title: Brief communication: fatal human metapneumovirus infection in stem-cell transplant recipients.
abstract: BACKGROUND
  Human metapneumovirus (hMPV), a recently discovered respiratory virus, is associated with clinical disease in young and elderly persons.
  
  
  OBJECTIVE
  To determine the importance of hMPV in hematopoietic stem-cell transplant recipients.
  
  
  METHODS
  Retrospective survey of patients with consecutive residual bronchoalveolar lavage (BAL) samples.
  
  
  METHODS
  Referral cancer center.
  
  
  METHODS
  Hematopoietic stem-cell transplant recipients who underwent BAL because of lower respiratory tract disease.
  
  
  METHODS
  Bronchoalveolar lavage specimens were assayed by quantitative real-time polymerase chain reaction methods.
  
  
  RESULTS
  Human metapneumovirus was detected in BAL specimens from 5 of 163 patients (3.0%). Persistent viral infection was noted in 3 patients with several samples, and hMPV was detected in 1 of 2 lung specimens tested. Infected patients became symptomatic within the first 40 days after transplantation. Initial symptoms included fever, cough, nasal congestion, and sore throat. Clinical findings included respiratory failure, pulmonary hemorrhage, and culture-negative septic shock. Four of 5 patients died with acute respiratory failure.
  
  
  CONCLUSIONS
  This retrospective study did not evaluate asymptomatic patients or those with mild disease.
  
  
  CONCLUSIONS
  Human metapneumovirus infection in the lower respiratory tract is associated with respiratory failure in immunocompromised adults who were previously considered to have "idiopathic pneumonia." The infection may result in fulminant respiratory decompensation and shock after transplantation.
authors.affiliation: Children's Hospital and Regional Medical Center, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, Washington 98105, USA. janet.englund@seattlechildrens.org
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.forename: W Garrett
authors.initials: WG
authors.lastname: Nichols
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hackman
authors.forename: Rhoda A
authors.initials: RA
authors.lastname: Morrow
authors.forename: David N
authors.initials: DN
authors.lastname: Fredricks
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000276:immunology; D018893:Bronchoalveolar Lavage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D029121:Metapneumovirus / Q000302:isolation & purification; D008875:Middle Aged; D018184:Paramyxoviridae Infections / Q000188:drug therapy / Q000209:etiology*; D011024:Pneumonia, Viral / Q000188:drug therapy / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D012254:Ribavirin