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Published on: December 19, 2020
Determinants of radiological patterns and severity in immunocompromised adults with Metapneumovirus infection
A Al-Hamoud1, N Pansu2, A-L Brun3
1Service de Pneumologie, Hôpital Foch, Suresnes, France.
Background:
Human Metapneumovirus (HMPV) belongs to the Pneumoviridae family and is responsible for respiratory infections. Mild infections are well-recognized in children, while its precise impact in various categories of immunocompromised adults has not been well addressed.
Research Question:
We retrospectively studied HMPV infections in immunocompromised adults followed in two large French university medical centers.
Study Design And Methods:
We identified immunocompromised adults with positive HMPV Polymerase Chain Reaction (PCR) for 36 months and reviewed their medical charts. For lung transplant recipients (LTR), FEV1 was collected at baseline, during and after infection. Imaging was centralized and chest involvement was categorized by dominant CT patterns. We compared severe patients (requiring oxygen or ventilation) and non hypoxemic patients.
Results:
Seventy-two patients were included, 27 were LTR, 25 had a hematological malignancy or were hematopoietic stem cell recipients, 20 had another immunocompromised status. Twenty patients (28%) presented a hypoxemic infection, requiring hospitalization and intensive care units transfers in 50/72 (69.4%) and 9/72 (12.5%) respectively, with only one death. Hypoxemia was less pronounced in LTRs (p = 0.014). Finally, age and dyspnea remained independent factors associated with hypoxemia (p < 0.005). The most frequent radiological patterns were bronchopneumonia (34.2%) and bronchiolitis (39.5% and 64.3% in the overall population and in LTRs respectively, p = 0.045). FEV1 improved in LTRs at one month and 85% had recovered their baseline FEV1 within 6 months.
Interpretations:
In immunocompromised adults, HMPV infections required frequent hospitalizations and ICU transfers, while mortality is low. In LTRs, bronchiolitis pattern was predominant with short and long-term favorable outcome.
Insights
Human Metapneumovirus (HMPV) infections in immunocompromised adults often lead to hospitalization and intensive care, but mortality remains low. Lung transplant recipients experienced predominantly bronchiolitis with good recovery.
Area of Science:
- Infectious Diseases
- Pulmonology
- Immunocompromised Hosts
Background:
- Human Metapneumovirus (HMPV) is a known cause of respiratory illness, particularly in children.
- The impact of HMPV in immunocompromised adults is not well-defined.
- This study addresses the clinical presentation and outcomes of HMPV in diverse immunocompromised adult populations.
Purpose of the Study:
- To investigate the characteristics and outcomes of HMPV infections in immunocompromised adults.
- To compare HMPV infection severity and presentation across different immunocompromised groups.
- To evaluate the pulmonary impact and recovery in lung transplant recipients (LTRs) with HMPV.
Main Methods:
- Retrospective study of immunocompromised adults with confirmed HMPV infection via PCR over 36 months.
- Analysis of medical charts, including hospitalization, intensive care unit (ICU) admission, and oxygen requirements.
- Radiological assessment (CT scans) and pulmonary function tests (FEV1) in lung transplant recipients.
Main Results:
- Seventy-two immunocompromised adults were included; 28% presented with hypoxemic infections.
- Hospitalization and ICU transfers were frequent (69.4% and 12.5%, respectively), with low mortality (one death).
- Bronchiolitis was the predominant radiological pattern, especially in LTRs (64.3%), with favorable FEV1 recovery within 6 months.
Conclusions:
- HMPV infections in immunocompromised adults necessitate frequent hospitalizations and ICU care, but generally have a low mortality rate.
- Lung transplant recipients with HMPV commonly exhibit bronchiolitis, with good short- and long-term pulmonary function outcomes.
- Age and dyspnea are significant predictors of hypoxemia in this patient group.
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