Elsevier

Journal of Critical Care

Volume 31, Issue 1, February 2016, Pages 233-237
Journal of Critical Care

Clinical Potpourri
The role of human metapneumovirus in the critically ill adult patient,☆☆

https://doi.org/10.1016/j.jcrc.2015.09.035Get rights and content

Abstract

Purpose

The purpose of the study is to describe the role of human metapneumovirus (hMPV) infection in critical illness and acute respiratory distress syndrome (ARDS).

Materials and methods

We collected clinical and demographic information from a retrospective chart review, comparing patients with and without an intensive care unit (ICU) admission. Among patients admitted to the ICU, we assessed whether hMPV was “unlikely,” “possibly,” or “likely” the reason for ICU admission, based on a prespecified definition, and whether the patient met criteria for ARDS.

Results

We identified 128 hospitalized adults with hMPV infection. Forty hospitalized patients (31%) with hMPV infection required admission to the ICU. Among patients cared for in the ICU, hMPV was “possibly” the reason for ICU admission in 55% of patients and “likely” the reason in 38%. Forty-eight percent of ICU patients met criteria for ARDS. Although most patients admitted to the ICU had significant comorbidities or were immunosuppressed, 6 patients requiring ICU admission had more minor comorbidities and no underlying immunosuppression.

Conclusions

Although most patients hospitalized with hMPV had chronic cardiac or pulmonary disease, hMPV can also be associated serious respiratory illness and ARDS in adult patients without significant comorbidities or immunosuppression.

Introduction

Human metapneumovirus (hMPV) was first identified in 2001, although serologic data indicate that it has been present in human populations as early as the 1950s. It is a member of the paramyxovirus family and genetically similar to respiratory syncytial virus (RSV) [1]. Human metapneumovirus infections typically occur between January and April, account for anywhere from 3 to 11% of respiratory tract infections [2], [3], [4], [5], and are commonly unidentified triggers in asthma and chronic obstructive pulmonary disease (COPD) in adults [2], [3], [4], [6], [7], [8]. Presenting symptoms are virtually indistinguishable from infection with RSV and include fever, cough, rhinorrhea, and wheezing [9]. Although severity of illness associated with acute hMPV infection varies considerably, some patients may manifest with severe respiratory illness requiring admission to an intensive care unit (ICU) and mechanical ventilation [4], [9].

Studies characterizing patients with hMPV who develop severe illness have primarily been limited to children, whereas those characterizing adults are infrequent and have limited data [10], [11]. The rate of ICU admission among hospitalized patients with hMPV in 1 study was 12%, with 11% of patients requiring ventilator support [4]. The existing literature consists of case reports and retrospective cohort studies and suggests that elderly individuals as well as those with significant comorbidities are at greatest risk for severe disease and even death secondary to hMPV infection [5], [12], [13]. This has shaped the prevailing wisdom among adult providers that only patients who are immunocompromised are at risk for serious illness due to hMPV infection.

We performed a large retrospective cohort study of adults hospitalized with an associated hMPV infection. We sought to better describe the association between hMPV infection, critical illness, and acute respiratory distress syndrome (ARDS) as well as characterize the comorbidities of adults with hMPV infection admitted to the ICU.

Section snippets

Methods

We identified all patients admitted to the University of Michigan Health System with laboratory-confirmed hMPV infection between January 2009 and May 2013. We defined a positive hMPV result as a positive reverse transcription–polymerase chain reaction (RT-PCR) or viral culture. Samples were obtained either in the emergency department or in the inpatient setting, although only the samples belonging to patients who required inpatient admission were included in the analysis. All diagnostic testing

Epidemiology

We identified 335 cases of hMPV by either RT-PCR or viral culture between December 2009 and May 2013 among adult and pediatric patients (Fig. 1). Most hMPV-positive results were detected via RT-PCR on a specimen obtained via nasopharyngeal or throat swab or, less commonly, bronchoalveolar lavage. A minority of the positive results (13) were detected via viral culture of throat specimens. Of these, 245 results occurred within 30 days of a hospital admission.

The number of hMPV infections varied

Discussion

Our study is the first to characterize the severity of illness in a large sample of adult patients with hMPV infection. We determined that a significant proportion of patients with hMPV required admission to the ICU, the majority of whom required mechanical ventilation and approximately half of whom met criteria for ARDS. To our knowledge, this is the largest case series of patients who developed ARDS potentially caused by hMPV. We also found that hMPV has the potential to produce significant

Acknowledgments

Drs Terri Stillwell and Michael Quasney gave significant feedback regarding the study design. Ms Lisa Sturm and Ms Lynn Holevinski performed the data extraction.

References (16)

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Funding source: Dr Cooke is supported by a grant from the Agency for Healthcare Research and Quality (K08HS020672).

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Conflict of interest: The authors have no conflicts of interest to disclose.

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