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Human Metapneumovirus Infection: Pneumonia Risk Factors in Patients With Solid Organ Transplantation and Computed Tomography Findings

Koo, Hyun, Jung, MD, PhD1; Lee, Han, Na, MD2; Choi, Sang, Ho, MD, PhD3; Sung, Heungsup, MD, PhD4; Oh, Sang, Young, MD, PhD1; Shin, So, Youn, MD, PhD5; Kim, Hwa, Jung, MD, PhD6; Do, Kyung-Hyun, MD, PhD1

doi: 10.1097/TP.0000000000001965
Original Clinical Science—General
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Background Human metapneumovirus (HMPV) is a newly detected pathogen that can cause lower respiratory tract disease. Clinical characteristics, computed tomography (CT) findings, and outcomes of HMPV pneumonia in patients with solid organ transplantation (SOT) have not been well demonstrated.

Methods Between January 2010 and February 2016, clinical and imaging findings of 59 patients with SOT (types of organ: kidney, 37; liver, 16; heart, 4; and pancreas and kidney, 2) who had HMPV infection detected in nasopharyngeal or bronchoalveolar lavage by reverse transcription polymerase chain reaction were retrospectively evaluated.

Results Most (90%) of the patients were detected between March and June. In the 59 patients with SOT with upper respiratory tract infection (URI), 29 (49%) progressed to lower respiratory tract disease after a median of 7 days (range, 2-31 days). Coinfection was noted in 39% of the patients. In Cox proportional hazards analysis, low lymphocyte count (≤0.7 × 103/μL; hazard ratio, 2.24; 95% confidence interval, 1.04-4.85; P = 0.04) and high C-reactive protein (>10 mg/dL; hazard ratio, 2.93; 95% confidence interval, 1.19-7.21; P = 0.02) at URI diagnosis were associated with HMPV pneumonia. On CT, HMPV pneumonia presented as bilateral ill-defined centrilobular nodules, consolidation and ground-glass opacities, whereas lymphadenopathy or effusion is not common. There were no significantly different imaging CT findings between patients with HMPV infection alone and those with coinfection.

Conclusions Human metapneumovirus pneumonias were detected in nearly half of patients with SOT showing URI symptoms with positive HMPV, and low lymphocyte count and high C-reactive protein at URI diagnosis were significant factors associated with HMPV pneumonia.

This single-center, retrospective analysis describes the risk factors, clinical presentation and outcomes of human metapneumovirus infection detected in nasopharyngeal or bronchoalveolar lavage in 59 recipients of solid organ transplants.

1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2 Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.

3 Infectious Disease Division, Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

4 Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

5 Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea.

6 Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Cancer Center, Seoul, Korea.

Received 3 June 2017. Revision received 12 September 2017.

Accepted 13 September 2017.

The authors declare no funding or conflicts of interest.

H.J.K., H.N.L., S.H.C., and K.H.D. participated in research design. H.J.K., H.N.L., S.H.C., S.Y.O., H.S., and K.H.D. participated in the writing of the paper. H.J.K., H.N.L., S.H.C., S.Y.O., S.Y.S., and K.H.D. participated in the performance of the research. H.J.K., H.J.K., and H.S. contributed new reagents or analytic tools. H.J.K., H.J.K., and K.H.D. participated in data analysis.

Correspondence: Kyung-Hyun Do, MD, PhD, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea. (dokh@amc.seoul.kr).

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