Chest radiographic features of human metapneumovirus infection in pediatric patients
Human metapneumovirus (HMPV) was identified in 2001 and is a common cause of acute respiratory illness in young children. The radiologic characteristics of laboratory-confirmed HMPV acute respiratory illness in young children have not been systematically assessed.
We systematically evaluated the radiographic characteristics of acute respiratory illness associated with HMPV in a prospective cohort of pediatric patients.
Materials and methods
We included chest radiographs from children <5 years old with acute respiratory illness who were enrolled in the prospective New Vaccine Surveillance Network (NVSN) study from 2003 to 2009 and were diagnosed with HMPV by reverse transcription-polymerase chain reaction (RT-PCR). Of 215 HMPV-positive subjects enrolled at our tertiary care children’s hospital, 68 had chest radiographs obtained by the treating clinician that were available for review. Two fellowship-trained pediatric radiologists, independently and then in consensus, retrospectively evaluated these chest radiographs for their radiographic features.
Parahilar opacities were the most commonly observed abnormality, occurring in 87% of children with HMPV. Hyperinflation also occurred frequently (69%). Atelectasis (40%) and consolidation (18%) appeared less frequently. Pleural effusion and pneumothorax were not seen on any radiographs.
The clinical presentations of HMPV include bronchiolitis, croup and pneumonia. Dominant chest radiographic abnormalities include parahilar opacities and hyperinflation, with occasional consolidation. Recognition of the imaging patterns seen with common viral illnesses like respiratory syncytial virus (RSV) and HMPV might facilitate diagnosis and limit unnecessary antibiotic treatment.
KeywordsBronchiolitis Chest Children Human metapneumovirus Infection Lungs Radiography Respiratory tract
This work was supported by grants from the Centers for Disease Control and Prevention (CDC) U38 CCU417958 and U01 IP000022 (K.M.E., M.R.G.) and the National Institutes of Health (NIH) AI-085062 (J.V.W.). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.
Compliance with ethical standards
Conflicts of interest
J.V. Williams is on the Scientific Advisory Board for Quidel, Inc., and the Independent Data Monitoring Committee for GlaxoSmithKline. M.A. Hilmes, F.D. Dunnavant, S.P. Singh, W.D. Ellis, D.C. Payne, Y. Zhu, M.R. Griffin and K.M. Edwards have no conflicts to disclose.
- 7.Martinello RA, Esper F, Weibel C et al (2006) Human metapneumovirus and exacerbations of chronic obstructive pulmonary disease. J Inf Secur 53:248–254Google Scholar
- 22.Bradley JS, Byington CL, Shah SS et al (2011) Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 53:617–630CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Syha R, Beck R, Hetzel J et al (2012) Human metapneumovirus (HMPV) associated pulmonary infections in immunocompromised adults — initial CT findings, disease course and comparison to respiratory-syncytial-virus (RSV) induced pulmonary infections. Eur J Radiol 81:4173–4178CrossRefPubMedGoogle Scholar