Burden of Human Metapneumovirus Infections in Cancer Patients: Risk Factors and Outcomes

Chaer, Firas El; Shah, Dimpy P.; Kmeid, Joumana; Ariza-Heredia, Ella; Hosing, Chitra M.; Mulanovich, Victor; Chemaly, Roy F.

BACKGROUND: Human metapneumovirus (hMPV) causes upper and lower respiratory tract infections (URI and LRI, respectively) in healthy and immunocompromised patients; however, its clinical burden in patients with cancer remains unknown. METHODS: In a retrospective study of all laboratory-confirmed hMPV infections treated at our institution between April 2012 and May 2015, we determined clinical characteristics, risk factors for progression to LRI, treatment, and outcomes in patients with cancer. RESULTS: We identified 181 hMPV infections in 90 (50%) patients with hematologic malignancies (HM), 57 (31%) hematopoietic cell transplantation (HCT) recipients, and 34 patients (19%) with solid tumors. Most patients (92%) had a community-acquired infection, presented with URI (67%), and 43% developed LRI (59 presented with LRI and 19 progressed from URI to LRI). On multivariable analysis, an underlying HM (adjusted odds ratio [aOR], 3.11(1.12-8.64); P=0.029), nosocomial infection (aOR, 26.9 (2.79-259.75); P=0.004), and hypoxia (SpO2 ≤ 92%) at presentation (aOR, 9.61(1.98-46.57); P = 0.005) were independent factors associated with LRI. All-cause mortality at 30 days from hMPV diagnosis was low (4%) and patients with LRI had a 10% mortality rate at day 30 from diagnosis; whereas, patients with URI had 0% mortality rate. CONCLUSIONS: hMPV infections in patients with cancer may cause significant morbidity, especially for those with underlying HM who may develop an LRI. Despite high morbidity and the lack of directed antiviral therapy for hMPV infections, mortality at day 30 from this infection remained low in this studied population.