Transplantation 2017 09 27() doi 10.1097/TP.0000000000001965
Human metapneumovirus (HMPV) is a newly detected pathogen which can cause lower respiratory tract disease. Clinical characteristics, computed tomography (CT) findings, and outcomes of HMPV pneumonia in solid organ transplantation (SOT) patients have not been well demonstrated.
Between January 2010 and February 2016, clinical and imaging findings of 59 patients receiving SOT (types of organ: 37 kidney, 16 liver, 4 heart and 2 pancreas and kidney) who had HMPV infection detected in nasopharyngeal or bronchoalveolar lavage by reverse transcription polymerase chain reaction were retrospectively evaluated.
Most (90%) of the patients were detected between March and June. In the 59 SOT patients with upper respiratory tract infection (URI), 29 (49%) progressed to lower respiratory tract disease (LRD) after a median of 7 days (range, 2-31 days). Co-infection was noted in 39% of patients. In Cox proportional hazards analysis, low lymphocyte count (≤0.7 × 10/μL) (hazard ratio (HR), 2.24, 95% CI (confidence interval), 1.04-4.85, P=0.04) and high C-reactive protein (CRP) > 10 mg/dL (HR, 2.93, 95% CI, 1.19-7.21, P=0.02) at URI diagnosis were associated with HMPV pneumonia. On CT, HMPV pneumonia presented as bilateral ill-defined centrilobular nodules, consolidation and ground-glass opacities, while lymphadenopathy or effusion is not common. There were no significantly different imaging CT findings between patients with HMPV infection alone and those with co-infection.
HMPV pneumonias were detected in nearly half of SOT patients showing URI symptoms with positive HMPV, and low lymphocyte count and high CRP at URI diagnosis were significant factors associated with HMPV pneumonia.