Human metapneumovirus infections
- James E Crowe, Jr, MD
James E Crowe, Jr, MD
- Vanderbilt Vaccine Center
- Vanderbilt University Medical Center
- Section Editors
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Respiratory tract infections are commonly caused by viral pathogens, especially in young children. Pathogens that are frequently identified in patients with these infections include respiratory syncytial virus, parainfluenza virus, influenza virus, and adenovirus. However, despite improved methods for identifying viral pathogens, the etiology remains undetermined in a significant number of patients.
In 2001, investigators from the Netherlands discovered a new member of the Paramyxoviridae family in the genus Metapneumovirus . The first representative of this genus to cause infection in humans has been called the human metapneumovirus (hMPV). Data suggest this virus has been responsible for respiratory tract infections for at least 60 years with a worldwide distribution [1-4].
The virology, pathogenesis, epidemiology, clinical manifestations, diagnosis, and treatment of hMPV will be discussed here. Other common respiratory viruses are reviewed separately. (See "Respiratory syncytial virus infection: Clinical features and diagnosis" and "Seasonal influenza in children: Clinical features and diagnosis" and "Clinical manifestations of seasonal influenza in adults" and "Parainfluenza viruses in children" and "Parainfluenza viruses in adults" and "Epidemiology and clinical manifestations of adenovirus infection".)
Within the Paramyxoviridae family, there are two subfamilies, Pneumovirinae and Paramyxovirinae. Genetic analysis determined that human metapneumovirus (hMPV) is most similar to the Pneumovirinae family, of which respiratory syncytial virus is a prominent member.
HMPV is an enveloped virus with a nonsegmented negative-sense RNA genome. HMPV is most closely related phylogenetically to avian metapneumovirus (APV) . The complete genome sequence reveals a high level of homology with APV . Phylogenetic analysis has identified two subgroups of hMPV, subgroups A and B, and two clades within each of these subgroups (designated A1, A2, B1, and B2), which often circulate concurrently [6,7]. A study of 727 Australian hMPV isolates was undertaken from 2001 to 2004 to determine the epidemiologic profile of genetic subtypes associated with acute respiratory tract infections . Concurrent annual circulation of all four hMPV subtypes was common, although a single, and usually different, hMPV subtype predominated each year.
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- CLINICAL MANIFESTATIONS
- - Possible role in COPD exacerbations
- Recurrent infection
- Immunocompromised hosts
- Reverse transcriptase PCR
- Direct fluorescent antibody
- Viral culture
- Shell vial cultures
- Infection control
- Vaccine development
- SUMMARY AND RECOMMENDATIONS