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Coronaviruses

INTRODUCTION

Coronaviruses are important human and animal pathogens. They are the cause of up to one-third of community-acquired upper respiratory tract infections in adults and probably also play a role in severe respiratory infections in both children and adults. In addition, it is likely that certain coronaviruses cause diarrhea in infants and children, and their possible role in central nervous diseases has been suggested but not proven.

The microbiology, epidemiology, clinical manifestations, diagnosis, treatment, and prevention of coronaviruses will be discussed here. Severe acute respiratory syndrome, which is caused by a coronavirus, is reviewed separately. (See "Severe acute respiratory syndrome (SARS)".)

MICROBIOLOGY

Coronaviruses are members of the Nidovirus family, viruses that replicate using a nested set of mRNAs ("nido-" for "nest"). Toroviruses are the only other nidoviruses known to cause disease in humans. They have similar genome organization compared with coronaviruses; however, they have different genome lengths and virion morphology [1]. Toroviruses have been associated only with diarrhea in humans and animals.

Viral composition — Coronaviruses are medium-sized, enveloped, positive-stranded RNA viruses whose name derives from their characteristic crown-like appearance in electron micrographs (figure 1) [1]. These viruses have the largest known viral RNA genomes, with a length of 27 to 32 kb. The host-derived membrane is studded with glycoprotein spikes and surrounds the genome, which is encased in a nucleocapsid that is helical in its relaxed form but assumes a roughly spherical shape in the virus particle (figure 2). Replication of viral RNA occurs in the host cytoplasm by a unique mechanism in which RNA polymerase binds to a leader sequence and then detaches and reattaches at multiple locations, allowing for the production of a nested set of mRNA molecules with common 3' ends (figure 3).

The genome encodes four or five structural proteins, S, M, N, HE, and E. Human coronaviruses 229E (HCoV-229E), HCoV-NL63, and the SARS coronavirus possess four genes that encode the S, M, N, and E proteins, respectively, whereas HCoV-OC43 and HCoV-HKU1 also contain a fifth gene that encodes the HE protein [2].
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