The role of human metapneumovirus in the critically ill adult patient

Abstract

Purpose The purpose of the study is to describe the role of human metapneumovirus (hMPV) infection in critical illness and acute respiratory distress syndrome (ARDS). Materials and methods We collected clinical and demographic information from a retrospective chart review, comparing patients with and without an intensive care unit (ICU) admission. Among patients admitted to the ICU, we assessed whether hMPV was “unlikely,” “possibly,” or “likely” the reason for ICU admission, based on a prespecified definition, and whether the patient met criteria for ARDS. Results We identified 128 hospitalized adults with hMPV infection. Forty hospitalized patients (31%) with hMPV infection required admission to the ICU. Among patients cared for in the ICU, hMPV was “possibly” the reason for ICU admission in 55% of patients and “likely” the reason in 38%. Forty-eight percent of ICU patients met criteria for ARDS. Although most patients admitted to the ICU had significant comorbidities or were immunosuppressed, 6 patients requiring ICU admission had more minor comorbidities and no underlying immunosuppression. Conclusions Although most patients hospitalized with hMPV had chronic cardiac or pulmonary disease, hMPV can also be associated serious respiratory illness and ARDS in adult patients without significant comorbidities or immunosuppression.

Viral Pneumonia and Acute Respiratory Distress Syndrome

“…28 In a case series of 128 hospitalized adults with hMPV infection, 31% required ICU admission and 14.8% developed ARDS. 154 Animal models show that hMPV infects bronchial epithelial cells, leading to bronchial hyperresponsiveness, and induces proinflammatory cytokines, including interleukin (IL)-2, IL-8, IL-4, and interferon alfa. 155,156 Histopathologic changes suggestive of ARDS, including hyaline membrane formation and organizing pneumonia-like reaction, have been described in open-lung or transbronchial biopsy specimens of immunocompromised patients with hMPV identified on BAL.…”

Viral Infection in the Development and Progression of Pediatric Acute Respiratory Distress Syndrome

“…Hung and Lin described a case of a 9-month-old male with adenoviral ARDS requiring extracorporeal membrane oxygenation (ECMO) (34). Hasvold et al studied adult patients hospitalized with hMPV and discovered progression to ARDS in 19 (14.8%) patients (35). In 2014, an outbreak of enterovirus D68 in the United States led to symptoms of respiratory failure similar to influenza A (H1N1) virus, although less severe (36).…”

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

“…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.…”