Human metapneumovirus and community-acquired respiratory illness in children. (Letters).
To the Editor: Stockton et al. have reported the detection of human metapneumovirus (HMPV) by using reverse transcriptase-polymerase chain reaction (PCR PCR polymerase chain reaction.
polymerase chain reaction
Polymerase chain reaction (PCR) ) in patients with influenzalike illness (1). These authors examined specimens submitted from patients, mainly adults, during winter 2000-01 and identified HMPV in 2.2% of patients with influenzalike illness who had tested negative for influenza virus and human respiratory syncytial virus Human respiratory syncytial virus (RSV) is a negative-sense, single-stranded RNA virus of the family Paramyxoviridae, which includes common respiratory viruses such as those causing measles and mumps. (HRSV HRSV Human Respiratory Syncytial Virus ). Although several papers have been published on HMPV infection in children (2-4), the real impact of this virus on the health of the pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children.
Of or relating to pediatrics. population remains to be determined. The data we obtained in the present study support the epidemiologic findings of J. Stockton et al. (1) and reinforce the notion that HMPV is a human pathogen associated with community-acquired acute respiratory tract infection Noun 1. respiratory tract infection - any infection of the respiratory tract
infection - the pathological state resulting from the invasion of the body by pathogenic microorganisms (ARTI).
We investigated the occurrence of HMPV in children <3 years of age with ARTI during two consecutive winter seasons (November 2000-February 2001 and November 2001-February 2002) as part of a study to detect respiratory viruses (HRSV, influenza A and B viruses, parainfluenza virus types 1-4, and adenovirus adenovirus
Any of a group of spheroidal viruses, made up of DNA wrapped in a protein coat, that cause sore throat and fever in humans, hepatitis in dogs, and several diseases in fowl, mice, cattle, pigs, and monkeys. ) among the pediatric population. The study population comprised 565 children who were brought to Hospital Donostia, San Sebastian, Spain, with reported symptoms of ARTI, most of which (>80%) affected the lower respiratory tract Noun 1. lower respiratory tract - the bronchi and lungs
lung - either of two saclike respiratory organs in the chest of vertebrates; serves to remove carbon dioxide and provide oxygen to the blood . Of these children, 379 were hospitalized and 186 were discharged without admission. Hospital Donostia belongs to the public health system and is the main referral hospital for a population of 9,500 children <3 years of age. More than 97% of hospitalizations of children in our region occur in this hospital.
pertaining to the nasal and pharyngeal cavities.
see nasopharyngeal meatus.
see reverse sneeze. aspirates were obtained and processed for cell culture by using rapid shell vial techniques on the MDCK MDCK Madin-Darby Canine Kidney Cells (virus tissue culture) , A-549, and LLC-MK2 cell lines. RNA RNA: see nucleic acid.
in full ribonucleic acid
One of the two main types of nucleic acid (the other being DNA), which functions in cellular protein synthesis in all living cells and replaces DNA as the carrier of genetic was then extracted from the original samples by using phenol-chloroform (TRIzol LS Reagent, Invitrogen Corp., Carlsbad, U.K.) and was converted into cDNA with random primers by using M-MuLV reverse transcriptase (USB USB
in full Universal Serial Bus
Type of serial bus that allows peripheral devices (disks, modems, printers, digitizers, data gloves, etc.) to be easily connected to a computer. Corp., Cleveland, OH). Nested PCR was performed to detect HRSV, influenza, and parainfluenza viruses as previously described (5,6). The remaining cDNA was frozen at -80[degrees]C until subsequent use. We tested for HMPV in all samples that tested negative for the previously studied viruses, as well as in 100 randomly selected study samples that were positive for one or more of these viruses. HMPV detection was performed by PCR by using 5 [micro]L of stored cDNA with primers derived from the F gene under previously described conditions (7). The PCR product (450 bp) from the HMPV-positive samples was sequenced in an ABI Abi (ā`bī) [short for Abijah], in the Bible, King Hezekiah's mother.
(Application Binary Interface) A specification for a specific hardware platform combined with the operating system. PRISM 3100 Genetic Analyzer (Applied Biosystems, Foster City, CA).
In 411 (72.7%) of the 565 patients studied, at least one of the initially investigated viruses was detected. HRSV was found in 313 (55.4%) children, influenza in 44 (7.8%), parainfluenza parainfluenza Infectious disease A virus that causes URIs–up to 50% of croup and 10–15% of bronchiolitis, bronchitis, pneumonias in toddlers Clinical Rhinorrhea, cold-like Sx Risk factors Preschool children; by school age most children have been exposed in 36 (6.4%), and adenovirus in 32 (5.7%); 14 mixed infections were detected. Of 154 children with a negative result, HMPV detection was performed in 147 (95.5%), with a positive result in six children (4.1%). No HMPV was detected in any of the 100 samples previously positive for the initially studied respiratory viruses. Four of the six HMPV-positive children required hospitalization: a 7-month-old boy with pulmonary bronchodysplasia, rhinitis, and fever of 38.4[degrees]C (patient 1); a 20-month-old girl with previous obstructive pulmonary disease who had acute respiratory insufficiency along with generalized hypoventilation hypoventilation /hy·po·ven·ti·la·tion/ (-ven?ti-la´shun) reduction in amount of air entering pulmonary alveoli.
primary alveolar hypoventilation , crackles, wheezing, and radiologic images of air entrapment entrapment, in law, the instigation of a crime in the attempt to obtain cause for a criminal prosecution. Situations in which a government operative merely provides the occasion for the commission of a criminal act (e.g. requiring bronchodilator bronchodilator /bron·cho·di·la·tor/ (-di´la-ter)
1. expanding the lumina of the air passages of the lungs.
