From the Guidelines
Human metapneumovirus (HMPV) clinical findings typically include flu-like symptoms, such as cough, nasal congestion, rhinorrhea, fever, wheezing, and shortness of breath, particularly in immunocompromised individuals, as reported in a study published in the Clinical Infectious Diseases journal 1.
Clinical Presentation
The illness usually begins with upper respiratory symptoms that may progress to lower respiratory involvement, particularly in young children, elderly patients, and immunocompromised individuals, such as those undergoing allogeneic HSCT 1.
- Common clinical findings include:
- Cough
- Nasal congestion
- Rhinorrhea
- Fever
- Wheezing
- Shortness of breath
Diagnosis and Treatment
Diagnosis is usually made through NAT, and rates range from 2.5% to 9% during the first 2 years after allogeneic HSCT 1.
- Treatment is primarily supportive, including adequate hydration, fever control, and respiratory support as needed.
- No general recommendation for treatment can currently be made, although some centers consider treating HMPV LRTID with ribavirin and/or IVIG despite the lack of supporting studies 1.
Prevention
The virus spreads through respiratory droplets and close contact, so preventive measures include hand hygiene and avoiding close contact with infected individuals, particularly for high-risk populations.
- Asymptomatic and prolonged shedding has been reported in HSCT patients, highlighting the importance of preventive measures in this population 1.
From the Research
Clinical Findings of Human Metapneumovirus
- Human Metapneumovirus (HMPV) is a re-emerging respiratory pathogen that causes significant morbidity and mortality, particularly among young children, the elderly, and immunocompromised individuals 2.
- The clinical manifestations of HMPV range from mild cold-like symptoms to severe pneumonia, often overlapping with those of other respiratory pathogens like RSV and COVID-19, complicating timely diagnosis and management 2, 3.
- HMPV infection can cause severe bronchiolitis and pneumonia in children, with symptoms indistinguishable from those caused by human respiratory syncytial virus 3.
- In adults, HMPV infection can precipitate acute respiratory distress syndrome (ARDS), as seen in cases where patients developed severe ARDS complicating HMPV infection 4, 5.
- The clinical characteristics of bronchiolitis cases caused by HMPV are similar to those caused by RSV or other viral pathogens, with no differences in disease characteristics, either clinical or laboratory 6.
Diagnosis and Management
- Molecular methods, such as reverse transcriptase PCR (RT-PCR), are the preferred diagnostic modality for detecting HMPV due to the slow growth of the virus in cell culture 3.
- Treatment for HMPV infection is supportive, as no current antivirals or vaccines are effective or recommended 3, 5.
- In severe cases, patients may require rescue therapy with veno-venous extracorporeal membrane oxygenation (V-V ECMO) or other intensive care measures 4.
- HMPV pneumonia should be considered as a differential diagnosis in patients with severe respiratory illness and ARDS to promote antibiotic stewardship 5.