Chest radiographic features of human metapneumovirus infection in pediatric patients
Chest radiographic features of human metapneumovirus infection in pediatric patients
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DOI：
10.1007/s00247-017-3943-5
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发表时间：
2017-12-01
影响因子：
2.3
通讯作者：
Williams, John V.
中科院分区：
文献类型：
--
作者：
Hilmes, Melissa A.;Dunnavant, F. Daniel;Williams, John V.
人类偏肺病毒（HMPV）于2001年被发现，是幼儿急性呼吸道疾病的常见原因。实验室确诊的小儿HMPV急性呼吸道疾病的影像学特征尚未得到系统评估。我们在一个前瞻性的儿科患者队列中系统评估了与HMPV相关的急性呼吸道疾病的影像学特征。我们纳入了入选前瞻性新疫苗监测网络（NVSN）的5岁以下急性呼吸道疾病儿童的胸片。研究从2003年到2009年，并通过逆转录-聚合酶链反应（RT-PCR）诊断为HMPV。在我们的三级儿童医院招募的215名HMPV阳性受试者中，68名接受治疗的临床医生获得了可供审查的胸片。两名经过培训的儿科放射科医生，先独立后达成共识，回顾性评价了这些胸片的影像学特征，肺门旁阴影是最常见的异常，发生在87%的HMPV患儿中。恶性通货膨胀也经常发生（69%）。肺不张（40%）和实变（18%）较少出现。HMPV的临床表现包括细支气管炎、哮吼及肺炎。主要的胸部影像学异常包括肺门旁阴影和过度充气，偶尔有实变。识别常见病毒性疾病（如呼吸道合胞病毒（RSV）和HMPV）的成像模式可能有助于诊断并限制不必要的抗生素治疗。
Human metapneumovirus (HMPV) was identified in 2001 and is a common cause of acute respiratory illness in young children. The radiologic characteristics of laboratory-confirmed HMPV acute respiratory illness in young children have not been systematically assessed.We systematically evaluated the radiographic characteristics of acute respiratory illness associated with HMPV in a prospective cohort of pediatric patients.We included chest radiographs from children < 5 years old with acute respiratory illness who were enrolled in the prospective New Vaccine Surveillance Network (NVSN) study from 2003 to 2009 and were diagnosed with HMPV by reverse transcription-polymerase chain reaction (RT-PCR). Of 215 HMPV-positive subjects enrolled at our tertiary care children's hospital, 68 had chest radiographs obtained by the treating clinician that were available for review. Two fellowship-trained pediatric radiologists, independently and then in consensus, retrospectively evaluated these chest radiographs for their radiographic features.Parahilar opacities were the most commonly observed abnormality, occurring in 87% of children with HMPV. Hyperinflation also occurred frequently (69%). Atelectasis (40%) and consolidation (18%) appeared less frequently. Pleural effusion and pneumothorax were not seen on any radiographs.The clinical presentations of HMPV include bronchiolitis, croup and pneumonia. Dominant chest radiographic abnormalities include parahilar opacities and hyperinflation, with occasional consolidation. Recognition of the imaging patterns seen with common viral illnesses like respiratory syncytial virus (RSV) and HMPV might facilitate diagnosis and limit unnecessary antibiotic treatment.