Human Metapneumovirus Pneumonia Research Articles

Profiles and predictive value of cytokines in children with human metapneumovirus pneumonia.

Human metapneumovirus (HMPV) is an important cause of respiratory tract infections in young children. Early innate immune response to HMPV is focused on induction of antiviral interferons (IFNs) and other pro-inflammatory cytokines that are critical for the formation of adaptive immune responses. To evaluate the predictive value of Th1/Th2 cytokines which include IL-2, IL-4, IL-6, IL-10, INF-γ and TNF-α in pneumonia caused by HMPV. A retrospective study was performed among 59 pneumonia pediatric patients with HMPV infection and 33 healthy children as the control cohort, which was detected by the immunofluorescence assay, and the Th1/Th2 cytokines were measured by flow cytometry. 131 children infected with Influenza virus A (IVA) and 41 children infected with influenza virus B (IVB) were detected by RT-PCR assay in throat swabs. When compared with the healthy children, children who were infected with HMPV pneumonia had a significantly lower level of IL-2 (p < 0.001) and higher levels of IL-4 (p < 0.001), IL-6 (p = 0.001), IL-10 (p < 0.001), and IFN-γ (p < 0.001). Compared with patients diagnosed with IVA or IVB infection, HMPV-positive patients had significantly higher levels of IL-4 (p < 0.001 and < 0.001), IFN-γ (p < 0.001 and < 0.001), and TNF-α (p < 0.001 and 0.016). Moreover, compared with IVA patients, HMPV-positive patients had a significantly lower level of IL-6 (p = 0.033). Finally, when comparing cytokine levels among the patients with HMPV pneumonia, IL-6 and TNF-α levels were found to be significantly higher in the severe group than the mild group (p = 0.027 and 0.049). The IL-6 and TNF-α were used to differentiate between mild symptoms and severe symptoms in children diagnosed with HMPV pneumonia with an AUC of 0.678 (95% CI 0.526-0.829) and 0.658 (95% CI 0.506-0.809), respectively. Our study indicated that difference in cytokine trends depending on the virus species. The levels of IL-4, TNF-α and IFN-γ were significantly distinguished in children infected with HMPV versus IVA and IVB. IL-6 and TNF-α may be helpful in assessing the severity and prognosis of HMPV infection.

Human Metapneumovirus Infection in Adults as the Differential Diagnosis of COVID-19

Human metapneumovirus (HMPV) is a respiratory tract virus identified 18 years prior to severe acute respiratory syndrome coronavirus-2. Both viruses cause acute respiratory failure characterised by a rapid onset of widespread inflammation in the lungs with clinical symptoms similar to those reported for other viral respiratory lung infections. HMPV, more generally known as childhood viral infection, causes mild and self-limiting infections in the majority of adults, but clinical courses can be complicated in risky groups and associated morbidity and mortality are considerable. Moreover, adults are not regularly screened for HMPV and the prevalence of adult HMPV infections in Turkey is unknown, with previous reports in the paediatric population. This should always be kept in mind during the coronavirus disease-2019 pandemic, particularly when neurological complications are added to respiratory findings. In our study, two adult cases of HMPV pneumonia and encephalitis have been recorded.

Clinical and Radiologic Characteristics of Human Metapneumovirus Infections in Adults, South Korea.

Clinical features of human metapneumovirus (HMPV) infection have not been well documented for adults. We investigated clinical and radiologic features of HMPV infection in 849 adults in a tertiary hospital in South Korea. We classified patients into groups on the basis of underlying diseases: immunocompetent patients, solid tumor patients, solid organ transplantation recipients, hematopoietic stem cell transplant recipients, hematologic malignancy patients, and patients receiving long-term steroid treatment. Of 849 HMPV-infected patients, 756 had community-acquired infections, 579 had pneumonia, and 203 had infections with other pathogens. Mortality rates were highest in hematopoietic stem cell transplantation recipients (22% at 30 days). Older age, current smoking, and underlying disease were associated with HMPV pneumonia. Body mass index and an immunocompromised state were associated with 30-day mortality rates in HMPV-infected patients. Bronchial wall thickening, ground-glass opacity, and ill-defined centrilobular nodules were common computed tomography findings for HMPV pneumonia. Macronodules and consolidation were observed in <50% of patients.

