Brief Communication: Fatal Human Metapneumovirus Infection in Stem-Cell Transplant Recipients

7 March 2006 | Volume 144 Issue 5 | Pages 344-349

Background: Human metapneumovirus (hMPV), a recently discovered respiratory virus, is associated with clinical disease in young and elderly persons.

Objective: To determine the importance of hMPV in hematopoietic stem-cell transplant recipients.

Design: Retrospective survey of patients with consecutive residual bronchoalveolar lavage (BAL) samples.

Setting: Referral cancer center.

Patients: Hematopoietic stem-cell transplant recipients who underwent BAL because of lower respiratory tract disease.

Measurements: Bronchoalveolar lavage specimens were assayed by quantitative real-time polymerase chain reaction methods.

Results: Human metapneumovirus was detected in BAL specimens from 5 of 163 patients (3.0%). Persistent viral infection was noted in 3 patients with several samples, and hMPV was detected in 1 of 2 lung specimens tested. Infected patients became symptomatic within the first 40 days after transplantation. Initial symptoms included fever, cough, nasal congestion, and sore throat. Clinical findings included respiratory failure, pulmonary hemorrhage, and culture-negative septic shock. Four of 5 patients died with acute respiratory failure.

Limitations: This retrospective study did not evaluate asymptomatic patients or those with mild disease.

Conclusion: Human metapneumovirus infection in the lower respiratory tract is associated with respiratory failure in immunocompromised adults who were previously considered to have "idiopathic pneumonia." The infection may result in fulminant respiratory decompensation and shock after transplantation.

Editors' Notes Context Human metapneumovirus (hMPV) is a newly discovered respiratory virus. Contribution This study from a cancer referral center retrospectively examined bronchoalveolar lavage samples collected from 1995 to 1999 from hematopoietic cell transplant recipients with new or changing pulmonary infiltrates. The authors cultured hMPV in 5 of 163 symptomatic patients who were thought to have had the idiopathic pneumonia syndrome. Clinical findings included fever, cough, nasal congestion, respiratory failure, pulmonary hemorrhage, and culture-negative sepsis. Four of the patients died. Cautions All patients had moderate to severe symptoms. Implications Human metapneumovirus may cause respiratory failure in immunocompromised adults. —The Editors

 

Author and Article Information

From the Children's Hospital and Regional Medical Center, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, Washington.

The paper was presented in part at the American Society of Hematology 46th Annual Meeting, San Diego, California, 4–7 December 2004.

Note: Drs. Englund and Boeckh contributed equally to the manuscript.

Acknowledgments: The authors acknowledge the immunohistochemical studies in lung tissue performed by Dr. Thijs Kuiken, Erasmus University. They thank Kristen White for specimen processing and Nancy Wright for laboratory assistance with PCR testing.

Grant Support: In part by National Institutes of Health (grants CA 18029, CA 15704, and PO1 AI 30731), the Fred Hutchinson Cancer Research Center (support grant P30 CA015704), and Adult Leukemia Research Center (grant P01 CA18029).

Potential Financial Conflicts of Interest: Consultancies: J.A. Englund (MedImmune Inc., Wyeth Vaccines); Grants received: J.A. Englund (MedImmune Inc.), R.A. Morrow (GlaxoSmithKline); Grants pending: J.A. Englund (National Institutes of Health).

Requests for Single Reprints: Janet A. Englund, MD, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Mail Stop W-8851, Seattle, WA 98105; e-mail, janet.englund{at}seattlechildrens.org.

Current Author Addresses: Dr. Englund: Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Mail Stop W-8851, Seattle, WA 98105.

Drs. Boeckh, Fredricks, and Corey: Program in Infectious Diseases, D3-100, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, P.O. Box 19024, Seattle, WA 98109-1024.

Dr. Kuypers: Department of Laboratory Medicine, University of Washington Clinical Virology Laboratory, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Mailstop 8G-3, Seattle, WA 98105.

Dr. Nichols: 5 Moore Drive, 17.1354B, Research Triangle Park, NC 27709.

Dr. Hackman: Department of Pathology, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, P.O. Box 19024, Seattle, WA 98109-1024.

Dr. Morrow: Department of Laboratory Medicine, University of Washington Clinical Virology Laboratory, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Mail Stop G 815, Seattle, WA 98105.

Author Contributions: Conception and design: J.A. Englund, M. Boeckh, W.G. Nichols, L. Corey.

Analysis and interpretation of the data: J.A. Englund, M. Boeckh, J. Kuypers, W.G. Nichols, R.C. Hackman, R.A. Morrow, D.N. Fredricks, L. Corey.

Drafting of the article: J.A. Englund, M. Boeckh, W.G. Nichols, R.C. Hackman, R.A. Morrow, L. Corey.

Critical revision of the article for important intellectual content: J.A. Englund, M. Boeckh, J. Kuypers, W.G. Nichols, L. Corey.

Final approval of the article: J.A. Englund, M. Boeckh, W.G. Nichols, R.A. Morrow, D.N. Fredricks, L. Corey.

Provision of study materials or patients: J.A. Englund, M. Boeckh, R.C. Hackman, L. Corey.

Obtaining of funding: M. Boeckh, L. Corey.

Administrative, technical, or logistic support: R.A. Morrow, L. Corey.

Collection and assembly of data: J.A. Englund, M. Boeckh, W.G. Nichols, R.C. Hackman, R.A. Morrow, D.N. Fredricks.