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Published on: December 22, 2014
Complexity of the respiratory microbiome in pediatric hMPV hospitalizations: a tNGS-based study linking microbial
Chunyun Fu1, Wenting Tang1, Junming Lu1
1Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China.
Objective:
Human metapneumovirus (hMPV) is a significant contributor to pediatric respiratory hospitalizations. This study aimed to delineate the epidemiological patterns, clinical characteristics, and outcomes in a large cohort of hospitalized children with hMPV infection.
Methods:
From April 2021 to November 2023, 5,021 children with acute respiratory infections were enrolled at a tertiary care center. Respiratory samples underwent targeted next-generation sequencing (tNGS) for comprehensive microbial detection. Clinical, laboratory, and imaging data were analyzed to compare disease severity between cases with single hMPV detection and those with multiple microbial detections.
Results:
hMPV was detected in 12.5% (629/5,021) of cases. Strikingly, 94.8% (596/629) of these cases had co-detection of additional respiratory microbes, predominantly in hMPV-bacteria-virus (212/596) and hMPV-bacteria (123/596) combinations. Commonly co-detected agents included Haemophilus influenzae (40.8%, 257/629) and Mycoplasma pneumoniae (23.1%, 145/629). Cases with multiple microbial detections were associated with elevated serum amyloid A (median 26.4 vs. 5.9 mg/L, P = 0.018), prolonged hospitalization (6.0 vs. 5.0 days, P = 0.003), and higher costs (¥8,237.5 vs. ¥3,906.5, P < 0.001). Among the 629 hMPV-positive cases, 309 (49.1%) required respiratory support. Pulmonary consolidation and hypoxemia were the most common respiratory complications, while gastrointestinal dysfunction and myocardial damage were the primary non-respiratory complications. The median hospital stay was 6 days. Of these, 34 cases (5.4%) required intensive care unit (ICU) admission, and two cases (0.3%) resulted in mortality. These severe outcomes occurred exclusively in cases where multiple microbes were detected.
Conclusion:
The respiratory microbiome in children hospitalized with hMPV is overwhelmingly complex, with frequent co-detection of multiple microbes (94.8%), which is associated with significant clinical burdens, including prolonged hospitalization, increased need for respiratory support, and higher treatment costs. tNGS, with its ability to simultaneously identify multiple microbes, shows potential diagnostic value in uncovering this complexity and could be promising for guiding clinical management and antibiotic stewardship.
Insights
Most hospitalized children with human metapneumovirus (hMPV) have multiple infections, leading to severe illness and higher costs. Targeted next-generation sequencing (tNGS) can detect these complex co-infections.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Virology
- Microbiome Research
Background:
- Human metapneumovirus (hMPV) is a major cause of respiratory hospitalizations in children.
- Understanding the complexity of hMPV infections is crucial for effective management.
Purpose of the Study:
- To investigate the epidemiological patterns, clinical features, and outcomes of hospitalized children with hMPV.
- To assess the impact of microbial co-detections on disease severity and healthcare resource utilization.
Main Methods:
- A cohort of 5,021 children with acute respiratory infections was studied from April 2021 to November 2023.
- Targeted next-generation sequencing (tNGS) was used for comprehensive microbial detection in respiratory samples.
- Clinical, laboratory, and imaging data were analyzed to compare outcomes between single and multiple microbial detections.
Main Results:
- hMPV was detected in 12.5% of cases, with 94.8% having co-detections of other microbes, commonly Haemophilus influenzae and Mycoplasma pneumoniae.
- Multiple microbial detections were linked to prolonged hospitalization (6.0 vs. 5.0 days), increased respiratory support needs (49.1%), and higher costs.
- Severe outcomes, including ICU admission and mortality, occurred exclusively in cases with multiple microbial detections.
Conclusions:
- The respiratory microbiome in hMPV-infected children is complex, with frequent co-infections significantly increasing clinical burden.
- tNGS offers diagnostic value in identifying these complex infections, aiding clinical management and antibiotic stewardship.
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