2. an agent which causes dilatation of the bronchi. administration (patient 2); a 16-month-old girl who had a febrile syndrome, basal crackles on pulmonary auscultation auscultation
Procedure for detecting certain defects or conditions by listening for normal and abnormal heart, breath, bowel, fetal, and other sounds in the body. The invention of the stethoscope in 1819 improved and expanded this practice, still very useful despite the , and perihilar infiltrates (patient 3); and an 11-month-old boy with pneumonia of the upper left lobe (patient 4). The two remaining patients, a 7-month-old boy (patient 5) and a 9-month-old girl (patient 6), both with upper respiratory symptoms and clear chest, did not require hospitalization. In all six patients, outcome was favorable
Analysis of the amplified sequences showed two clusters of HMPV. The first was composed of HMPV from patients 1, 3, 4, and 6 (GenBank accession nos. AY152846, AY152851, AY152850, and AY152847, respectively), and the second was composed of HMPV from patients 2 and 5 (GenBank accession nos. AY152849 and AY152848). The similarity among nucleotide sequences in the same cluster was [greater than or equal to] 95% and oscillated from 86% to 88% when compared to those from a different cluster. During the second study season, we observed circulation of both clusters. When we compared these sequences of HMPV F gene obtained in Spain with those recently described in North America (7), we found that the sequences of the first cluster showed [greater than or equal to] 95% similarity with the isolate CAN97-83 (GenBank accession no. AY145296), and the sequences from the second cluster showed [greater than or equal to] 95% similarity with isolates CAN98-73 to CAN98-79 (GenBank accession nos. AY 145287-AY 145293), connecting the Canadian isolates to two well characterized groups of HMPV. Our results suggest that in Spain, as well as in other places in the world (2,7), two major HMPV groups exist. The severity of the episodes observed varied from mild upper respiratory symptoms to severe infections requiring hospitalization for 2-6 days. Overall, as reported by other authors (2,8), the clinical picture provoked by HMPV was indistinguishable from that of other respiratory viruses. The fact that HMPV was not detected in any of the samples from patients also positive for other respiratory viruses suggests that coinfection is infrequent. The data reported in our study, obtained during two consecutive winter seasons in a pediatric population of southern Europe, allow us to estimate that the incidence of moderate or severe respiratory infections caused by HMPV is low and that the impact of the other respiratory viruses is considerably greater. Despite these results, we think that this new respiratory pathogen warrants surveillance. HMPV appears to be capable of provoking severe infections, and its role in human respiratory infections is still poorly understood.
(1.) Stockton J, Stephenson I, Fleming D, Zambon M. Human Metapneumovirus as a cause of community-acquired respiratory illness. Emerg Infect Dis 2002;8:897-901.
(2.) Van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de Groot R, Fouchier RA, et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 2001;7:719-24.
(3.) Jartti T, van den Hoogen B, Garofalo RP, Osterhaus AD, Ruuskanen O. Metapneumovirus and acute wheezing in children. Lancet 2002;360:1393-4.
(4.) Freymouth F, Vabret A, Legrand L, Eterradossi N, Lafay-Delaire F, Brouard J, et al. Presence of the new human metapneumovirus in French children with bronchiolitis Bronchiolitis Definition
Bronchiolitis is an acute viral infection of the small air passages of the lungs called the bronchioles.
Bronchiolitis is extremely common. . Pediatr Infect Dis J 2003;22:92-4.
(5.) Stockton J, Ellis JS, Saville M, Clewley JP, Zambon MC. Multiplex PCR for typing and subtyping influenza and respiratory syncytial viruses. J Clin Microbiol 1998;36: 2990-5.
(6.) Aguilar JC, Perez-Brena MP, Garcia ML, Cruz N, Erdman DD, Echevarria JE. Detection and identification of human parainfluenza viruses Human parainfluenza viruses (HPIVs) are a group of four distinct serotypes of single-stranded RNA viruses belonging to the paramyxovirus family. They are the second most common cause of lower respiratory tract infection in younger children. 1, 2, 3, and 4 in clinical samples of pediatric patients by multiplex reverse transcription-PCR. J Clin Microbiol 2000;38:1191-5.
(7.) Peret TC, Boivin G, Li Y, Couillard M, Humphrey C, Osterhaus AD, et al. Characterization of human metapneumoviruses isolated from patients in North America. J Infect Dis 2002; 185:1660-3.
(8.) Nissen MD, Siebert DJ, Mackay IM, Sloots TP, Withers SJ. Evidence of human metapneumovirus in Australian children. Med J Aust 2002; 176:188.
Address for correspondence: Emilio Perez-Trallero, Servicio de Microbiologia, Hospital Donostia, Paseo Dr. Beguiristain s/n, 20014 San Sebastian, Spain; fax: +34 94 300 7063; email: email@example.com
Diego Vicente, * Gustavo Cilla, * Milagrosa Montes, * and Emilio Perez-Trallero * ([dagger])
* Hospital Donostia, San Sebastian, Spain; and ([dagger]) Universidad del Pais Vasco, San Sebastian, Spain