Human metapneumovirus in Pediatric Patients with Acute Respiratory Tract Infections in the Aseer Region of Saudi Arabia

Alsuheel, Ali Mohammed; Ali, Abdelwahid Saeed; Al-Hakami, Ahmed Musa; Shati, Ayed Abdullah; Chandramoorthy, Harish C.; Al-Qahtani, Saleh Mohammed

The results of the present study concur with several other studies demonstrating an association between hMPV infection and acute respiratory conditions such as bronchopneumonia and pneumonia. [3, 5] A previous study implicated hMPV as a causative agent for severe and acute respiratory infections among pediatric patients, [34] which is similar to the findings of the current study. Another study found that children with hMPV infection are likely to have immunodeficiency; however, the current study was not able to substantiate these findings as none of the patients were found to be immunocompromised. [13] The prevalence of hMPV infection of the current study (about 10%) was similar to that reported in studies from Saudi Arabia and Kuwait. [14, 15] However, other similar studies that used direct immunofluorescence assays for the detection of hMPV antibodies in sera of patients revealed much higher prevalence rates. [35] This suggests that different results can be obtained with different diagnostic techniques for hMPV infection. In the current study, we used DFA with monoclonal antibody, which has previously been shown to have 100% specificity, thereby indicating the reliability of our results. [31] The current study did not find any gender predilection in terms of the infections; these findings are in accordance with that of Bastien et al. [4] and Kahn. [29] In this study, all nine hMPV-positive children were from Abha or its surrounding areas. These areas are known for their high altitude, low temperature and low oxygen tension. It was well known that the prevalence of viral respiratory infections is high in cold and dry areas. [36] In addition, almost 78% of the hMPV-positive cases were in children who had been admitted during the autumn and winter seasons. It is also known that the majority of the viruses responsible for bronchiolitis and bronchopneumonia have their peak infectivity during winter and late autumn, with only sporadic cases through other seasons. [37, 38] The hMPV-positive patients in the current study had fever, cough, nasal congestion, cyanosis, stridor and shortness of breath, while some also had underlying chronic illnesses such as chronic heart disease and bronchial asthma; similar hMPV-associated illnesses were observed in another study. [39] Physical examination revealed wheezing and bilateral crepitation and clinically, the most common presentations were bronchopneumonia and aspiration pneumonia. These findings are in line with those of Williams et al., [40] who found significant association between hMPV and wheezing exacerbations and/or bronchiolitis in infants and young children.