Respiratory Tract Infections Due to Human Metapneumovirus in Immunocompromised Children

Chu, Helen Y.; Renaud, Christian; Ficken, Elle; Thomson, Blythe; Kuypers, Jane; Englund, Janet A.

Our study is one of the first to describe the presentation and management of symptomatic hMPV infection in immunocompromised children. The presentation of hMPV in pediatric solid organ transplant recipients was shown to be similar to patients with other immunocompromising conditions, with fever and cough as the most common symptoms. We also show that the majority of immunocompromised patients diagnosed with hMPV are subsequently admitted to the hospital for further evaluation, but that only 2% of those initially presenting with URTI symptoms go on to develop LRTI. However, there were no clear differences in the presentation of patients with URTI or LRTI in terms of age, symptoms (fever or cough), laboratory abnormalities, or underlying condition that would clearly identify risk factors for LRTI disease and guide decisionmaking. Interestingly, 2 of the 3 patient deaths were in patients with hMPV pneumonia diagnosed prior to HSCT. Both of these patients, however, had underlying diseases (aplastic anemia and SCID), which made it extremely unlikely that they would be able to clear their viral infection without reconstitution of their immune system through HSCT. These patients both underwent HSCT, and subsequently died of hMPV pneumonia despite use of ribavirin and IVIG and supportive care including mechanical ventilation and ICU stay. These 2 patients continued to have detectable virus within days of death.