Human Metapneumovirus in Severe Respiratory Syncytial Virus Bronchiolitis

Greensill, Julie; McNamara, Paul; Dove, Winifred; Flanagan, Brian; Smyth, Rosalind L; Hart, C. A.

doi:10.3201/eid0903.020289

Cited by 288 publications

(245 citation statements)

References 15 publications

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“…Moreover, other studies described striking coinfection rates of up to 70% of patients, although in smaller cohorts (e.g., Ref. [4]). Most interestingly, the coinfected cohort of patients observed by Garcia-Garcia et al also did not show a more severe clinical course.…”

Section: Hmpv Infections Are Frequently Accompanied By Co-infectionsmentioning

confidence: 91%

HMPV infections are frequently accompanied by co‐infections

Simon

Wilkesmann

Müller

et al. 2006

Pediatric Pulmonology

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recently reported on their findings in a Spanish cohort of 101 pediatric patients hospitalized for HMPV-related respiratory tract infections. Although this article is highly confirmative to their previous study 2 and our matched pairs analysis, 3 it contains some interesting observations and conclusions we would like to comment on. As in our study, the authors have not found a significant difference in the clinical severity between HMPV and RSV-infections, although they did not used a matched pairs approach 3 but a random sample of 95 hospitalized infants-aged <2 and documented as RSV-infected. In addition, they observed a high rate (29.7%) of coinfections with at least one other viral respiratory pathogen. In earlier publications, and also in the reviewer's comments to our own publication 3 such high rates of coinfections were called 'strikingly high.' Coinfections may be detected more frequently in hospitalized patients simply as a result of a more sophisticated diagnostic approach. 5,6 In our study 3 39 patients (44.3 %) with a coinfection were observed, none of them displayed a more severe clinical course than mono-infected patients. Moreover, other studies described striking coinfection rates of up to 70% of patients, although in smaller cohorts (e.g., Ref. [4]). Most interestingly, the coinfected cohort of patients observed by Garcia-Garcia et al. also did not show a more severe clinical course. This is in contrast to earlier observations (reviewed by Kahn [5] and Schildgen et al. [6]), but in high agreement with our study. 3 This controversially discussed observation consequently has to be investigated more in detail, probably by the use of an appropriate animal model system. ACKNOWLEDGMENTS

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Section: Hmpv Infections Are Frequently Accompanied By Co-infectionsmentioning

confidence: 91%

HMPV infections are frequently accompanied by co‐infections

Simon

Wilkesmann

Müller

et al. 2006

Pediatric Pulmonology

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“…hMPV infections may exacerbate reactive airway disease among both the young and the old Greensill et al, 2003). There is evidence that some patients suffer repeat hMPV infections , that mixed hMPV infections may be common (Schildgen et al, 2005), that many hMPV infections occur in winter months, and that the immunocompromised may be at greater risk of hMPV disease (van den Hoogen et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

Multi-year study of human metapneumovirus infection at a large US Midwestern Medical Referral Center

Gray

Capuano

Setterquist

et al. 2006

Journal of Clinical Virology

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Background-Because of its recent identification, few multi-year epidemiologic studies of hMPV infection have been reported.Objective-We sought to retrospectively describe hMPV infections among patients evaluated by a large US Midwestern referral laboratory. Results-34 (2.6%) of 1294 specimens were hMPV positive. Among these, 21 (62%) were culture positive and available for genetic typing. A previously considered rare genotype of hMPV, B1, was the most common single genotype identified, comprising 9 (43%) of the 21 isolates. Multivariate logistic regression modeling identified patients aged 0.4-9 years (OR = 8.9; 95% CI = 2.0-38.5) and those under intensive care (OR = 3.2; 95% CI = 1.1-8.7) as more likely to have hMPV infection than their peers.Conclusion-In this large referral hospital viral assays more often had evidence of hMPV when they were collected from children receiving intensive care.

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“…Our observation suggests that the seasonal distribution of hMPVand RSV were similar during this 1998-1999 RSV season in Houston, TX. Prior worldwide studies have shown that hMPV infections occur in a seasonal distribution from winter to spring, and tend to follow that of RSV and influenza [28][29][30]33 However, in studies from the temperate regions, patients have tested positive for hMPV from October until May, and occasionally as early as August and September. 25,57 These studies and our findings indicate that, like RSV, the seasonality of hMPV is highly dependent on the geographic locale.…”

Section: Discussionmentioning

confidence: 99%

Human metapneumovirus and respiratory syncytial virus infections in older children with cystic fibrosis

Garcia

Hiatt

Jewell

et al. 2006

Pediatric Pulmonology

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Summary. Background: Human metapneumovirus (hMPV) has been isolated from children with acute respiratory infection worldwide. Its epidemiology remains to be defined in children with cystic fibrosis (CF). We describe the epidemiology and clinical impact of hMPV in CF children and compared it to respiratory syncytial virus (RSV). Methods: CF children ages 7-18 years were studied prospectively during the 1998-1999 RSV season. Nasopharyngeal specimens were collected during acute respiratory illnesses and tested for respiratory viruses. Blood specimens were drawn early, mid, and end of the RSV season, and tested for serological evidence of hMPV and RSV infections. Rates of lower respiratory tract illnesses (LRTI) and hospitalizations for pulmonary exacerbations were compared during the time intervals they developed serological evidence of infection to their non-infection intervals. Results: Six of 44 CF children had a virus positive respiratory illness in 56 LTRI events and 18 hospitalizations. Serological evidence of hMPV and RSV infections occurred in 16 and 20 CF children, respectively; 8 had infections with both viruses. A greater proportion of CF children had !1 LRTI during their infection intervals compared to their non-infection intervals (13/25 vs. 5/25; P ¼ 0.03). A trend for higher rates of LRTI was observed in the infection intervals compared to noninfection intervals (9.5 AE 11.0 vs. 4.2 AE 9.9 per 1,000 child-days; P ¼ 0.06), and it was significantly greater with a more conservative estimate (one event per child per interval; 7.4 AE 7.7 vs. 2.6 AE 5.4 per 1,000 child-days; P 0.01). No differences in hospitalizations rates were detected. Conclusion: The infection rates and clinical impact observed for hMPV were comparable to that for RSV in CF children 7-18 years of age.

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Human Metapneumovirus in Severe Respiratory Syncytial Virus Bronchiolitis

Cited by 288 publications

References 15 publications

HMPV infections are frequently accompanied by co‐infections

HMPV infections are frequently accompanied by co‐infections

Multi-year study of human metapneumovirus infection at a large US Midwestern Medical Referral Center

Human metapneumovirus and respiratory syncytial virus infections in older children with cystic fibrosis

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