Skip to main content

Advertisement

SpringerLink
Log in

Human metapneumovirus infections cause similar symptoms and clinical severity as respiratory syncytial virus infections

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Human metapneumovirus (hMPV) is a recently discovered pathogen in respiratory tract infection. The published literature suggests milder illness severity in hMPV compared with respiratory syncytial virus (RSV) infection. In two consecutive seasons, 637 nasopharyngeal aspirates from pediatric patients were tested by hMPV polymerase chain reaction, and risk factors and clinical and laboratory items were analyzed. The hMPV patients were compared with hMPV-negative but RSV-positive patients by matched pair analysis. HMPV was detected in 17.9% of all samples. In total, 88 hMPV-infected patients with complete datasets were considered. More than half of all hMPV patients were older than 12 months, 45.5% had at least one risk factor for a severe course of viral respiratory tract infection, and 27.3% were born prematurely, 15.9% with a birth weight <1,500 g. At least one other virus was also detected in 39 patients (44.3%; RSV in 29.5%). Coinfection did not result in greater severity of illness. On matched pair analysis (hMPV-positive/RSV-negative vs. hMPV-negative/RSV-positive), the epidemiological and clinical features of hMPV infection were similar to those of RSV infection, as in the hMPV group higher proportions of patients with hypoxemia on admission (33% vs. 21%) and of intensive care treatment (20.8% vs. 10.4%) were observed. More hMPV patients showed lobar infiltrates in radiological chest examination. In 60% of all hMPV infections, the attending physicians prescribed antimicrobial chemotherapy. We conclude that in hospitalized children, hMPV infection is as serious as RSV infection and therefore deserves the same attention. Virologic diagnosis from respiratory secretions is mandatory because clinical, laboratory, and radiological signs cannot sufficiently discriminate between viral and bacterial respiratory tract infection in infants and children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Black CP (2003) Systematic review of the biology and medical management of respiratory syncytial virus infection. Respir Care 48:209–231; discussion 231–203

    PubMed  Google Scholar 

  2. Boivin G, De Serres G, Cote S, Gilca R, Abed Y, Rochette L, Bergeron MG, Dery P (2003) Human metapneumovirus infections in hospitalized children. Emerg Infect Dis 9:634–640

    PubMed  Google Scholar 

  3. Bosis S, Esposito S, Niesters HG, Crovari P, Osterhaus AD, Principi N (2005) Impact of human metapneumovirus in childhood: comparison with respiratory syncytial virus and influenza viruses. J Med Virol 75:101–104

    Article  PubMed  Google Scholar 

  4. Crowe JE Jr (2004) Human metapneumovirus as a major cause of human respiratory tract disease. Pediatr Infect Dis J 23:S215–S221

    Article  PubMed  Google Scholar 

  5. Dollner H, Risnes K, Radtke A, Nordbo SA (2004) Outbreak of human metapneumovirus infection in Norwegian children. Pediatr Infect Dis J 23:436–440

    Article  PubMed  Google Scholar 

  6. Donnelly LF (2001) Practical issues concerning imaging of pulmonary infection in children. J Thorac Imaging 16:238–250

    Article  PubMed  CAS  Google Scholar 

  7. Ebihara T, Endo R, Kikuta H, Ishiguro N, Ishiko H, Hara M, Takahashi Y, Kobayashi K (2004) Human metapneumovirus infection in Japanese children. J Clin Microbiol 42:126–132

    Article  PubMed  Google Scholar 

  8. Ebihara T, Endo R, Kikuta H, Ishiguro N, Ishiko H, Kobayashi K (2004) Comparison of the seroprevalence of human metapneumovirus and human respiratory syncytial virus. J Med Virol 72:304–306

    Article  PubMed  Google Scholar 

  9. Esper F, Martinello RA, Boucher D, Weibel C, Ferguson D, Landry ML, Kahn JS (2004) A 1-year experience with human metapneumovirus in children aged <5 years. J Infect Dis 189:1388–1396

    Article  PubMed  Google Scholar 

  10. Fitzgerald DA, Kilham HA (2004) Bronchiolitis: assessment and evidence-based management. Med J Aust 180:399–404

    PubMed  Google Scholar 

  11. Gern JE (2004) Viral respiratory infection and the link to asthma. Pediatr Infect Dis J 23:S78–S86

    Article  PubMed  Google Scholar 

  12. Goldstein B, Giroir B, Randolph A (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6:2–8

    Article  PubMed  Google Scholar 

  13. Greensill J, McNamara PS, Dove W, Flanagan B, Smyth RL, Hart CA (2003) Human metapneumovirus in severe respiratory syncytial virus bronchiolitis. Emerg Infect Dis 9:372–375

