title: Human metapneumovirus (hMPV) infection in immunocompromised children.
abstract: Human metapneumovirus (hMPV) is a major cause of upper and lower respiratory tract infection (URTI, LRTI) in children. The prognosis of hMPV is unclear in immunocompromised patients.
  
  
  
  To describe the characteristics of hMPV infection in immunocompromised pediatric patients and to review the literature.
  
  
  
  This retrospective study included 39 immunocompromised children (age 0-18 years) with proven hMPV infection attending two tertiary pediatric medical centers in 2004-2014. Demographic, clinical, laboratory, and radiological data were collected from the medical files.
  
  
  
  Median age was 6 years. Seven patients had primary immune deficiency and 32, secondary immune deficiency, including 9 patients who underwent hematopoietic stem cell transplantation (HSCT). Most cases (92%) occurred in January-May. Twenty patients (51%) had lower respiratory tract infection and 17 (44%), upper respiratory tract infection; 2 patients (5%) had fever only. Presenting symptoms were fever (70%), cough (54%), and rhinorrhea (35%). Severe lymphopenia (<1000lymphocytes/mL) was noted in 64% of patients and elevated liver enzyme levels in 49%. Seventeen patients had pneumonia: bilateral and alveolar in 13 patients, each. HSCT was not associated with more severe disease. Respiratory failure occurred in 6 patients, of whom 4 died (10% of cohort). All children who died had severe lymphopenia. On multivariate analysis, bacterial or fungal co-infection was the only major risk factor for death. Review of the literature showed variable clinical presentations and severity in pediatric patients with hMPV infection.
  
  
  
  Infection with hMPV may be associated with relatively high morbidity and mortality in immunocompromised children. Death was associated with bacterial and fungal co-infection.
authors: Pediatric Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel. Electronic address: odedshv@clalit.org.il.
authors: Oded
authors: O
authors: Scheuerman
authors: Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children's Hospital, Tel Hashomer, Ramat Gan 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel.
authors: Galia
authors: G
authors: Barkai
authors: Department of Virology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel.
authors: Michal
authors: M
authors: Mandelboim
authors: National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.
authors: Hagit
authors: H
authors: Mishali
authors: Department of Epidemiology & Preventive Medicine, Tel Aviv, Ramat Aviv 6997801, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel.
authors: Gabriel
authors: G
authors: Chodick
authors: Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel.
authors: Itzhak
authors: I
authors: Levy
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D029121:Metapneumovirus; D018184:Paramyxoviridae Infections / Q000453:epidemiology* / Q000821:virology*; D012131:Respiratory Insufficiency; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Hematopoietic stem cell transplantation; Human metapneumovirus; Immunocompromised children; Respiratory tract infection