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Clin Infect Dis. 2020 Feb 3. pii: ciaa088. doi: 10.1093/cid/ciaa088. [Epub ahead of print]

Clinical Features of Human Metapneumovirus-Associated Community-Acquired Pneumonia Hospitalizations.

Author information

1
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
2
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
3
Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN.
4
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.
5
Centers for Disease Control and Prevention, Atlanta, GA.
6
University of Utah Health Sciences Center, Salt Lake City, UT.
7
University of Tennessee Health Sciences Center, Memphis, TN.
8
St. Jude Children's Research Hospital, Memphis, TN.
9
Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA.
10
Northwestern University Feinberg School of Medicine, Chicago, IL.

Abstract

BACKGROUND:

Human metapneumovirus (HMPV) is a leading cause of respiratory tract infections. Few studies have compared the clinical characteristics and severity of HMPV-associated pneumonia with other pathogens.

METHODS:

Active population-based surveillance was previously conducted for radiographically-confirmed community-acquired pneumonia hospitalizations among children and adults in eight United States hospitals. Clinical data and specimens for pathogen detection were systematically collected. We described clinical features of all HMPV-associated pneumonia, and after excluding co-detections with other pathogen types, we compared features of HMPV-associated pneumonia with other viral, atypical, and bacterial pneumonia and modeled severity (mild, moderate, severe) and length of stay using multivariable proportional odds regression.

RESULTS:

HMPV was detected in 298/2358 (12.6%) children and 88/2320 (3.8%) adults hospitalized with pneumonia and was commonly co-detected with other pathogens (125/298 [42%] children and 21/88 [24%] adults). Fever and cough were the most common presenting symptoms of HMPV-associated pneumonia and were also common symptoms of other pathogens. After excluding co-detections, in children (n=1778), compared to HMPV (reference), bacterial pneumonia exhibited increased severity (OR 3.66 [95% CI 1.43-9.40]), RSV (0.76 [0.59-0.99]) and atypical (0.39 [0.19-0.81]) infections exhibited decreased severity, and other viral pneumonia exhibited similar severity (0.88 [0.55-1.39]). In adults (n=2145), bacterial (3.74 [1.87-7.47]) and RSV pneumonia (1.82 [1.32-2.50]) were more severe than HMPV (reference), but all other pathogens had similar severity.

CONCLUSIONS:

Clinical features did not reliably distinguish HMPV-associated pneumonia from other pathogens. HMPV-associated pneumonia was less severe than bacterial and adult RSV pneumonia but otherwise as or more severe than other common pathogens.

PMID:
32010955
DOI:
10.1093/cid/ciaa088

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