Burden of human metapneumovirus infections in patients with cancer: Risk factors and outcomes.
BACKGROUND
Human metapneumovirus (hMPV) causes upper and lower respiratory tract infections (URIs and LRIs, respectively) in healthy and immunocompromised patients; however, its clinical burden in patients with cancer remains unknown.


METHODS
In a retrospective study of all laboratory-confirmed hMPV infections treated at the authors' institution between April 2012 and May 2015, clinical characteristics, risk factors for progression to an LRI, treatment, and outcomes in patients with cancer were determined.


RESULTS
In total, 181 hMPV infections were identified in 90 patients (50%) with hematologic malignancies (HMs), in 57 (31%) hematopoietic cell transplantation (HCT) recipients, and in 34 patients (19%) with solid tumors. Most patients (92%) had a community-acquired infection and presented with URIs (67%), and 43% developed LRIs (59 presented with LRIs and 19 progressed from a URI to an LRI). On multivariable analysis, an underlying HM (adjusted odds ratio [aOR], 3.11; 95% confidence interval [CI], 1.12-8.64; P = .029), nosocomial infection (aOR, 26.9; 95% CI, 2.79-259.75; P = .004), and hypoxia (oxygen saturation [SpO2], ≤ 92%) at presentation (aOR, 9.61; 95% CI, 1.98-46.57; P = .005) were identified as independent factors associated with LRI. All-cause mortality at 30 days from hMPV diagnosis was low (4%), and patients with LRIs had a 10% mortality rate at day 30 from diagnosis; whereas patients with URIs had a 0% mortality rate.


CONCLUSIONS
hMPV infections in patients with cancer may cause significant morbidity, especially for those with underlying HM who may develop an LRI. Despite high morbidity and the lack of directed antiviral therapy for hMPV infections, mortality at day 30 from this infection remained low in this studied population. Cancer 2017;123:2329-2337. © 2017 American Cancer Society.
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Department of Medicine, Baylor College of Medicine, Houston, Texas.
Firas
F
El Chaer
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Dimpy P
DP
Shah
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Joumana
J
Kmeid
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Ella J
EJ
Ariza-Heredia
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Chitra M
CM
Hosing
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Victor E
VE
Mulanovich
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Roy F
RF
Chemaly
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000821:virology; D003428:Cross Infection / Q000453:epidemiology / Q000821:virology; D005260:Female; D019337:Hematologic Neoplasms / Q000453:epidemiology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology; D007223:Infant; D008297:Male; D029121:Metapneumovirus; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology*; D016017:Odds Ratio; D018184:Paramyxoviridae Infections / Q000453:epidemiology* / Q000821:virology; D011024:Pneumonia, Viral / Q000453:epidemiology* / Q000821:virology; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
cancer; death; human metapneumovirus (hMPV); leukemia; pneumonia; respiratory virus; stem cell transplantation