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Human metapneumovirus (hMPV) infection in immunocompromised children
Oded Scheuerman1, Galia Barkai2, Michal Mandelboim3
1Pediatric Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel.
Background:
Human metapneumovirus (hMPV) is a major cause of upper and lower respiratory tract infection (URTI, LRTI) in children. The prognosis of hMPV is unclear in immunocompromised patients.
Objectives:
To describe the characteristics of hMPV infection in immunocompromised pediatric patients and to review the literature.
Study Design:
This retrospective study included 39 immunocompromised children (age 0-18 years) with proven hMPV infection attending two tertiary pediatric medical centers in 2004-2014. Demographic, clinical, laboratory, and radiological data were collected from the medical files.
Results:
Median age was 6 years. Seven patients had primary immune deficiency and 32, secondary immune deficiency, including 9 patients who underwent hematopoietic stem cell transplantation (HSCT). Most cases (92%) occurred in January-May. Twenty patients (51%) had lower respiratory tract infection and 17 (44%), upper respiratory tract infection; 2 patients (5%) had fever only. Presenting symptoms were fever (70%), cough (54%), and rhinorrhea (35%). Severe lymphopenia (<1000lymphocytes/mL) was noted in 64% of patients and elevated liver enzyme levels in 49%. Seventeen patients had pneumonia: bilateral and alveolar in 13 patients, each. HSCT was not associated with more severe disease. Respiratory failure occurred in 6 patients, of whom 4 died (10% of cohort). All children who died had severe lymphopenia. On multivariate analysis, bacterial or fungal co-infection was the only major risk factor for death. Review of the literature showed variable clinical presentations and severity in pediatric patients with hMPV infection.
Conclusions:
Infection with hMPV may be associated with relatively high morbidity and mortality in immunocompromised children. Death was associated with bacterial and fungal co-infection.
Insights
Human metapneumovirus (hMPV) infection can cause severe respiratory illness in immunocompromised children. Bacterial or fungal co-infections significantly increase the risk of death in these vulnerable patients.
Area of Science:
- Pediatric Infectious Diseases
- Immunocompromised Host Pathogens
- Respiratory Viral Infections
Background:
- Human metapneumovirus (hMPV) is a significant cause of respiratory infections in children.
- The clinical outcomes of hMPV in immunocompromised pediatric populations remain poorly understood.
Purpose of the Study:
- To characterize hMPV infections in immunocompromised children.
- To review existing literature on hMPV in this patient group.
Main Methods:
- Retrospective analysis of 39 immunocompromised children (0-18 years) with confirmed hMPV.
- Data collected included demographics, clinical presentation, laboratory results, and radiological findings.
- Literature review of pediatric hMPV infections.
Main Results:
- The majority of cases (92%) occurred between January and May.
- Lower respiratory tract infections (51%) and upper respiratory tract infections (44%) were common.
- Severe lymphopenia (64%) and elevated liver enzymes (49%) were frequent; 10% of the cohort died, with bacterial/fungal co-infection as a key risk factor.
Conclusions:
- hMPV infection poses significant morbidity and mortality risks for immunocompromised children.
- Bacterial and fungal co-infections are critical determinants of mortality in these patients.
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