Determinants of radiological patterns and severity in immunocompromised adults with Metapneumovirus infection - 20/05/24

Doi : 10.1016/j.rmed.2024.107604

A. Al-Hamoud ^a, N. Pansu ^b, A.-L. Brun ^c, N. Etienne ^b, E. Farfour ^d, V. Avettand-Fenoel ^e,^f, C. Rouzaud ^b, A. Roux ^a,^g, F. Suarez ^h, H. Salvator ^a,^g, A. Serris ^b, E. Catherinot ^a,^⁎,^{^{1
Both authors contributed equally to this work.}} , O. Lortholary ^b,^{^{1
Both authors contributed equally to this work.}}
^a Service de Pneumologie, Hôpital Foch, Suresnes, France
^b Université Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Paris, France
^c Service d’Imagerie Médicale, Hôpital Foch, Suresnes, France
^d Laboratoire de Microbiologie, Hôpital Foch, Suresnes, France
^e Laboratoire de Virologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
^f Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
^g Université Versailles Saint Quentin, UMR0892 INRAe-UVSQ, Faculté des Sciences de la Vie Simone Veil, Montigny le Bretonneux, France
^h Service d’Hématologie, Hôpital Necker-Enfants Malades, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France

^⁎Corresponding author. Service de Pneumologie, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France.Service de PneumologieHôpital Foch40 rue WorthSuresnes92150France

Abstract

Background

Human Metapneumovirus (HMPV) belongs to the Pneumoviridae family and is responsible for respiratory infections. Mild infections are well-recognized in children, while its precise impact in various categories of immunocompromised adults has not been well addressed.

Research question

We retrospectively studied HMPV infections in immunocompromised adults followed in two large French university medical centers.

Study design and methods

We identified immunocompromised adults with positive HMPV Polymerase Chain Reaction (PCR) for 36 months and reviewed their medical charts. For lung transplant recipients (LTR), FEV1 was collected at baseline, during and after infection. Imaging was centralized and chest involvement was categorized by dominant CT patterns. We compared severe patients (requiring oxygen or ventilation) and non hypoxemic patients.

Results

Seventy-two patients were included, 27 were LTR, 25 had a hematological malignancy or were hematopoietic stem cell recipients, 20 had another immunocompromised status. Twenty patients (28%) presented a hypoxemic infection, requiring hospitalization and intensive care units transfers in 50/72 (69.4%) and 9/72 (12.5%) respectively, with only one death. Hypoxemia was less pronounced in LTRs (p = 0.014). Finally, age and dyspnea remained independent factors associated with hypoxemia (p < 0.005). The most frequent radiological patterns were bronchopneumonia (34.2%) and bronchiolitis (39.5% and 64.3% in the overall population and in LTRs respectively, p = 0.045). FEV1 improved in LTRs at one month and 85% had recovered their baseline FEV1 within 6 months.

Interpretations

In immunocompromised adults, HMPV infections required frequent hospitalizations and ICU transfers, while mortality is low. In LTRs, bronchiolitis pattern was predominant with short and long-term favorable outcome.

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Highlights

•	In immunocompromised adults, HMPV infections required frequent hospitalizations and ICU transfers, while mortality is low.
•	Most of the patients with an available CT-scan had evidence of airway infection such as bronchitis, bronchiolitis or bronchopneumonia.
•	In lung transplant recipients, bronchiolitis pattern was predominant.
•	A significant FEV1 loss during infection occurred in most of lung transplant recipients and a new CLAD was observed in 14%.

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Keywords list (MeSH terms) : Human metapneumovirus, Immunocompromised, Lower respiratory tract infection, Bronchiolitis, lung transplantation, Hematological malignancy

Plan

Introduction

Materials/methods

Diagnostic strategy

Immunocompromised conditions

CRediT authorship contribution statement

☆	Parts of this work was presented at the RICAI (Réunion interdisciplinaire de chimiothérapie anti-infectieuse) conference in 2021 (CO-112) and the 2022 CPLF (Congrès de Pneumologie de Langue Française) conference (Rev Mal Resp Actualités. 2022; 14(1):251–252).

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Determinants of radiological patterns and severity in immunocompromised adults with Metapneumovirus infection - 20/05/24

Abstract

Background

Research question

Study design and methods

Results

Interpretations

Highlights

Plan

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