Comparison of Human Metapneumovirus, Respiratory Syncytial Virus and Influenza A Virus Lower Respiratory Tract Infections in Hospitalized Young Children.
Wolf, Dana G. MD *; Greenberg, David MD +; Kalkstein, Davina MD *; Shemer-Avni, Yonat PhD ++; Givon-Lavi, Noga PhD +; Saleh, Niveen BSc *; Goldberg, Miri D. BSc *; Dagan, Ron MD +
Pediatric Infectious Disease Journal.
25(4):320-324, April 2006.
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Background: We compared the clinical and demographic features of children with lower respiratory tract infection (LRI) caused by human metapneumovirus (HMPV), respiratory syncytial virus (RSV) and influenza A virus and sought to determine whether coinfection by HMPV and other respiratory viruses leads to increased disease severity.
Methods: Nasal wash specimens were prospectively obtained from 516 children hospitalized for LRI during a 1-year period and tested for the presence of HMPV by reverse transcription-polymerase chain reaction and for RSV and influenza A by direct immunofluorescence.
Results: HMPV was detected in 68 (13%) patients and was the third most common viral pathogen; 16 of 68 HMPV-positive children (24%) had coinfection with other respiratory viruses (HMPVco).
HMPV patients were older than RSV patients (17.6 /- 16.8 months versus 10.5 /- 11.8 months, P = 0.02). HMPV was associated with wheezing and hypoxemia at a rate similar to that of RSV and higher than that of influenza A. Atelectasis was more common among HMPV (40%) than among RSV and influenza patients (13%, P < 0.05 for each). HMPV infection was more often associated with a diagnosis of pneumonia than RSV and influenza A and was more often associated with a diagnosis of asthma and less often associated with a diagnosis of bronchiolitis than RSV infection (P < 0.05 for each), even when corrected for age. Children with HMPVco had a higher rate of gastrointestinal symptoms but did not show a more severe respiratory picture.
Conclusions: The clinical pattern of HMPV more closely resembles that of RSV than that of influenza A LRI, yet the differences in age, radiographic findings and clinical diagnosis suggest that HMPV pathogenesis may differ from that of RSV.
(C) 2006 Lippincott Williams & Wilkins, Inc.