Brief communication: fatal human metapneumovirus infection in stem-cell transplant recipients.
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.
Englund
Janet A
JA
Children's Hospital and Regional Medical Center, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, Washington 98105, USA. janet.englund@seattlechildrens.org
Boeckh
Michael
M
Kuypers
Jane
J
Nichols
W Garrett
WG
Hackman
Robert C
RC
Morrow
Rhoda A
RA
Fredricks
David N
DN
Corey
Lawrence
L
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
D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D012254:Ribavirin