Download Metapneumovirus

Metapneumovirus
JASON KIDD
MORNING REPORT
3/23/2010
Pop Quiz
Background
 First described in 2001 by van den Hoogen
 Nasophargyngeal aspirates from 28 children over a 20 year
period
 Children had similar symptoms to RSV
 World wide distribution: Has been isolated in US, Brazil,
Japan, Australia and UK
Virology
RNA Virus
Paramyxoviridae family
Antibodies have been
isolated in samples
from as far back as 1958
Epidemiology
 Most of the early literature is in pediatric population
 In adult population, immune compromised at
highest risk
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Boivin et al (2002), studied a group of 10 patients age >65
years with human metapneumovirus. Two of these patients
died, one had a history of leukemia and the other had
Alzheimer's disease.
Falsey et al (2003) studied a cohort of 1564 subjects over two
winters in Rochester, New York. The study suggested that
human metapneumovirus infection could be severe in the
elderly and that, during some years, metapneumovirus may
account for a significant portion of the older people
hospitalized with respiratory tract infections.
Epidemiology
 Johnstone et al described a group of 193 adults
admitted with CAP. Of 193, 79 pts (39%) had a
pathogen identified. Streptococcus pneumoniae was
the most common bacteria; Influenza (n=7), hMPV
(n=5) and RSV (n=5) were most common viruses
Symptoms
 Cough, fever, dyspnea
 Can range from URTIRespiratory failure
 Significant pulmonary inflammatory changes in BAL
 Increased IL-8, foamy macrophages
 In temperate countries, hMPV has a seasonal
distribution, overlapping with RSV with most cases
reported during the winter/spring.
Treatment?
 Primarily supportive measures
 Raza et al (2007) presented a case describing
successful use of ribavarin in a patient with a history
of double lung transplant and respiratory failure.
 Ribavarin has been shown to have in vitro activity
against metapneumovirus (Wyde et al 2007)
Our patient
 Petitioned FDA and UNC IRB for use of IV Ribavarin
 Day 133 mg/kg of Ribavarin
 Day 2-516 mg/kg of Ribavarin
 O2 requirement decreased, she was transferred to
floor and discharged on 2L NC. Two weeks later, she
was seen by her PCP and no longer was using O2
References
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Boivin G, Abed Y, Pelletier G, Ruel L, Moisan D, Cote S, Peret TC, Erdman DD and Anderson LJ 2002
Virological features and clinical manifestations associated with human metapneumovirus: a new
paramyxovirus responsible for acute respiratory tract infections in all age groups; J Infect. Dis. 186
1330-1334
Falsey AR, Erman D, Anderson LJ and Walsh EE 2003. Human Metapneumovirus Infections in Young
and Elderly Adults. J Infectious Diseases 2003; 187:785-790
Hamelin M, Boivin G 2005 Human Metapneumovirus A Ubiquitous and long standing respiratory
pathogen Pediatr Infect Dis J 24:S203-S207
Johnstone J, Majumder SR, Fox JD and Marrie TJ 2008 Viral infection in adults hospitalized with community
acquired pneumonia. Prevalence, pathogens and presentation. Chest; 134: 1141-1148
Raza K, Ismailjee SB, Crespo M, Studer S, Sanghavi S, Paterson DL, Kwak EJ, Rinaldo CR, Pilewski
JM, McCurry K and Husain S 2007 Successful outcome of human metapneumovirus (hMPV)
pneumonia in a lung transplant recipient treated with intravenous ribavarin. J Heart and Lung
Transplant 2007;26:862-864
Rohde G, Borg I, Arinir U, Kronsbein J, Rausse R, Bauer TT, Bufe A, Schultze Werninghaus G 2005
Relevance of human metapneumovirus in exacerbations of COPD. Respiratory Research 6:150
van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de Groot R, Fouchier RA and Osterhaus AD 2001
A newly discovered human pneumovirus isolated from young children with respiratory tract
disease; Nat Med. 7 719-724
Wyde PR, Chetty SN, Jewell AM, Boivin G, Piedra PA. Comparison of the inhibition of human
metapneumovirus and respiratory syncitial virus by ribavarin and immune serum globulin in
vitro. Antiviral Res 2003; 60:51-59
Thank you