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Clinical Features of Human Metapneumovirus-Associated Community-acquired Pneumonia Hospitalizations
Leigh M Howard1, Kathryn M Edwards1, Yuwei Zhu2
1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Background:
Human metapneumovirus (HMPV) is a leading cause of respiratory tract infections. Few studies have compared the clinical characteristics and severity of HMPV-associated pneumonia with other pathogens.
Methods:
Active, population-based surveillance was previously conducted for radiographically confirmed, community-acquired pneumonia hospitalizations among children and adults in 8 United States hospitals. Clinical data and specimens for pathogen detection were systematically collected. We described clinical features of all HMPV-associated pneumonia and, after excluding codetections with other pathogen types, we compared features of HMPV-associated pneumonia with other viral, atypical, and bacterial pneumonia and modeled the severity (mild, moderate, and severe) and length of stay using multivariable proportional odds regression.
Results:
HMPV was detected in 298/2358 (12.6%) children and 88/2320 (3.8%) adults hospitalized with pneumonia and was commonly codetected with other pathogens (125/298 [42%] children and 21/88 [24%] adults). Fever and cough were the most common presenting symptoms of HMPV-associated pneumonia and were also common symptoms of other pathogens. After excluding codetections in children (n = 1778), compared to HMPV (reference), bacterial pneumonia exhibited increased severity (odds ratio [OR], 3.66; 95% confidence interval [CI], 1.43-9.40), respiratory syncytial virus (RSV; OR, 0.76; 95% CI, .59-.99) and atypical (OR, 0.39; 95% CI, .19-.81) infections exhibited decreased severity, and other viral pneumonia exhibited similar severity (OR, 0.88; 95% CI, .55-1.39). In adults (n = 2145), bacterial (OR, 3.74; 95% CI, 1.87-7.47) and RSV pneumonia (OR, 1.82; 95% CI, 1.32-2.50) were more severe than HMPV (reference), but all other pathogens had similar severity.
Conclusions:
Clinical features did not reliably distinguish HMPV-associated pneumonia from other pathogens. HMPV-associated pneumonia was less severe than bacterial and adult RSV pneumonia, but was otherwise as or more severe than other common pathogens.
Insights
Human metapneumovirus (HMPV) causes respiratory infections. This study found HMPV pneumonia severity is comparable to other viruses but less severe than bacterial pneumonia in children and adults.
Area of Science:
- Infectious Diseases
- Pulmonology
- Virology
Background:
- Human metapneumovirus (HMPV) is a significant cause of respiratory tract infections.
- Limited research exists comparing HMPV pneumonia's clinical features and severity against other pathogens.
Purpose of the Study:
- To compare the clinical characteristics and severity of HMPV-associated pneumonia with pneumonia caused by other common respiratory pathogens.
- To model the severity and length of stay for HMPV pneumonia relative to other etiologies.
Main Methods:
- Population-based surveillance of radiographically confirmed community-acquired pneumonia hospitalizations in children and adults.
- Systematic collection of clinical data and pathogen detection specimens.
- Comparison of HMPV pneumonia features with viral, atypical, and bacterial pneumonia, excluding co-detections; severity modeled using multivariable proportional odds regression.
Main Results:
- HMPV was detected in 12.6% of pediatric and 3.8% of adult pneumonia hospitalizations, often with co-infections.
- In children, bacterial pneumonia was more severe than HMPV; RSV and atypical infections were less severe.
- In adults, bacterial and RSV pneumonia were more severe than HMPV; other pathogens showed similar severity.
Conclusions:
- Clinical presentation alone is insufficient to reliably differentiate HMPV pneumonia from other causes.
- HMPV pneumonia demonstrates less severity compared to bacterial pneumonia and adult RSV pneumonia.
- HMPV pneumonia severity is comparable to or greater than other common viral and atypical pathogens.
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