Human metapneumovirus in lung transplant recipients and comparison to respiratory syncytial virus.
BACKGROUND
Human metapneumovirus is a newly described virus isolated in 2001 from children with acute respiratory viral infection. It has subsequently been reported globally, although there are limited data in lung transplant recipients.


OBJECTIVE
To prospectively analyze whether human metapneumovirus was circulating in our adult lung transplant community and assess the morbidity of this infection and to compare the clinical presentation and outcome after intravenous ribavirin of human metapneumovirus with that of respiratory syncytial virus (RSV).


METHODS
Lung transplant patients with clinical features of respiratory viral infection underwent nasopharyngeal aspirates. Patients with a positive specimen for RSV or human metapneumovirus by reverse transcriptase-polymerase chain reaction analysis and graft dysfunction received intravenous ribavirin and pulse steroid therapy.


RESULTS
Eighty-nine patients had 199 visits for aspirate studies. A viral cause was determined for 62 visits in 47 patients (19 human metapneumovirus, 18 RSV, 13 parainfluenza, 9 influenza A, 2 adenovirus, and 1 influenza B). A significant percentage of patients with metapneumovirus (63%) and RSV (72%) developed graft dysfunction, with average declines in FEV(1) of 30 +/- 12.4% and 25.9 +/- 11.2%, respectively. In these patients, bronchiolitis obliterans syndrome onset or progression occurred in no patients with human metapneumovirus compared with 5 of 13 (38%) patients with RSV at 6 months.


CONCLUSIONS
Human metapneumovirus is a leading cause of acute respiratory tract illness in lung transplant recipients. The incidence and clinical spectrum at presentation are similar to RSV, although the latter seems to be associated with a higher risk of chronic rejection. We recommend testing of nasopharyngeal aspirates for human metapneumovirus with polymerase chain reaction to assess local epidemiologic patterns.
Hopkins
Peter
P
Department of Respiratory Medicine, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Australia 4032. peterwakatipu@hotmail.com
McNeil
Keith
K
Kermeen
Fiona
F
Musk
Michael
M
McQueen
Emily
E
Mackay
Ian
I
Sloots
Terry
T
Nissen
Michael
M
D001706:Biopsy; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D029121:Metapneumovirus / Q000235:genetics / Q000302:isolation & purification*; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D018184:Paramyxoviridae Infections / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D011446:Prospective Studies; D011793:Queensland / Q000453:epidemiology; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D018113:Respiratory Syncytial Virus, Human / Q000235:genetics / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
D004279:DNA, Viral