Diagnostic Considerations

Codetection of Human metapneumovirus (hMPV) with other viral respiratory pathogens has been documented in several studies and reported in various frequencies and different settings, but clinical significance in these situations remains unclear.^{[37, 38, 39, 40]} For example, one prospective cohort study showed that codetection of hMPV with other respiratory viruses was twice higher in outpatient settings than inpatient (22.9% vs 11.7%) that was mostly due to codetected adenovirus.^[71] RSV and hMPV codetection was found in 70% of children with RSV infection who required intensive care in Liverpool, United Kingdom.^[37]In addition, Semple et al showed that the rate of intensive care admissions and mechanical ventilation in patients who had codetection between RSV and hMPV was greater than in infection with either pathogen alone.^[39]However, other studies have not shown that codetection plays a significant role in disease severity.^{[38, 41]} There are multiple reports showing hMPV codetection with SARS-CoV-2.^{[75, 73, 74]} However, further research is needed to definitively elucidate the clinical impact of codetection.

Differential Diagnoses

Adenovirus
Bacterial Pharyngitis
Bocavirus
Bronchiolitis
Influenza
Human Parainfluenza Viruses (HPIV) and Other Parainfluenza Viruses
Picornavirus Infections
Respiratory Syncytial Virus Infection
Rhinovirus (RV) Infection (Common Cold)
Viral Pharyngitis
Viral Pneumonia

Workup

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Media Gallery

Phylogenetic tree showing sequence analysis of human metapneumovirus (hMPV).
Phylogenetic tree of human metapneumovirus (hMPV) strains. Courtesy of Microorganisms [Nao N, Saikusa M, Sato K, et al. Recent Molecular Evolution of Human Metapneumovirus (HMPV): Subdivision of HMPV A2b Strains. Microorganisms. 2020 Sep;8(9):1280. Online at: https://www.mdpi.com/2076-2607/8/9/1280.].
Phylogenetic analysis of the L-proteins of members of the family Paramyxoviridae. Courtesy of ICTV 9th Report on Virus Classification and Taxon Nomenclature (2011) [https://talk.ictvonline.org/ictv-reports/ictv_9th_report/negative-sense-rna-viruses-2011/w/negrna_viruses/200/paramyxoviridae-figures].

of 3

Author

Varvara Probst, MD Resident Physician, Department of Pediatrics University of Florida College of Medicine

Varvara Probst, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Ayesha Mirza, MD Associate Professor of Pediatric Infectious Diseases, University of Florida College of Medicine-Jacksonville

Ayesha Mirza, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Tropical Medicine and Hygiene, HIV Medicine Association, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University School of Medicine in Shreveport; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Michael Rajnik, MD Associate Professor, Department of Pediatrics, Program Director, Pediatric Infectious Disease Fellowship Program, Uniformed Services University of the Health Sciences

Michael Rajnik, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

Ashley Maranich, MD Pediatric Infectious Disease Staff, San Antonio Military Medical Center, Wilford Hall Medical Center

Disclosure: Nothing to disclose.

Aliyah Baluch, MD, MSc, FACP Assistant Professor of Medicine, Department of Oncologic Sciences, University of South Florida Morsani College of Medicine; Assistant Member, Division of Infectious Diseases, Department of Internal Medicine, Moffitt Cancer Center

Aliyah Baluch, MD, MSc, FACP is a member of the following medical societies: American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Transplantation, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Michael D Nissen, MBBS, FRACP, FRCPA, Theodorus P Sloots, PhD, and David Siebert, MD, to the development and writing of this article.

Human Metapneumovirus Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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