Human metapneumovirus infections cause similar symptoms and clinical severity as respiratory syncytial virus infections
Human metapneumovirus infections cause similar symptoms and clinical severity as respiratory syncytial virus infections
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DOI：
10.1007/s00431-006-0105-4
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发表时间：
2006-07-01
影响因子：
3.6
通讯作者：
Simon, Arne
中科院分区：
文献类型：
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作者：
Wilkesmann, Anja;Schildgen, Oliver;Simon, Arne
人偏肺病毒（humanmetapneumovirus，hMPV）是近年来发现的一种呼吸道感染病原体。已发表的文献表明，与呼吸道合胞病毒（RSV）感染相比，hMPV的疾病严重程度较轻。采用聚合酶链反应（PCR）方法对637例儿童鼻咽分泌物进行hMPV检测，并对相关危险因素、临床及实验室指标进行分析。采用配对分析方法比较hMPV与hMPV阴性但RSV阳性患者的差异。HMPV检出率为17.9%。总共考虑了88例具有完整数据集的hMPV感染患者。超过一半的hMPV患者年龄超过12个月，45.5%的患者至少有一种严重病毒性呼吸道感染的危险因素，27.3%的患者早产，15.9%的患者出生体重<1，500 g。在39例患者中还检测到至少一种其他病毒（44.3%; RSV 29.5%）。合并感染并没有导致更严重的疾病。在配对分析（hMPV阳性/RSV阴性vs. hMPV阴性/RSV阳性）中，hMPV感染的流行病学和临床特征与RSV感染相似，因为在hMPV组中观察到入院时低氧血症（33% vs. 21%）和重症监护治疗（20.8% vs. 10.4%）的患者比例较高。hMPV患者胸部影像学表现为肺叶浸润者较多。在60%的hMPV感染中，主治医生处方了抗菌化疗。我们的结论是，在住院儿童，hMPV感染是严重的RSV感染，因此值得同样的重视。从呼吸道分泌物中进行病毒学诊断是强制性的，因为临床、实验室和放射学体征不能充分区分婴儿和儿童的病毒性和细菌性呼吸道感染。
Human metapneumovirus (hMPV) is a recently discovered pathogen in respiratory tract infection. The published literature suggests milder illness severity in hMPV compared with respiratory syncytial virus (RSV) infection. In two consecutive seasons, 637 nasopharyngeal aspirates from pediatric patients were tested by hMPV polymerase chain reaction, and risk factors and clinical and laboratory items were analyzed. The hMPV patients were compared with hMPV-negative but RSV-positive patients by matched pair analysis. HMPV was detected in 17.9% of all samples. In total, 88 hMPV-infected patients with complete datasets were considered. More than half of all hMPV patients were older than 12 months, 45.5% had at least one risk factor for a severe course of viral respiratory tract infection, and 27.3% were born prematurely, 15.9% with a birth weight < 1,500 g. At least one other virus was also detected in 39 patients (44.3%; RSV in 29.5%). Coinfection did not result in greater severity of illness. On matched pair analysis (hMPV-positive/RSV-negative vs. hMPV-negative/RSV-positive), the epidemiological and clinical features of hMPV infection were similar to those of RSV infection, as in the hMPV group higher proportions of patients with hypoxemia on admission (33% vs. 21%) and of intensive care treatment (20.8% vs. 10.4%) were observed. More hMPV patients showed lobar infiltrates in radiological chest examination. In 60% of all hMPV infections, the attending physicians prescribed antimicrobial chemotherapy. We conclude that in hospitalized children, hMPV infection is as serious as RSV infection and therefore deserves the same attention. Virologic diagnosis from respiratory secretions is mandatory because clinical, laboratory, and radiological signs cannot sufficiently discriminate between viral and bacterial respiratory tract infection in infants and children.