Oded Scheuerman1, Galia Barkai2, Michal Mandelboim3, Hagit Mishali4, Gabriel Chodick5, Itzhak Levy6. 1. Pediatric 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. Electronic address: odedshv@clalit.org.il. 2. Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children's Hospital, Tel Hashomer, Ramat Gan 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel. 3. Department of Virology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel. 4. National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel. 5. Department of Epidemiology & Preventive Medicine, Tel Aviv, Ramat Aviv 6997801, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel. 6. 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.
Abstract
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.
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.
Authors: Meredith C Rogers; Margot Miranda-Katz; Yu Zhang; Tim D Oury; Melissa B Uccellini; Adolfo García-Sastre; John V Williams Journal: Viruses Date: 2020-07-04 Impact factor: 5.048
Authors: Nicolas Leister; Simone Commotio; Christoph Menzel; Sirin Yücetepe; Christoph Ulrichs; Stefanie Wendt; Christoph Dedden; Uwe Trieschmann; Tobias Hannes Journal: Cardiol Young Date: 2022-08-03 Impact factor: 1.023