Metapneumovirus

3. Metapneumovirus Jason Kidd Morning Report 3/23/2010

4. Pop Quiz

5. Background • First described in 2001 by van den Hoogen • Nasophargyngeal aspirates from 28 children over a 20 year period • Children had similar symptoms to RSV • World wide distribution: Has been isolated in US, Brazil, Japan, Australia and UK

6. Virology RNA Virus Paramyxoviridae family Antibodies have been isolated in samples from as far back as 1958

7. Epidemiology • Most of the early literature is in pediatric population • In adult population, immune compromised at highest risk • Boivin et al (2002), studied a group of 10 patients age >65 years with human metapneumovirus. Two of these patients died, one had a history of leukemia and the other had Alzheimer's disease. • Falsey et al (2003) studied a cohort of 1564 subjects over two winters in Rochester, New York. The study suggested that human metapneumovirus infection could be severe in the elderly and that, during some years, metapneumovirus may account for a significant portion of the older people hospitalized with respiratory tract infections.

8. Epidemiology • Johnstone et al described a group of 193 adults admitted with CAP. Of 193, 79 pts (39%) had a pathogen identified. Streptococcus pneumoniae was the most common bacteria; Influenza (n=7), hMPV (n=5) and RSV (n=5) were most common viruses

9. Symptoms • Cough, fever, dyspnea • Can range from URTIRespiratory failure • Significant pulmonary inflammatory changes in BAL • Increased IL-8, foamy macrophages • In temperate countries, hMPV has a seasonal distribution, overlapping with RSV with most cases reported during the winter/spring.

10. Treatment? • Primarily supportive measures • Raza et al (2007) presented a case describing successful use of ribavarin in a patient with a history of double lung transplant and respiratory failure. • Ribavarin has been shown to have in vitro activity against metapneumovirus (Wyde et al 2007)

11. Our patient • Petitioned FDA and UNC IRB for use of IV Ribavarin • Day 133 mg/kg of Ribavarin • Day 2-516 mg/kg of Ribavarin • O2 requirement decreased, she was transferred to floor and discharged on 2L NC. Two weeks later, she was seen by her PCP and no longer was using O2

12. References • Boivin G, Abed Y, Pelletier G, Ruel L, Moisan D, Cote S, Peret TC, Erdman DD and Anderson LJ 2002 Virological features and clinical manifestations associated with human metapneumovirus: a new paramyxovirus responsible for acute respiratory tract infections in all age groups; J Infect. Dis. 186 1330-1334 • Falsey AR, Erman D, Anderson LJ and Walsh EE 2003. Human Metapneumovirus Infections in Young and Elderly Adults. J Infectious Diseases 2003; 187:785-790 • Hamelin M, Boivin G 2005 Human Metapneumovirus A Ubiquitous and long standing respiratory pathogen Pediatr Infect Dis J 24:S203-S207 • Johnstone J, Majumder SR, Fox JD and Marrie TJ 2008 Viral infection in adults hospitalized with community acquired pneumonia. Prevalence, pathogens and presentation. Chest; 134: 1141-1148 • Raza K, Ismailjee SB, Crespo M, Studer S, Sanghavi S, Paterson DL, Kwak EJ, Rinaldo CR, Pilewski JM, McCurry K and Husain S 2007 Successful outcome of human metapneumovirus (hMPV) pneumonia in a lung transplant recipient treated with intravenous ribavarin. J Heart and Lung Transplant 2007;26:862-864 • Rohde G, Borg I, Arinir U, Kronsbein J, Rausse R, Bauer TT, Bufe A, Schultze Werninghaus G 2005 Relevance of human metapneumovirus in exacerbations of COPD. Respiratory Research 6:150 • van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de Groot R, Fouchier RA and Osterhaus AD 2001 A newly discovered human pneumovirus isolated from young children with respiratory tract disease; Nat Med. 7 719-724 • Wyde PR, Chetty SN, Jewell AM, Boivin G, Piedra PA. Comparison of the inhibition of human metapneumovirus and respiratory syncitial virus by ribavarin and immune serum globulin in vitro. Antiviral Res 2003; 60:51-59

13. Thank you