Clinical Features of Human Metapneumovirus Pneumonia in Non-Immunocompromised Patients: An Investigation of Three Long-Term Care Facility Outbreaks.

Several studies have reported outbreaks due to human metapneumovirus (hMPV) in long-term care facilities (LTCF) for the elderly. However, most of these reports are epidemiological studies and do not investigate the clinical features of hMPV pneumonia. Three independent outbreaks of hMPV occurred at separate LTCF for intellectually challenged and elderly residents. A retrospective evaluation of hMPV pneumonia and its clinical and radiological features was conducted using available medical records and data. In 105 hMPV infections, 49% of patients developed pneumonia. The median age of pneumonia cases was significantly higher than non-pneumonia cases (P < .001). Clinical manifestations of hMPV pneumonia included high fever, wheezing in 43%, and respiratory failure in 31% of patients. An elevated number of white blood cells as well as increased levels of C-reactive protein, creatine phosphokinase, and both aspartate and alanine transaminases was also observed among pneumonia cases. Evaluation of chest imaging revealed proximal bronchial wall thickenings radiating outward from the hilum in most patients. The aforementioned characteristics should be considered as representative of hMPV pneumonia. Patients presenting with these features should have laboratory testing performed for prompt diagnosis.

Human Metapneumovirus Infection: Pneumonia Risk Factors in Patients With Solid Organ Transplantation and Computed Tomography Findings.

Human metapneumovirus (HMPV) is a newly detected pathogen that can cause lower respiratory tract disease. Clinical characteristics, computed tomography (CT) findings, and outcomes of HMPV pneumonia in patients with solid organ transplantation (SOT) have not been well demonstrated. Between January 2010 and February 2016, clinical and imaging findings of 59 patients with SOT (types of organ: kidney, 37; liver, 16; heart, 4; and pancreas and kidney, 2) who had HMPV infection detected in nasopharyngeal or bronchoalveolar lavage by reverse transcription polymerase chain reaction were retrospectively evaluated. Most (90%) of the patients were detected between March and June. In the 59 patients with SOT with upper respiratory tract infection (URI), 29 (49%) progressed to lower respiratory tract disease after a median of 7 days (range, 2-31 days). Coinfection was noted in 39% of the patients. In Cox proportional hazards analysis, low lymphocyte count (≤0.7 × 10/μL; hazard ratio, 2.24; 95% confidence interval, 1.04-4.85; P = 0.04) and high C-reactive protein (>10 mg/dL; hazard ratio, 2.93; 95% confidence interval, 1.19-7.21; P = 0.02) at URI diagnosis were associated with HMPV pneumonia. On CT, HMPV pneumonia presented as bilateral ill-defined centrilobular nodules, consolidation and ground-glass opacities, whereas lymphadenopathy or effusion is not common. There were no significantly different imaging CT findings between patients with HMPV infection alone and those with coinfection. Human metapneumovirus pneumonias were detected in nearly half of patients with SOT showing URI symptoms with positive HMPV, and low lymphocyte count and high C-reactive protein at URI diagnosis were significant factors associated with HMPV pneumonia.

