Tuberc Respir Dis.  2009 Aug;67(2):135-139.

A Case of Severe Human Metapneumovirus Pneumonia Requiring Mechanical Ventilation in an Immunocompetent Adult

• Lim HJ
• Lee JW
• Park YS
• Kim NH
• Kim M
• Yim JJ
• Yang SC
• Yoo CG
• Kim YW
• Han SK
• Shim YS
• Lee SM

Abstract

Human metapneumovirus (hMPV) is a recently recognized human respiratory pathogen, which is known to be associated with upper and lower respiratory tract infections mainly in children, immunocompromised patients, and the elderly. The clinical manifestations of hMPV infections are similar to those of the human respiratory syncytial virus infection, which range from mild upper respiratory tract infection to severe bronchiolitis and pneumonia. Recently, hMPV has come to be thought of as the cause a similar spectrum of disease in adults as that seen in children; however, most of the reports of hMPV infections have focused on infection in children. We report a case of severe hMPV pneumonia requiring mechanical ventilation in an immunocompetent adult in Korea.

Keyword

Metapneumovirus; Pneumonia; Respiratory insufficiency

MeSH Terms

Adult
Aged
Bronchiolitis
Child
Humans
Immunocompromised Host
Korea
Metapneumovirus
Pneumonia
Respiration, Artificial
Respiratory Insufficiency
Respiratory Syncytial Virus, Human
Respiratory Tract Infections

Figure

• 

  Figure 1 (A) The initial chest radiograph showed bilateral diffuse hazziness in both lower lung fields. (B) After a few hours, bilateral diffuse consolidation on chest radiograph progressed rapidly.

• 

  Figure 2 Initial chest computed tomography scan of the patient showed bilateral diffuse consolidation.

• 

  Figure 3 The radiologic findings of the patient with hMPV pneumonia was markedly improved during admission (A, on seventh hospital day; B, on fifteenth hospital day).

Reference

1. Van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de Groot R, Fouchier RA, et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med. 2001. 7:719–724.

2. Deffrasnes C, Hamelin ME, Boivin G. Human metapneumovirus. Semin Respir Crit Care Med. 2007. 28:213–221.

3. Chung JY, Han TH, Kim BE, Kim CK, Kim SW, Hwang ES. Human metapneumovirus infection in hospitalized children with acute respiratory disease in Korea. J Korean Med Sci. 2006. 21:838–842.

4. Falsey AR. Human metapneumovirus infection in adults. Pediatr Infect Dis J. 2008. 27:S80–S83.

5. Pabbaraju K, Wong S, McMillan T, Lee BE, Fox JD. Diagnosis and epidemiological studies of human metapneumovirus using real-time PCR. J Clin Virol. 2007. 40:186–192.

6. Hamelin ME, Côté S, Laforge J, Lampron N, Bourbeau J, Weiss K, et al. Human metapneumovirus infection in adults with community-acquired pneumonia and exacerbation of chronic obstructive pulmonary disease. Clin Infect Dis. 2005. 41:498–502.

7. Carrat F, Leruez-Ville M, Tonnellier M, Baudel JL, Deshayes J, Meyer P, et al. A virologic survey of patients admitted to a critical care unit for acute cardiorespiratory failure. Intensive Care Med. 2006. 32:156–159.

8. Cameron RJ, de Wit D, Welsh TN, Ferguson J, Grissell TV, Rye PJ. Virus infection in exacerbations of chronic obstructive pulmonary disease requiring ventilation. Intensive Care Med. 2006. 32:1022–1029.

9. Johnstone J, Majumdar SR, Fox JD, Marrie TJ. Viral infection in adults hospitalized with community-acquired pneumonia: prevalence, pathogens, and presentation. Chest. 2008. 134:1141–1148.

10. Larcher C, Geltner C, Fischer H, Nachbaur D, Müller LC, Huemer HP. Human metapneumovirus infection in lung transplant recipients: clinical presentation and epidemiology. J Heart Lung Transplant. 2005. 24:1891–1901.

11. Englund JA, Boeckh M, Kuypers J, Nichols WG, Hackman RC, Morrow RA, et al. Brief communication: fatal human metapneumovirus infection in stem-cell transplant recipients. Ann Intern Med. 2006. 144:344–349.

12. Williams JV, Martino R, Rabella N, Otegui M, Parody R, Heck JM, et al. A prospective study comparing human metapneumovirus with other respiratory viruses in adults with hematologic malignancies and respiratory tract infections. J Infect Dis. 2005. 192:1061–1065.

13. Sivaprakasam V, Collins TC, Aitken C, Carman WF. Life-threatening human metapneumovirus infections in West of Scotland. J Clin Virol. 2007. 39:234–237.

14. Johnstone J, Majumdar SR, Fox JD, Marrie TJ. Human metapneumovirus pneumonia in adults: results of a prospective study. Clin Infect Dis. 2008. 46:571–574.

15. Kamboj M, Gerbin M, Huang CK, Brennan C, Stiles J, Balashov S, et al. Clinical characterization of human metapneumovirus infection among patients with cancer. J Infect. 2008. 57:464–471.

16. Ulbrandt ND, Ji H, Patel NK, Riggs JM, Brewah YA, Ready S, et al. Isolation and characterization of monoclonal antibodies which neutralize human metapneumovirus in vitro and in vivo. J Virol. 2006. 80:7799–7806.

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

18. Hamelin ME, Prince GA, Boivin G. Effect of ribavirin and glucocorticoid treatment in a mouse model of human metapneumovirus infection. Antimicrob Agents Chemother. 2006. 50:774–777.

19. Biacchesi S, Skiadopoulos MH, Yang L, Lamirande EW, Tran KC, Murphy BR, et al. Recombinant human Metapneumovirus lacking the small hydrophobic SH and/or attachment G glycoprotein: deletion of G yields a promising vaccine candidate. J Virol. 2004. 78:12877–12887.

20. Herd KA, Mahalingam S, Mackay IM, Nissen M, Sloots TP, Tindle RW. Cytotoxic T-lymphocyte epitope vaccination protects against human metapneumovirus infection and disease in mice. J Virol. 2006. 80:2034–2044.