Human metapneumovirus pulmonary infection

Last revised by Liz Silverstone on 13 Jan 2024

Human metapneumovirus (hMPV) pulmonary infection is a recently detected condition reported to cause mild to severe respiratory tract infection, particularly in children, immunocompromised patients, and the elderly 6.

Human metapneumovirus (HMPV), is an RNA virus and was first described in 2001. It is a common pathogen and can cause acute viral respiratory tract infections in all age groups.

IgG antibodies against HMPV have been detected in up to 100% of persons with reinfection being common 1.

HMPV is ubiquitous especially in colder countries where most or all children are seropositive by 10 years of age. Infection is by droplet and reinfection can occur throughout life. Disease is generally mild but can be severe, e.g. fulminant respiratory failure in immunocompromised patients or permanent graft dysfunction in lung transplant patients. Infection prevention relies on avoiding droplet transmission because vaccination and prophylactic antiviral preparations are not yet available.

HMPV typically presents with URTI symptoms which can progress to bronchiolitis, wheezing and bronchopneumonia. Up to 2/3 of asthma exacerbations are caused by a viral infection enhancing the response to allergens and causing airway inflammation. (Rhinovirus is the main culprit.) Asthma attacks are more frequent following recovery from viral infections and lung function may subsequently deteriorate 1.

Changes can be non-specific and bronchitis/bronchopneumonia is most typical.

In children according to one study 2:

  • parahilar / peribronchovascular opacities were the most commonly observed abnormality (87% of children with HMPV).

  • lungs may also hyperinflated

  • atelectasis (40%) and consolidation (18%) have been less frequently described. 

Non-specific changes with ground-glass opacity have been the most commonly reported findings with nodular consolidation described in a lesser number of patients 3

Involvement can often be bilateral.

Empirical treatment with inhaled ribavirin and IV immunoglobulins is of uncertain benefit. Otherwise management is supportive. Co-infections with other viruses or bacteria can be problematic causing severe exacerbations.

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