    PubMed  Google Scholar 

  14. Ison MG, Hayden FG (2002) Viral infections in immunocompromised patients: what’s new with respiratory viruses? Curr Opin Infect Dis 15:355–367

    PubMed  Google Scholar 

  15. Jartti T, van den Hoogen B, Garofalo RP, Osterhaus AD, Ruuskanen O (2002) Metapneumovirus and acute wheezing in children. Lancet 360:1393–1394

    Article  PubMed  Google Scholar 

  16. Konig B, Konig W, Arnold R, Werchau H, Ihorst G, Forster J (2004) Prospective study of human metapneumovirus infection in children less than 3 years of age. J Clin Microbiol 42:4632–4635

    Article  PubMed  Google Scholar 

  17. Kuiken T, van den Hoogen BG, van Riel DA, Laman JD, van Amerongen G, Sprong L, Fouchier RA, Osterhaus AD (2004) Experimental human metapneumovirus infection of cynomolgus macaques (Macaca fascicularis) results in virus replication in ciliated epithelial cells and pneumocytes with associated lesions throughout the respiratory tract. Am J Pathol 164:1893–1900

    PubMed  Google Scholar 

  18. Leung J, Esper F, Weibel C, Kahn JS (2005) Seroepidemiology of human metapneumovirus (hMPV) on the basis of a novel enzyme-linked immunosorbent assay utilizing hMPV fusion protein expressed in recombinant vesicular stomatitis virus. J Clin Microbiol 43:1213–1219

    Article  PubMed  CAS  Google Scholar 

  19. Low DE, Pichichero ME, Schaad UB (2004) Optimizing antibacterial therapy for community-acquired respiratory tract infections in children in an era of bacterial resistance. Clin Pediatr (Phila) 43:135–151

    Article  Google Scholar 

  20. Maggi F, Pifferi M, Vatteroni M, Fornai C, Tempestini E, Anzilotti S, Lanini L, Andreoli E, Ragazzo V, Pistello M, Specter S, Bendinelli M (2003) Human metapneumovirus associated with respiratory tract infections in a 3-year study of nasal swabs from infants in Italy. J Clin Microbiol 41:2987–2991

    Article  PubMed  Google Scholar 

  21. McIntosh ED, De Silva LM, Oates RK (1993) Clinical severity of respiratory syncytial virus group A and B infection in Sydney, Australia. Pediatr Infect Dis J 12:815–819

    Article  PubMed  CAS  Google Scholar 

  22. McIntosh K (2002) Community-acquired pneumonia in children. N Engl J Med 346:429–437

    Article  PubMed  Google Scholar 

  23. McIntosh K, McAdam AJ (2004) Human metapneumovirus-an important new respiratory virus. N Engl J Med 350:431–433

    Article  PubMed  CAS  Google Scholar 

  24. Meissner HC (2003) Selected populations at increased risk from respiratory syncytial virus infection. Pediatr Infect Dis J 22:S40–S44; discussion S44–S45

    Article  PubMed  Google Scholar 

  25. Mullins JA, Erdman DD, Weinberg GA, Edwards K, Hall CB, Walker FJ, Iwane M, Anderson LJ (2004) Human metapneumovirus infection among children hospitalized with acute respiratory illness. Emerg Infect Dis 10:700–705

    PubMed  Google Scholar 

  26. Ogra PL (2004) Respiratory syncytial virus: the virus, the disease and the immune response. Paediatr Respir Rev 5(Suppl A):S119–S126

    Article  PubMed  Google Scholar 

  27. Peiris JS, Tang WH, Chan KH, Khong PL, Guan Y, Lau YL, Chiu SS (2003) Children with respiratory disease associated with metapneumovirus in Hong Kong. Emerg Infect Dis 9:628–633

    PubMed  Google Scholar 

  28. Pelletier G, Dery P, Abed Y, Boivin G (2002) Respiratory tract reinfections by the new human metapneumovirus in an immunocompromised child. Emerg Infect Dis 8:976–978

    PubMed  Google Scholar 

  29. Rawlinson WD, Waliuzzaman Z, Carter IW, Belessis YC, Gilbert KM, Morton JR (2003) Asthma exacerbations in children associated with rhinovirus but not human metapneumovirus infection. J Infect Dis 187:1314–1318

    Article  PubMed  Google Scholar 

  30. Reina J, Gonzalez Gardenas M, Ruiz de Gopegui E, Padilla E, Ballesteros F, Mari M, Munar M (2004) Prospective evaluation of a dot-blot enzyme immunoassay (Directigen RSV) for the antigenic detection of respiratory syncytial virus from nasopharyngeal aspirates of paediatric patients. Clin Microbiol Infect 10:967–971