Lung Nodules in a Patient With Recently Resected GI Stromal Tumor (GIST): Beginning of a Confusing Domino Effect

SESSION TITLE: Other Infections SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: With improved diagnostic tools, more pulmonary infections are being identified and pulmonary physicians are facing an ever expanding array of pulmonary pathology cases as a result of such infections. CASE PRESENTATION: A 50-year-old male with GIST resected 2 months ago, presented with dry cough associated with fever, night sweats, myalgias, wheezing. On exam, he had diminished bibasilar breath sounds. CT angiogram chest showed extensive pulmonary nodules with mediastinal and hilar lymphadenopathy (Fig 1-a). Urine streptococcus, legionella and histoplasma antigen, Quantiferon Gold and HIV screen were all negative. Coccidioides titer1:2. ANA and ANCA panel were negative. He underwent fluoroscopically-guided transbronchial biopsy of the lingula. Cytology of lingular wash suggested malignant cells. BAL was also positive for human metapneumovirus (HMPV). PET scan showed no uptake. Thoracoscopy and wedge resection of lingula were performed. The main histopathologic finding was non-necrotizing granulomatous inflammation with bronchiolocentric distribution (Fig 2). DISCUSSION: HMPV pneumonia may explain CT findings of ground-glass attenuation and nodular opacities. Coccidioidomycosis have been reported to manifest spiculated nodules or masses, consolidation, cavitation and lymphadenopathy on CT imaging. While histopathologic findings mimic a lymphangitic distribution, suggesting malignancy, non-necrotizing granulomatous pattern in histopathology strongly suggests pulmonary coccidioidomycosis. Focal organizing pneumonia and incidental organizing thromboembolus were simultaneously identified. This finding can be explained by HMPV pneumonia as it has been reported to cause severe pneumonia in immunocompromised hosts and develop organizing pneumonia. As of last follow up, patient is free of respiratory symptoms while steroid therapy has been tapered. Follow up CT showed near resolution of lung nodules (Fig 1-b). CONCLUSIONS: Two infectious processes, HMPV and Coccidioidomycosis led to a divergent and confusing clinical picture which includes a false alarm of malignancy, and true consequences of granulomatous disease and organizing pneumonia. While diagnosing and treating different pulmonary infections, it is getting ever more important to know and understand the possible mimics (Malignancy in our case) and consequences (Granulomatous disease and Organizing pneumonia in our case) of the infections. Reference #1: Malo J et al. Ann Am Thorac Soc 2014 Reference #2: Samuel S et al. Cancer Control 2016 Reference #3: Franquet T et al. J Comput Assist Tomogr 2005 DISCLOSURE: The following authors have nothing to disclose: Zahia Esber, Edgar Sanchez, Luis Herrera, Rumi Khan No Product/Research Disclosure Information

Human metapneumovirus pneumonia in patients with hematological malignancies

BackgroundHuman metapneumovirus (HMPV) has recently emerged as a cause of respiratory infections in hematological patients. Clinical data are lacking to guide the management of HMPV pneumonias. ObjectivesTo characterize the clinical and radiographic presentation and outcome of HMPV pneumonias diagnosed in hematological patients. Study designWe screened the patients with a positive HMPV respiratory test in two French teaching hospitals between 2007 and 2011. Among them, the medical charts from the hematological patients who presented with HMPV pneumonia were reviewed. ResultsAmong the 54 patients with several underlying hematological conditions who were positive for HMPV, we found 13 cases of HMPV pneumonias. HMPV could be the cause of pneumonia as a single pathogen without associated upper respiratory infection. Centrilobular nodules were constant on lung computed tomography scans. No patients died despite the absence of administration of antiviral treatments. ConclusionsOur data provide further insights in the diagnosis and management of HMPV pneumonias in this setting.

Erratum: Treatment with oral ribavirin and IVIG of severe human metapneumovirus pneumonia (HMPV) in immune compromised child

Erratum: Treatment with oral ribavirin and IVIG of severe human metapneumovirus pneumonia (HMPV) in immune compromised child

Treatment with oral ribavirin and IVIG of severe human metapneumovirus pneumonia (HMPV) in immune compromised child

Treatment with oral ribavirin and IVIG of severe human metapneumovirus pneumonia (HMPV) in immune compromised child

Severe Human Metapneumovirus Pneumonia in a Child With Chronic Illness

Severe Human Metapneumovirus Pneumonia in a Child With Chronic Illness

Successful treatment of human metapneumovirus pneumonia using combination therapy with intravenous ribavirin and immune globulin

