1294. Human Metapneumovirus (hMPV) is a Cause of Severe Respiratory Infection and Failure in Hospitalized Adults with Comorbid Conditions
Session: Poster Abstract Session: Viral Epidemiology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Recent reports indicate that human metapneumovirus (hMPV) causes an influenza-like illness (ILI), community acquired pneumonia, and exacerbations of chronic obstructive pulmonary disease (COPD) in adults. Severe complications have been observed in the elderly and immunocompromised. However, the spectrum of disease has not been fully described in adults. The purpose of our study is to describe the clinical presentation and hospital course of adult patients with hMPV infection.

Methods: A retrospective cohort study at an 850 bed academic tertiary care center was performed. Electronic medical records were reviewed for all adult patients who tested positive for hMPV by real time polymerase chain reaction from 11/20/09 to 10/01/10.

Results: 14 patients tested positive for hMPV. All were hospitalized from December-April with 57% in January.  The mean age was 50 (range 26-87), 50% male. Presenting symptoms included wheezing (64%), dyspnea (79%), cough (79%), and sputum production (43%). Many were afebrile (71%), with a normal white blood cell count (64%), hypoxia (79%), and an abnormal chest x-ray (57%). All had pre-existing comorbidities: 7 (50%) had lung disease, 4 (29%) had COPD, 29% were severely immunocompromised (SI) due to solid organ transplant or hematologic malignancy, and 50% were obese. Eight patients (57%) experienced respiratory failure (Table).  There were no deaths.

 

Table. Obesity, COPD, SI and Diabetes Mellitus (DM) accounted for the majority of comorbidities among those with Respiratory Failure

 

Respiratory Failure (n=8)

No Respiratory Failure (n=6)

Obesity

5 (62.5%)

2 (33.3%)

COPD

4 (50%)

0 (0%)

SI

3 (37.5%)

1 (17%)

DM

2 (25%)

1 (17%)

Conclusion:  Similar to previous reports of adult hMPV infection, most patients presented with an influenza-like illness and wheezing during winter months. In contrast to prior reports, a large proportion of hospitalized patients developed respiratory failure requiring mechanical ventilation. Obesity, COPD, SI, and DM may be risk factors for respiratory failure due to hMPV infection, but larger numbers of patients will need to be studied. hMPV should be considered in the differential diagnosis of severe respiratory infection in hospitalized adults with comorbidity.


Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Ashley Chaplin, MD, Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, Matthew Miles, MD, IM-Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest Baptist Health, Winston-Salem, NC, Vera Luther, MD, IM-Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC and Elizabeth Palavecino, MD, Pathology, Wake Forest School of Medicine, Winston Salem, NC

Disclosures:

A. Chaplin, None

M. Miles, None

V. Luther, None

E. Palavecino, None

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