Outcomes of severe human metapneumovirus-associated community-acquired pneumonia in adults

Abstract

Background: The outcomes of severe human metapneumovirus (HMPV)-associated pneumonia have not been adequately evaluated. Objectives: We aimed to investigate the incidence and outcomes of severe HMPV-associated CAP and to compare them with those of severe IFV associated CAP. Study design: From March 2010 to August 2017, all consecutive adult patients with severe HMPV-associated CAP and severe influenza virus (IFV)-associated CAP who required intensive care unit admission were prospectively identified and followed in a 2,700-bed tertiary care hospital. The characteristics and outcomes of severe HMPVassociated CAP patients were compared with those of severe IFV-associated CAP patients. Results: HMPV and IFV were identified in 3.2% (50) and 7.0% (109) of the 1559 patients with severe CAP, respectively. The mortality rates were not significantly different between the HMPV and IFV groups (30-day mortality: 24.0% vs. 32.1%, p = 0.30; 60-day mortality: 32.0% vs. 38.5%, p = 0.43). Oral ribavirin therapy was not associated with improved outcome (60-day mortality: ribavirin therapy group 35.0% [7/20] vs. no ribavirin therapy group 30.0% [9/30], p = 0.71). Subgroup analyses showed no significant differences in mortality among non-immunocompromised (60-day mortality: HMPV 25.6% vs. IFV 31.1%, p = 0.55) and immunocompromised patients (60-day mortality; HMPV 54.5% vs. 54.3%, p = 0.99). The length of ICU and hospital stay did not differ between groups. Conclusions: The incidence of HMPV infection was approximately half that of IFV infection in a cohort of patients with severe CAP. The mortality rate of severe HMPV-associated CAP was similar to that of severe IFV associated CAP.of adults with severe HMPV-associated community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission [5,6]. Outcome analyses of prior ICU studies have been limited by its retrospective design, relatively small number of patients, lack of adequate control groups, and heterogeneous study populations.

The Clinical Characteristics and Outcomes of Adult Patients With Pneumonia Related to Three Paramyxoviruses

“…Previous studies showed that the mortality of PMV infection among adults is 0–50%, depending on the virus type, immune status of the host, and severity of disease ( 28 – 30 ), which is consistent with our results. However, most of these studies focused on lower respiratory tract infections or acute respiratory infections affected by these PMVs.…”

“…Furthermore, the outcomes of infectious diseases were influenced by hosts, pathogens, and environments ( 31 ). In some studies, clinical outcomes were only compared directly with disease severity of the three PMV infections and were not controlled for confounders ( 10 , 21 , 23 , 28 , 29 , 32 ). In our study, after adjustment for numerous potential confounders, we found that, compared with hMPV-P and hPIV-p, RSV-p was associated with increased risks for invasive ventilation, ICU admission, and 30-day mortality.…”

Drug repurposing for therapeutic discovery against human metapneumovirus infection

“…We report the discovery of novel anti-HMPV compounds identified from a large drug library using an in-house developed and optimised in vitro medium-throughput screening (MTS). HMPV is a significant cause of childhood pneumonia worldwide, with no specific therapy available (Choi et al, 2019; van den Hoogen et al, 2003). The need for a readily available drug is therefore critical and the screening of approved drugs provides candidates with established safety profiles.…”

Drug Repurposing for Therapeutic Discovery against Human Metapneumovirus Infection

“…HMPV is a significant cause of childhood pneumonia worldwide, with no specific therapy available (Choi et al, 2019;van den Hoogen et al, 2003). The need for a readily available drug is therefore critical and the screening of approved drugs provides candidates with established safety profiles.…”

“…Recent epidemiological studies suggest that HMPV is responsible for 10-12% of paediatric hospitalisations, associated with a cost of $277 million in the US alone (Davis et al, 2016). In immunocompromised patients with severe HMPV-associated community-acquired pneumonia (CAP), the reported mortality rate is up to 72.7%, higher than the reported severe influenza virus-associated CAP (54.3%) (Choi et al, 2019). Despite the clinical significance of HMPV, there is currently neither vaccine nor antiviral treatment available on the market.…”