Human metapneumovirus infection is associated with a substantial morbidity and mortality burden in adult inpatients.

Background

Human metapneumovirus (hMPV) is one of the leading respiratory viruses. This prospective observational study aimed to describe the clinical features and the outcomes of hMPV-associated lower respiratory tract infections in adult inpatients.

Methods

Consecutive adult patients admitted to one of the 31 participating centers with an acute lower respiratory tract infection and a respiratory multiplex PCR positive for hMPV were included. A primary composite end point of complicated course (hospital death and/or the need for invasive mechanical ventilation) was used.

Results

Between March 2018 and May 2019, 208 patients were included. The median age was 74 [62-84] years. Ninety-seven (47 %) patients were men, 187 (90 %) had at least one coexisting illness, and 67 (31 %) were immunocompromised. Median time between first symptoms and hospital admission was 3 [2-7] days. The two most frequent symptoms were dyspnea (86 %) and cough (85 %). The three most frequent clinical diagnoses were pneumonia (42 %), acute bronchitis (20 %) and acute exacerbation of chronic obstructive pulmonary disease (16 %). Among the 52 (25 %) patients who had a lung CT-scan, the most frequent abnormality was ground glass opacity (41 %). While over four-fifths of patients (81 %) received empirical antibiotic therapy, a bacterial coinfection was diagnosed in 61 (29 %) patients. Mixed flora (16 %) and enterobacteria (5 %) were the predominant documentations. The composite criterion of complicated course was assessable in 202 (97 %) patients, and present in 37 (18 %) of them. In the subpopulation of pneumonia patients (42 %), we observed a more complicated course in those with a bacterial coinfection (8/24, 33 %) as compared to those without (5/60, 8 %) (p = 0.02). Sixty (29 %) patients were admitted to the intensive care unit. Among them, 23 (38 %) patients required invasive mechanical ventilation. In multivariable analysis, tachycardia and alteration of consciousness were identified as risk factors for complicated course.

Conclusion

hMPV-associated lower respiratory tract infections in adult inpatients mostly involved elderly people with pre-existing conditions. Bacterial coinfection was present in nearly 30 % of the patients. The need for mechanical ventilation and/or the hospital death were observed in almost 20 % of the patients.

Informations de copyright

© 2024 The Author(s).

Déclaration de conflit d'intérêts

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Astrid VABRET disclosed payment or honoraria for lectures, presentations and support for attending meetings and/or travel from ANOFI, 10.13039/501100003103ASTRA ZENECA, MODERNA, and participation on a Data Safety Monitoring Board from SANOFI, 10.13039/100030732MSD, MODERNA and GSK. Frederic Schlemmer disclosed consulting fees from 10.13039/100004319Pfizer, payment or honoraria for lectures, presentations from 10.13039/100005564Gilead, and participation on a Data Safety Monitoring Board from Boerhinger Ingelheim, 10.13039/100019719Chiesi, Elivie, 10.13039/100005564Gilead, 10.13039/100004330GlaxoSmithKline and Oxyvie. Anne Bergeron disclosed payment or honoraria for lectures, presentations and support for attending meetings and/or travel from Astra Zeneca and 10.13039/100004336Novartis, and participation on a Data Safety Monitoring Board from Enanta. Anahita Rouzé disclosed payment or honoraria for lectures, presentations and support for attending meetings and/or travel from 10.13039/100030732MSD, 10.13039/100005564Gilead, Mundipharma. Blandine RAMMAERT disclosed payment or honoraria for lectures, presentations from Gilead. Cedric Daubin disclosed support for attending meetings and/or travel from 10.13039/100005564Gilead. Nicolas Terzi disclosed payment or honoraria for lectures, presentations from 10.13039/100004319Pfizer and Boehringher Inghelheim, and support for attending meetings and/or travel from 10.13039/100005564Gilead. Quentin Philippot disclosed payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from 10.13039/100005564Gilead and Elsevier, and grants or contracts from APHP, 10.13039/501100017007ARS Ile de France and 10.13039/501100001677Inserm 10.13039/501100007492Fondation Bettencourt Schueller, and support for the present manuscript from SOS Oxygen. Other authors did not disclose competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.