    Article  PubMed  CAS  Google Scholar 

  31. Schildgen O, Geikowski T, Glatzel T, Simon A, Wilkesmann A, Roggendorf M, Viazov S, Matz B (2004) New variant of the human metapneumovirus (HMPV) associated with an acute and severe exacerbation of asthma bronchiale. J Clin Virol 31:283–288

    Article  PubMed  CAS  Google Scholar 

  32. Schildgen O, Glatzel T, Geikowski T, Scheibner B, Matz B, Bindl L, Born M, Viazov S, Wilkesmann A, Knöpfle G, Roggendorf M, Simon A (2005) Human metapneumovirus RNA in encephalitis patient. Emerg Infect Dis 11:467–470

    PubMed  Google Scholar 

  33. Semple MG, Cowell A, Dove W, Greensill J, McNamara PS, Halfhide C, Shears P, Smyth RL, Hart CA (2005) Dual infection of infants by human metapneumovirus and human respiratory syncytial virus is strongly associated with severe bronchiolitis. J Infect Dis 191:382–386

    Article  PubMed  Google Scholar 

  34. Toikka P, Irjala K, Juven T, Virkki R, Mertsola J, Leinonen M, Ruuskanen O (2000) Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J 19:598–602

    Article  PubMed  CAS  Google Scholar 

  35. Ulloa-Gutierrez R, Skippen P, Synnes A, Seear M, Bastien N, Li Y, Forbes JC (2004) Life-threatening human metapneumovirus pneumonia requiring extracorporeal membrane oxygenation in a preterm infant. Pediatrics 114:e517–e519

    Article  PubMed  Google Scholar 

  36. van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de Groot R, Fouchier RA, Osterhaus AD (2001) A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 7:719–724

    Article  PubMed  CAS  Google Scholar 

  37. van den Hoogen BG, Osterhaus DM, Fouchier RA (2004) Clinical impact and diagnosis of human metapneumovirus infection. Pediatr Infect Dis J 23:S25–S32

    Article  PubMed  Google Scholar 

  38. Viazov S, Ratjen F, Scheidhauer R, Fiedler M, Roggendorf M (2003) High prevalence of human metapneumovirus infection in young children and genetic heterogeneity of the viral isolates. J Clin Microbiol 41:3043–3045

    Article  PubMed  CAS  Google Scholar 

  39. Williams JV, Harris PA, Tollefson SJ, Halburnt-Rush LL, Pingsterhaus JM, Edwards KM, Wright PF, Crowe JE, Jr. (2004) Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children. N Engl J Med 350:443–450

    Article  PubMed  CAS  Google Scholar 

  40. Wyde PR, Chetty SN, Jewell AM, Boivin G, Piedra PA (2003) Comparison of the inhibition of human metapneumovirus and respiratory syncytial virus by ribavirin and immune serum globulin in vitro. Antiviral Res 60:51–59

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Carola Maiworm and Sergei Viazov for critical comments on the manuscript and to Max Konstantin von Renesse for support with statistical analysis. This work was supported by a grant from the Else-Kröner-Fresenius-Stiftung (Bad Homburg, Germany; grant number A01/05//F00).

Conflict of interest statement

None of the investigators has any potential conflict of interest. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and regional) and with the Helsinki Declaration of 1975, as revised in 2000. The DSM RSV Paed study is sponsored by a grant from Abbott, Wiesbaden, Germany.

Author information

Authors and Affiliations

  1. Children’s Hospital, Medical Center, University of Bonn, Bonn, Germany

    Anja Wilkesmann, Michael J. Lentze, Udo Bode & Arne Simon

  2. Institute of Medical Microbiology and Immunology, University of Bonn, Bonn, Germany

    Oliver Schildgen, Anna Maria Eis-Hübinger, Tilman Geikowski & Thomas Glatzel

  3. Department of Pediatric Hematology and Oncology, Children’s Hospital, Medical Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany

    Arne Simon

Authors
  1. Anja Wilkesmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oliver Schildgen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Maria Eis-Hübinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tilman Geikowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Glatzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael J. Lentze
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Udo Bode
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Arne Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arne Simon.

Additional information

The first two authors contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wilkesmann, A., Schildgen, O., Eis-Hübinger, A.M. et al. Human metapneumovirus infections cause similar symptoms and clinical severity as respiratory syncytial virus infections. Eur J Pediatr 165, 467–475 (2006). https://doi.org/10.1007/s00431-006-0105-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-006-0105-4

Keywords

Search

Navigation