title: Human metapneumovirus and human coronavirus infection and pathogenicity in Saudi children hospitalized with acute respiratory illness.
abstract: OBJECTIVE
  Human metapneumovirus (hMPV) and the Netherlands human coronavirus (HCoV-NL63) have been isolated from children with respiratory tract infection. The prevalence of these viruses has not been reported from Saudi Arabia. We sought to determine whether hMPV and HCoV-NL63 are responsible for acute respiratory illness and also to determine clinical features and severity of illness in the hospitalized pediatric patient population.
  
  
  METHODS
  Prospective hospital-based study from July 2007 to November 2008.
  
  
  METHODS
  Nasopharyngeal specimens from children less than 16 years old who were suffering from acute respiratory diseases were tested for hMPV and HCoV-NL63 by reverse transcriptase-polymerase chain reaction. Samples were collected from July 2007 to November 2008.
  
  
  RESULTS
  Both viruses were found among Saudi children with upper and lower respiratory tract diseases during the autumn and winter of 2007 and 2008, contributing to 11.1% of all viral diagnoses, with individual incidences of 8.3% (hMPV) and 2.8% (HCoV-NL63) among 489 specimens. Initial symptoms included fever, cough, and nasal congestion. Lower respiratory tract disease occurs in immunocompromised individuals and those with underlying conditions. Clinical findings of respiratory failure and culture-negative shock were established in 7 children infected with hMPV and having hematologic malignancies, myelofibrosis, Gaucher disease, and congenital immunodeficiency; 2 of the 7 patients died with acute respiratory failure. All children infected with HCoV-NL63 had underlying conditions; 1 of the 4 patients developed respiratory failure.
  
  
  CONCLUSIONS
  hMPV and HCoV-NL63 are important causes of acute respiratory illness among hospitalized Saudi children. hMPV infection in the lower respiratory tract is associated with morbidity and mortality in immunocompromised children. HCoV-NL63 may cause severe lower respiratory disease with underlying conditions.
authors.affiliation: Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. hajjar@kfshrc.edu.sa
authors.forename: Sami
authors.initials: S
authors.lastname: Al Hajjar
authors.forename: Sahar
authors.initials: S
authors.lastname: Al Thawadi
authors.forename: Amal
authors.initials: A
authors.lastname: Al Seraihi
authors.forename: Saleh
authors.initials: S
authors.lastname: Al Muhsen
authors.forename: Hala
authors.initials: H
authors.lastname: Imambaccus
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D017934:Coronavirus / Q000302:isolation & purification; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000821:virology; D005260:Female; D006761:Hospitals; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008297:Male; D029121:Metapneumovirus / Q000302:isolation & purification; D018184:Paramyxoviridae Infections / Q000453:epidemiology* / Q000821:virology; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000821:virology*; D012529:Saudi Arabia / Q000453:epidemiology; D012720:Severity of Illness Index