LETTERS 1320 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 15, No. 8, August 2009 ed in 7 patients; 5 were co-infected with HBoV (2 patients had LRTIs, 2 had upper respiratory tract infections, and 1 had undefned symptoms), and 2 were co-infected with RSV (both patients had symptoms of LRTIs). Of the other 3 patients co-infected with HRV and HBoV, 1 was infected with HRV-B (had LRTI), 1 with HRV-C (had LRTI), and 1 with an untypeable HRV (had undefned symptoms). Co- infections with HRV and RSV (4,5) and HRV and HBoV (4) have been reported. Although the clinical role of these co-infections needs to be clarifed, these studies suggest that co-infec- tions may result in more severe dis- ease symptoms. The role of HRV-C in causing illness among the children of Singapore will require further study. This study was supported by the Na- tional Medical Research Council of Singa- pore and the DSO National Laboratories, Singapore. Boon-Huan Tan, Liat-Hui Loo, Elizabeth Ai-Sim Lim, Shirley Lay-Kheng Seah, Raymond T.P. Lin, Nancy W.S. Tee, and Richard J. Sugrue Author affliations: DSO National Labora- tories, Singapore (B.-H. Tan, E.A.-S. Lim, S.L.-K. Seah); Nanyang Technological Uni- versity, Singapore (L.-H. Loo, R.J. Sugrue); Kandang Kerbau Women’s and Children’s Hospital, Singapore (L.-H. Loo, N.W.S. Tee); and National University Hospital, Sin- gapore (R.T.P. Lin) DOI: 10.3201/eid1508.090321 References 1. Lamson D, Renwick N, Kapoor V, Liu Z, Palacios G, Ju J, et al. MassTag poly- merase-chain-reaction detection of respi- ratory pathogens, including a new rhino- virus genotype, that caused infuenza-like illness in New York State during 2004– 2005. J Infect Dis. 2006;194:1398–402. DOI: 10.1086/508551 2. Lau SK, Yip CC, Tsoi HW, Lee RA, So LY, Lau YL, et al. Clinical features and complete genome characterization of a distinct human rhinovirus (HRV) genetic cluster, probably representing a previously undetected HRV species, HRV-C, associ- ated with acute respiratory illness in chil- dren. J Clin Microbiol. 2007;45:3655–64. DOI: 10.1128/JCM.01254-07 3. Lee WM, Kiesner C, Pappas T, Lee I, Grin- dle K, Jartti T, et al. A diverse group of pre- viously unrecognized human rhinoviruses are common causes of respiratory illnesses in infants. PLoS One. 2007;2:e966. DOI: 10.1371/journal.pone.0000966 4. McErlean P, Shackelton LA, Lambert SB, Nissen MD, Sloots TP, Mackay IM. Characterisation of a newly identifed human rhinovirus, HRV-QPM, discov- ered in infants with bronchiolitis. J Clin Virol. 2007;39:67–75. DOI: 10.1016/j. jcv.2007.03.012 5. Xiang Z, Gonzalez R, Xie Z, Xiao Y, Chen L, Li Y, et al. Human rhinovirus group C infection in children with lower respiratory tract infection. Emerg Infect Dis. 2008;14:1665–7. DOI: 10.3201/ eid1410.080545 6. Loo LH, Tan BH, Ng LM, Tee NW, Lin RT, Sugrue RJ. Human metapneumovirus in children, Singapore. Emerg Infect Dis. 2007;13:1396–8. 7. Tan BH, Lim EA, Seah SG, Loo LH, Tee NW, Lin RT, et al. The incidence of human bocavirus infection among children admit- ted to hospital in Singapore. J Med Virol. 2009;81:82–9. DOI: 10.1002/jmv.21361 8. Hayden FG, Turner RB, Gwaltney JM, Chi-Burris K, Gersten M, Hsyu P, et al. Phase II, randomized, double-blind, placebo-controlled studies of ruprintri- vir nasal spray 2-percent suspension for prevention and treatment of experimen- tally induced rhinovirus colds in healthy volunteers. Antimicrob Agents Chemoth- er. 2003;47:3907–16. DOI: 10.1128/ AAC.47.12.3907-3916.2003 9. Tamura K, Dudley J, Nei M, Kumar S. MEGA4: Molecular Evolutionary Genet- ics Analysis (MEGA) software version 4.0. Mol Biol Evol. 2007;24:1596–9. DOI: 10.1093/molbev/msm092 10. Miller EK, Edwards KM, Weinberg GA, Iwane MK, Griffn MR, Hall CB, et al. New Vaccine Surveillance Network. A novel group of rhinoviruses is associated with asthma hospitalizations. J Allergy Clin Immunol. 2009;123:98–104. DOI: 10.1016/j.jaci.2008.10.007 Address for correspondence: Boon-Huan Tan, Detection and Diagnostics Laboratory, DSO National Laboratories, #13-00, 27 Medical Dr, Singapore 117510; email: tboonhua@dso. org.sg Nondominant Hemisphere Encephalitis in Patient with Signs of Viral Meningitis, New York, USA To the Editor: Herpes simplex virus (HSV) is the most common cause of sporadic fatal encephalitis across the globe and for all ages. HSV is the etiologic agent of 10%–20% of the 20,000 cases of encephalitis per year in the United States (1); >50% of untreated cases are fatal. Of the 2 types of HSV, HSV-1 and HSV-2, HSV-1 most commonly affects per- sons 20–40 years of age, whereas HSV-2 commonly affects neonates. This rapidly progressive disease is a common cause of fatal encephalitis in the United States. Signs and symp- toms include fever and headache for a few days, followed by confusion, focal defcits, seizures or hemipare- sis, hallucinations, and altered levels of consciousness (2). One third of all HSV encephalitis cases affict chil- dren and adolescents. Lumbar punc- ture typically shows lymphocytic pleocytosis, increased erythrocytes, and elevated protein (2); glucose level is typically within normal lim- its. Serologic assays often show prior infection. Brain imaging frequently indicates unilateral frontal or tempo- ral lobe abnormalities with edema or hematoma (3,4). The involvement of the nondominant brain hemisphere is associated with atypical signs and symptoms (5). Diagnosis is usually made by using PCR to examine vi- ral DNA in cerebrospinal fuid (CSF) (6). This method of fnding DNA in CSF is highly sensitive (98%) and specifc (94%–100%). Without thera- py, 70% of patients die; with therapy, 20%–30% die (6). Illness includes behavioral sequelae. A 43-year-old female immigrant from China was admitted to Flushing