PURPOSE: Human metapneumovirus (hMPV) is a paramyxovirus most closely related to respiratory syncytial virus (RSV). First recognized in 2003, hMPV has been associated with self-limited episodes of bronchiolitis in children and pneumonia in infants. The spectrum of disease is not well described in adults in the United States. The virus causes a flulike illness, but there have also been reports of severe COPD exacerbations requiring hospitalization as well as an outbreak of severe lower respiratory tract infections in a long-term care facility. In immunocompromised patients, hMPV infection has been associated with significant morbidity and mortality including respiratory failure and death.
METHODS: We performed a single-center retrospective chart review to describe the spectrum of disease in adult inpatients that tested positive for hMPV and RSV by PCR between November 20, 2009 and October 1, 2010. This study was approved by the Wake Forest School of Medicine Institutional Review Board, ID # IRB00013035.
RESULTS: We identified 7 adult patients who tested positive for RSV (mean age 57, range 43-81) and 14 who tested positive for hMPV (mean age 51, range 27-88). Twelve patients (four with RSV and eight with hMPV) were admitted to the intensive care unit (ICU) during their hospitalization, and 3 patients died during that hospitalization. All 12 ICU patients developed acute respiratory failure, representing 1.5% of cases of respiratory failure during the study period. Ten of the 12 patients developed ARDS; in seven patients with ARDS no other potential pathogen or pathology was identified as a cause for their symptoms.
CONCLUSIONS: Infection with RSV and hMPV is an important cause of potential acute respiratory failure and ARDS. PCR testing on a routine basis may identify them as one cause of formerly “idiopathic” ARDS.
CLINICAL IMPLICATIONS: Given the possibility of localized outbreaks of infection with RSV and hMPV and the significant morbidity and mortality attributable to ARDS, rapid and sensitive diagnosis is recommended.
DISCLOSURE: The following authors have nothing to disclose: Matthew Miles, Ashley Chaplin, Elizabeth Palavecino, Vera Luther, Robert Chin
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