An outbreak of severe respiratory tract infection due to human metapneumovirus in a long-term care facility
An outbreak of severe respiratory tract infection due to human metapneumovirus in a long-term care facility
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DOI：
10.1086/513204
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发表时间：
2007-05-01
影响因子：
11.8
通讯作者：
Couture, Christian
中科院分区：
文献类型：
--
作者：
Boivin, Guy;De Serres, Gaston;Couture, Christian
背景资料。人偏肺病毒(HMPV)是一种新发现的副粘病毒，主要与儿童毛细支气管炎有关。我们试图描述与长期护理机构中hMPV感染大爆发相关的流行病学、病毒学和组织病理学结果。公共卫生当局对疫情进行了调查，他们使用标准化问卷从该设施的所有居民那里收集相关临床信息。鼻咽样本取自部分有流感样疾病的患者，通过病毒培养和逆转录聚合酶链式反应进行检测。一名死亡患者的肺组织样本可用于分子、组织病理学和免疫组织化学检测。在2006年1月1日至2006年2月15日期间，长期护理机构的364名居民中共有96人(27%)出现呼吸道症状或体质症状。受影响最严重的病房的发病率为72%(43例患者中有31例)，其中包括6例聚合酶链式反应确诊的hMPV感染病例中的4例。相比之下，在5份聚合酶链式反应阳性样本中，只有2份病毒培养结果为hMPV阳性。报告最多的诊断是上呼吸道感染或流感样疾病，尽管在确诊HMPV感染病例的3个病房中，有1个病房的21%的居民患有下呼吸道感染。确诊病例病死率为50%(3/6例)，疑似病例病死率为9.4%(9/96例)。1例死亡病例的组织病理学发现证实在受影响肺叶的细支气管上皮细胞中存在hMPV RNA和蛋白质。系统发育分析显示，两种不同的hMPV毒株同时存在于不同的病区。HMPV可能与住院老年人急性呼吸道感染的重要暴发有关。
Background. Human metapneumovirus (hMPV) is a newly described paramyxovirus that is mainly associated with bronchiolitis in children. We sought to describe the epidemiological, virological, and histopathological findings associated with a large outbreak of hMPV infection in a long-term care facility.Methods. An investigation of the outbreak was performed by public health authorities, who used standardized questionnaires to collect relevant clinical information from all residents of the facility. Nasopharyngeal samples were obtained from a subset of patients who had influenza-like illnesses for testing by viral culture and reverse-transcriptase polymerase chain reaction. Lung tissue samples from a patient whose case was fatal were available for molecular, histopathological, and immunohistochemical testing.Results. A total of 96 (27%) of 364 residents of a long-term care facility presented with respiratory or constitutional symptoms between 1 January 2006 and 15 February 2006. The attack rate in the most affected ward was 72% ( 31 of 43 patients), which included 4 of the 6 polymerase chain reaction - confirmed cases of hMPV infection. In contrast, viral culture results were positive for hMPV in only 2 of the 5 polymerase chain reaction positive samples tested. The most reported diagnosis was an upper respiratory tract infection or an influenza-like illness, although 21% of residents in 1 of the 3 wards that had confirmed cases of hMPV infection had lower respiratory tract infections. The fatality rate was 50% ( 3 of 6 patients) among confirmed cases and 9.4% ( 9 of 96 patients) among patients with possible cases. A patient with a fatal case had histopathological findings that confirmed the presence of hMPV RNA and proteins in the bronchiolar epithelium of affected lobes. Phylogenetic analysis revealed the presence of 2 distinct strains of hMPV circulating simultaneously on different wards.Conclusion. hMPV can be associated with important outbreaks of acute respiratory tract infection in elderly institutionalized persons.