eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Human Metapneumovirus: Differential Diagnoses & Workup

Author: Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Contributor Information and Disclosures

Updated: May 19, 2009

Differential Diagnoses

Bronchiolitis
Parainfluenza Virus Infections
Respiratory Syncytial Virus Infection
Rhinovirus Infection

Workup

Laboratory Studies

  • A general respiratory virus culture obtained by nasal wash or nasopharyngeal swab should be performed in patients with clinical symptoms of lower respiratory tract viral infections.
  • Human metapneumovirus (hMPV) has proven to be difficult to identify using common clinical virologic procedures. Human metapneumovirus replicates slowly in primary cynomolgus monkey kidney cells and poorly in Vero cells and A549 cells (a human respiratory epithelial cell line). Other cell lines commonly used in viral diagnostic laboratories do not appear to support the replication of human metapneumovirus.
  • Commercial reagents to confirm the presence of human metapneumovirus infection are available. Detection techniques that have been developed include virus identification by reverse transcriptase-polymerase chain reaction (RT-PCR), enzyme-linked immunosorbent assay (ELISA), and the rapid culture technique known as shell vial amplification. The clinical sample appropriate for submission to the laboratory may include nasal wash or aspirate fluid, nasopharyngeal flock swab culture, endotracheal tube aspirate, and/or bronchoalveolar lavage fluid.9 To determine the optimal biologic sample, consult directly with the local clinical virology team because the best sample types vary according to the specific tests offered.
  • Further diagnostic evaluation, including a CBC count and a blood culture, may be necessary to exclude invasive bacterial disease.

Imaging Studies

  • Chest radiography is appropriate in patients who present with symptoms of lower respiratory tract disease.

Histologic Findings

  • Currently, histologic findings are unknown.

More on Human Metapneumovirus

Overview: Human Metapneumovirus
Differential Diagnoses & Workup: Human Metapneumovirus
Treatment & Medication: Human Metapneumovirus
Follow-up: Human Metapneumovirus
Multimedia: Human Metapneumovirus
References
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References

  1. van den Hoogen BG, de Jong JC, Groen J, et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med. Jun 2001;7(6):719-24. [Medline].

  2. Walsh EE, Peterson DR, Falsey AR. Human metapneumovirus infections in adults: another piece of the puzzle. Arch Intern Med. Dec 8 2008;168(22):2489-96. [Medline].

  3. Garbino J, Soccal PM, Aubert JD, Rochat T, Meylan P, Thomas Y. Respiratory viruses in bronchoalveolar lavage: a hospital-based cohort study in adults. Thorax. Jan 27 2009;[Medline].

  4. Kamboj M, Gerbin M, Huang CK, Brennan C, Stiles J, Balashov S. Clinical characterization of human metapneumovirus infection among patients with cancer. J Infect. Dec 2008;57(6):464-71. [Medline].

  5. Falsey AR, Dallal GE, Formica MA, Andolina GG, Hamer DH, Leka LL. Long-term care facilities: a cornucopia of viral pathogens. J Am Geriatr Soc. Jul 2008;56(7):1281-5. [Medline].

  6. Falsey AR. Human metapneumovirus infection in adults. Pediatr Infect Dis J. Oct 2008;27(10 Suppl):S80-3. [Medline].

  7. Stempel HE, Martin ET, Kuypers J, Englund JA, Zerr DM. Multiple viral respiratory pathogens in children with bronchiolitis. Acta Paediatr. Jan 2009;98(1):123-6. [Medline].

  8. Paranhos-Baccala G, Komurian-Pradel F, Richard N, Vernet G, Lina B, Floret D. Mixed respiratory virus infections. J Clin Virol. Dec 2008;43(4):407-10. [Medline].

  9. Spyridaki IS, Christodoulou I, de Beer L, Hovland V, Kurowski M, Olszewska-Ziaber A. Comparison of four nasal sampling methods for the detection of viral pathogens by RT-PCR-A GA(2)LEN project. J Virol Methods. Mar 2009;156(1-2):102-6. [Medline].

  10. [Guideline] Bronchiolitis in children. A national clinical guideline. Scottish Intercollegiate Guidelines Network (SIGN). Nov 2006;[Full Text].

  11. [Best Evidence] Doan QH, Kissoon N, Dobson S, et al. A randomized, controlled trial of the impact of early and rapid diagnosis of viral infections in children brought to an emergency department with febrile respiratory tract illnesses. J Pediatr. Jan 2009;154(1):91-5. [Medline].

  12. Hamelin ME, Boivin G. Development and validation of an enzyme-linked immunosorbant assay for human metapneumovirus serology based on recombinant viral protein. Clin Diag Lab Immunol. 2005;12:249-53. [Medline].

  13. Kuypers J, Wright N, Corey L, Morrow R. Detection and quantification of human metapneumovirus in pediatric specimens by real-time RT-PCR. J Clin Virol. 2005;33:299-305. [Medline].

  14. Nissen MD, Siebert DJ, Mackay IM, Sloots TP, Withers SJ. Evidence of human metapneumovirus in Australian children. Med J Aust. Feb 18 2002;176(4):188. [Medline].

  15. Percivalle E, Sarasini A, Visai L, Revello MG, Gerna G. Rapid detection of human metapneumovirus strains in nasopharyngeal aspirates and shell vial cultures by monoclonal antibodies. J Clin Microbiol. Jul 2005;43(7):3443-6. [Medline]. [Full Text].

  16. Robinson JL, Lee BE, Bastien N, Li Y. Seasonality and clinical features of human metapneumovirus infection in children in Northern Alberta. J Med Virol. 2005;76:98-105. [Medline].

  17. Schildgen O, Glatzel T, Geikowski T, et al. Human metapneumovirus RNA in encephalitis patient. Emerg Infect Dis. Mar 2005;11(3):467-70. [Medline].

  18. Suzuki A, Watanabe O, Okamoto M, et al. Detection of human metapneumovirus from children with acute otitis media. Pediatric Infectious Disease Journal. 2005;24:655-7. [Medline].

  19. Tu CC, Chen LK, Lee YS, Ko CF, Chen CM, Yang HH. An outbreak of human metapneumovirus infection in hospitalized psychiatric adult patients in Taiwan. Scand J Infect Dis. Mar 23 2009;1-5. [Medline].

  20. Williams JV, Martino R, Rabella N, et al. A prospective study comparing human metapneumovirus with other respiratory viruses in adults with hematologic malignancies and respiratory tract infections. Journal of Infectious Diseases. 2005;192:1061-5. [Medline].

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Further Reading

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Keywords

human metapneumovirus, hMPV, common cold, bronchiolitis, respiratory failure, respiratory tract infection, respiratory syncytial virus, rhinorrhea, congestion, cough, dyspnea, tachypnea, wheezing, rales, RSV, human respiratory syncytial virus, human pneumovirus, encephalitis, treatment, diagnosis

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Contributor Information and Disclosures

Author

Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine
Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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