Successful treatment of human metapneumovirus pneumonia using combination therapy with intravenous ribavirin and immune globulin

Human Metapneumovirus Pneumonia in Adults: Results of a Prospective Study

We prospectively collected clinical, laboratory, and radiographic data regarding community-acquired human metapneumovirus (hMPV) infection in consecutive adults hospitalized with pneumonia. hMPV infection was diagnosed using highly accurate reverse-transcription-polymerase chain reaction analysis of nasopharyngeal samples. Eight (4%) of 193 patients had hMPV RNA present, all detected during influenza season. hMPV is an important cause of pneumonia in adults.

Human metapneumovirus pneumonia in children: Results of an Italian study and mini-review

Human metapneumovirus (hMPV) is a newly identified paramyxovirus causing lower respiratory tract infections (LRTI). Current knowledge on hMPV is mainly based on retrospective studies performed in stored respiratory and serum samples. We found 15 previous prospective clinical studies on LRTI (11 clinical and 4 epidemiological studies) that have been reviewed. Our aims were to analyse the role of hMPV in community acquired pneumonia (CAP) and the seroconversion rate to hMPV in a prospective study in North Italian children. During a 15-month study period, 124 children were admitted due to presumptive CAP and, in 116 of them, CAP was radiologically confirmed. The aetiology of CAP was assessed by serology to 15 microorganisms, including enzyme immunoassay to hMPV. hMPV infection was found in 5 children (4.9%), being single in 2 and mixed in 3 cases. The seroconversion rate to hMPV increased with age, reaching nearly 100% seropositivity rate at school age. In conclusion, hMPV caused 0% to 17.5% of LRTI cases in children in the mini-review. The figure was about 5% in the present and in the only earlier paediatric CAP study. Thus, hMPV is a real but rare cause of paediatric CAP, although seroconversion to hMPV in most children takes place in early childhood.

Human Metapneumovirus Infection in Hematopoietic Stem Cell Transplant Recipients

To review the high-resolution computed tomography (CT) findings in hematopoietic stem cell transplant (HCT) recipients who had proven human metapneumovirus (HMPV) pneumonia. The study included 5 HCT recipients who had proven HMPV pneumonia. The patients included 4 men and 1 woman ranging in age from 23 to 58 years (mean age = 42 years). The CT scans were assessed for the presence, appearance, size, and distribution of parenchymal abnormalities. Human metapneumovirus was isolated in all 5 patients in this series. None of these patients had any other infectious organism identified in cultures or bronchoalveolar lavage. The predominant CT findings were bilateral abnormalities in all patients, consisting primarily of a mixture of patterns, including, most commonly, ground-glass attenuation and nodular opacities. Areas of ground-glass opacification had no zonal predominance and were bilateral, asymmetric, and patchily distributed. Multiple nodules were identified in 4 (80%) of 5 patients. Nodules were multiple; less than 5 nodules were identified in 1 case, and 5 to 10 nodules were identified in 3 cases. All nodules in all cases were less than 10 mm in diameter. Areas of air-space consolidation were identified in 2 (40%) patients. All patients were available for follow-up; lesions improved in 4 patients. The thin-section CT manifestations of HMPV pneumonia usually consist of a mixture of patterns, including, most commonly, ground-glass attenuation and nodular opacities.

Life-Threatening Human Metapneumovirus Pneumonia Requiring Extracorporeal Membrane Oxygenation in a Preterm Infant

We present the first report in the literature of a child with human metapneumovirus pneumonia who required extracorporeal membrane oxygenation for survival. This was a 3-month-old premature boy from British Columbia, Canada, who developed severe respiratory failure, experienced failure of high-frequency oscillatory mechanical ventilation, and required extracorporeal membrane oxygenation support for 10 days. This case illustrates the importance of including this newly discovered pathogen among the causes of childhood pneumonia.