title: Respiratory Tract Infections Due to Human Metapneumovirus in Immunocompromised Children.
abstract: BACKGROUND
  The clinical presentation and management of human metapneumovirus (hMPV) infections in immunocompromised children is not well understood.
  
  
  METHODS
  We performed a retrospective evaluation of pediatric patients with laboratory-confirmed hMPV infections and underlying hematologic malignancy, solid tumors, solid organ transplant, rheumatologic disease, and/or receipt of chronic immunosuppressants. Data were analyzed using t tests and Fisher's exact tests.
  
  
  RESULTS
  Overall, 55 patients (median age: 5 years; range: 5 months-19 years) with hMPV infection documented between 2006 and 2010 were identified, including 24 (44%) with hematologic malignancy, 9 (16%) undergoing hematopoietic stem cell transplant, 9 (16%) with solid tumors, and 8 (15%) with solid organ transplants. Three (5%) presented with fever alone, 35 (64%) presented with upper respiratory tract infections, and 16 (29%) presented with lower respiratory tract infections (LRTI). Twelve (23%) patients required intensive care unit admission and/or supplemental oxygen ≥28% FiO2. Those with severe disease were more likely to be neutropenic (P = .02), but otherwise did not differ by age (P = .27), hematopoietic stem cell transplant recipient status (P = .19), or presence of lymphopenia (P = .09). Nine (16%) patients received treatment with ribavirin, intravenous immunoglobulin, or both. Three children (5%) died of hMPV pneumonia.
  
  
  CONCLUSIONS
  Immunocompromised pediatric patients with hMPV infection have high rates of LRTI and mortality. The benefits of treatment with ribavirin and intravenous immunoglobulin in this patient population require further evaluation.
authors.affiliation: Department of Medicine, University of Washington.
authors.forename: Helen Y
authors.initials: HY
authors.lastname: Chu
authors.affiliation: Division of Infectious Diseases.
authors.forename: Christian
authors.initials: C
authors.lastname: Renaud
authors.affiliation: Division of Infectious Diseases.
authors.forename: Elle
authors.initials: E
authors.lastname: Ficken
authors.affiliation: Division of Hematology-Oncology, Seattle Children's Hospital.
authors.forename: Blythe
authors.initials: B
authors.lastname: Thomson
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle.
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.affiliation: Division of Infectious Diseases.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
keywords: human metapneumovirus; immunocompromised; pediatric; transplant; treatment