was γ–receptor deficiency in an infant with fatal in Children bacille Calmette-Guérin infection. N Engl J included, and positive samples were Med. 1996;26:1956–60. To the Editor: Respiratory tract confirmed by analyzing a second 3. Casanova JL, Blanche S, Emile JF, infection is a major cause of illness in sample. Amplification specificity was Jouanguy E, Lamhamedi S, Altare S, et al. verified by sequencing. Idiopathic disseminated bacillus Calmette- children. Despite the availability of Guérin infection: a French national retro- sensitive diagnostic methods, detect- Nine (3.4%) samples were posi- spective study. Pediatrics. 1996;98:774–8. ing infectious agents is difficult in a tive. Comparison of PCR product 4. Roesler J, Kofink B, Wandisch J, Heyden S, substantial proportion of respiratory sequences of these 9 isolates Paul D, Friedrich W, et al. Listeria monocy- (GenBank accession nos. AM109958– togenes and recurrent mycobacterial infec- samples from children with respirato- tions in a child with complete interferon- ry tract disease (1). This fact suggests AM109966) showed minor differ- gamma-receptor (IFNgammaR1) deficien- the existence of currently unknown ences that occurred at 1 to 4 nucleotide cy: mutational analysis and evaluation of respiratory pathogens. positions, and a high level of sequence therapeutic options. Exp Hematol. 1999; identity (99%–100%) was observed 27:1368–74. A new virus has been recently 5. Dorman SE, Uzel G, Roesler J, Bradley J, identified in respiratory samples from with the NP1 sequences of the previ- Bastian J, Billman G, et al. Viral infection in children with lower respiratory tract ously identified ST1 and ST2 isolates interferon-gamma receptor deficiency. J disease in Sweden (2). Analysis of the (2). This finding indicates that HBoV Pediatr. 1999;135:643–5. is a highly conserved virus. 6. Doffinger R, Jouanguy E, Dupuis S, full-length genome sequence showed Fondaneche MC, Stephan JL, Emilie JF, et that this virus is closely related to HBoV was the only virus identified al. Partial interferon-gamma receptor sig- bovine parvovirus and canine minute in 6 children and was associated with naling chain deficiency in a patient with virus and is a member of the genus respiratory syncytial virus in 3 other bacille Calmette-Guérin and Myco- children. An infection with other res- bacterium abscessus infection. J Infect Dis. Bocavirus, subfamily Parvovirinae, 2000;181:379–84. family Parvoviridae. This virus has piratory viruses was detected among 7. Jouanguy E, Lamhamedi-Cherradi S, Altare been provisionally named human 153 (60.5%) of the 253 HBoV-nega- F, Fondaneche M, Tuerlinckx D, Blanche S, Bocavirus (HBoV) (2). HBoV in res- tive children. The viruses identified et al. Partial interferon–gamma receptor 1 were respiratory syncytial virus in 114 deficiency in a child with tuberculoid piratory samples from Australian chil- bacillus Calmette-Guérin infection and a dren was also recently reported (3). (43.5%) samples, human metapneu- sibling with clinical tuberculosis. J Clin Involvement of this new virus in res- movirus in 27 (10.3%) samples, Invest. 1997;100:2658–64. piratory tract diseases merits further influenza A virus in 14 (5.4%) sam- 8. Reuter U, Roesler J, Thiede C, Schulz A, ples, rhinovirus in 4 (1.5%) samples, Classen CF, Oelschlagel, et al. Correction investigation. We have therefore ret- of complete interferon–gamma receptor 1 rospectively tested for HBoV adenovirus in 2 (0.8%) samples, and deficiency by bone marrow transplantation. nasopharyngeal samples collected parainfluenza virus type 3 in 1 (0.4%) Blood. 2002;100:4234–5. from children <5 years of age hospi- sample. Respiratory syncytial virus talized with respiratory tract disease. was associated with human metapneu- Address for correspondence: Anna Liberek, Samples were collected from 262 movirus in 9 (3.4%) samples. Department of Paediatrics, Children’s children from November 1, 2003, to Clinical characteristics of the Gastroenterology and Oncology, Medical January 31, 2004. The samples were HBoV-infected children are shown in University, Ul, Nowe Ogrody 1-680-803, tested for respiratory viruses by using the Table. Children infected with only Gdansk, Poland; email: [email protected] direct immunofluorescence assays HBoV had mild-to-moderate fevers. with monoclonal antibodies to respi- Leukocyte counts and