Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children

Abstract

Background: We sought to determine the role of human metapneumovirus in lower respiratory tract illness in previously healthy infants and children.

Methods: We tested nasal-wash specimens, obtained over a 25-year period from otherwise healthy children presenting with acute respiratory tract illness, for human metapneumovirus.

Results: A viral cause other than human metapneumovirus was determined for 279 of 687 visits for acute lower respiratory tract illness (41 percent) by 463 children in a population of 2009 infants and children prospectively seen from 1976 to 2001. There were 408 visits for lower respiratory tract illness by 321 children for which no cause was identified. Of these 321 children, specimens from 248 were available. Forty-nine of these 248 specimens (20 percent) contained human metapneumovirus RNA or viable virus. Thus, 20 percent of all previously virus-negative lower respiratory tract illnesses were attributable to human metapneumovirus, which means that 12 percent of all lower respiratory tract illnesses in this cohort were most likely due to this virus. The mean age of human metapneumovirus-infected children was 11.6 months, the male:female ratio was 1.8:1, 78 percent of illnesses occurred between December and April, and the hospitalization rate was 2 percent. The virus was associated with bronchiolitis in 59 percent of cases, pneumonia in 8 percent, croup in 18 percent, and an exacerbation of asthma in 14 percent. We also detected human metapneumovirus in 15 percent of samples from 261 patients with upper respiratory tract infection but in only 1 of 86 samples from asymptomatic children.

Conclusions: Human metapneumovirus infection is a leading cause of respiratory tract infection in the first years of life, with a spectrum of disease similar to that of respiratory syncytial virus.

Copyright 2004 Massachusetts Medical Society

Figures

Figure 1. Epidemiologic Pattern of Lower Respiratory Tract Infections with Human Metapneumovirus and Other Viruses

Data are combined from 25 years of surveillance in the Vanderbilt Vaccine Clinic.

Figure 2. Phylogenetic Tree of Human Metapneumovirus Isolates from Tennessee (TN) and the Netherlands (NL)

The closely related avian pneumovirus (APV-C) was used for comparison. A low frequency of nucleotide substitutions per site (as indicated by the length of the horizontal branch) suggests close genetic relatedness. Two major genotypes are apparent as clusters at the top and bottom of the figure. The first two digits of each TN isolate indicate the year of isolate, the third digit (or third and fourth) the month, and the last digit the number of the sample among all samples collected that month. Sequences are available from GenBank (accession numbers AY216940 to AY216986).

Figure 3. Chest Radiograph Obtained in a Six-Month-Old Infant with Human Metapneumovirus Bronchiolitis

Hyperinflation and diffuse perihilar infiltrates are evident.