C-reactive pro- ratory syncytial virus; influenza virus tein levels were normal or moderately types A and B; parainfluenza virus elevated. Chest radiographs obtained types 1, 2, and 3; and adenovirus. for 7 children showed abnormalities Samples were also placed on MRC5 such as hyperinflation and interstitial cell monolayers for virus isolation infiltrates. Bronchiolitis was the and tested for human metapneu- major diagnosis. Dyspnea, respiratory movirus by reverse transcription– distress, and cough were the most polymerase chain reaction (RT-PCR). common respiratory symptoms Nucleic acids were extracted from observed. Four (44%) HBoV-infected samples, stored at –80°C, and tested children were born preterm, which for HBoV DNA by PCR with primers suggests that these children have an specific for the predicted NP1 gene as increased susceptibility to HBoV- previously described (2). The expect- associated diseases. All children

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recovered and were discharged within 3. Sloots TP, McErlean P, Speicher DJ, Arden have been recently identified (1). 1 to 6 days. K, Nissen MD, Mackay IA. Evidence of Among them, CTX-M–type ESBLs human coronavirus HKU1 and human The 3.4% incidence of HBoV bocavirus in Australian children. J Clin are rapidly expanding and are derived observed in our study is similar to that Virol. 2005;35:99–102. from chromosomal class A β-lacta- (3.1%) reported by Allander et al. (2). mases of Kluyvera spp. (1,2). The HBoV was the only infectious agent Address for correspondence: Vincent CTX-M enzymes are not related to identified in 6 children, which sug- Foulongne, Laboratory of Virology, Montpellier TEM or SHV enzymes, as they share gests that it was the causative agent of University Hospital, 80 Ave A. Fliche, only 40% identity with these ESBLs the disease. However, more studies Montpellier 34295, France; email: (2).These ESBLS are usually charac- conducted in children with and with- [email protected] terized by a higher level of resistance out respiratory disease as well as in to cefotaxime than ceftazidime, adults and elderly persons are needed except for CTX-M-19 (2). Most to better assess the pathogenic role of organisms that harbor ESBLs are also HBoV. resistant to other classes of antimicro- bial drugs, such as aminoglycosides, fluoroquinolones, chloramphenicol, This work was supported by a grant and tetracyclines (1,2). from the Programme Hospitalier de Reports concerning the existence Recherche Clinique of the Montpellier Extended-spectrum of ESBL-producing Enterobac- University Hospital (AOI 2003). β -Lactamase– teriaceae in sub-Saharan Africa are producing scarce. We therefore conducted a Vincent Foulongne,* Enterobacteriaceae, study in the Central African Republic Michel Rodière,* to determine the frequency of ESBLs and Michel Segondy* Central African in Enterobacteriaceae isolated at the *Montpellier University Hospital, Montpellier, Republic Institut Pasteur de Bangui and to char- France acterize their bla , bla , and To the Editor: Since the early TEM SHV bla genes. 1980s, extended-spectrum β-lacta- CTX-M References From January 2003 to March mases (ESBLs) have been the largest 1. Juven T, Mertsola J, Waris M, Leimonen M, 2005, all Enterobacteriaceae isolated source of resistance to broad-spec- Meurman O, Roivanen M, et al. Etiology of from human specimens at the Institut trum oxyimino-cephalosporins among community-acquired pneumonia in 254 Pasteur de Bangui were screened for hospitalized children. Pediatr Infect Dis J. Enterobacteriaceae (1). Molecular ESBLs. Antimicrobial drug suscepti- 2000;19:293–8. analysis techniques suggest that many 2. Allander T, Tammi MT, Eriksson M, bility was determined by using the ESBLs are derived from mutations in Bjerkner A, Tiveljung-Lindell A, Anderson disk diffusion method (Bio-Rad, TEM-1, TEM-2, and SHV-1 β-lacta- B. Cloning of a human parvovirus by Marnes la Coquette, France) on molecular screening of respiratory tract mases and that these ESBLs can Mueller-Hinton agar (MHA) and samples. Proc Natl Acad Sci U S A. hydrolyze the extended-spectrum 2005;102:12891–6. interpreted according to the recom- cephalosporins (particularly cef- mendations of the Comité de tazidime) and aztreonam (1). l’Antibiogramme de la Société Members of a new group of ESBLs

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