Journal of Clinical Pediatrics >
Clinical analysis of 558 hospitalized children with human metapneumovirus pneumonia
Received date: 2022-03-07
Online published: 2023-06-12
Objective To analyze the clinical characteristics of human metapneumovirus (hMPV) pneumonia in children and the risk factors for severe hMPV pneumonia. Methods The clinical data of children with hMPV pneumonia hospitalized from October 2020 to March 2021 were retrospectively analyzed. The patients were divided into mild group and severe group for comparative analysis. Results A total of 558 patients (309 boys and 249 girls) with hMPV pneumonia were included, and the median age was 3.4 (1.7-4.4) years. There were 515 children in mild group and 43 in severe group. One hundred and nine children were complicated with underlying disease. Compared with the mild group, the severe group had a higher proportion of children younger than 3 years old and with a history of underlying diseases, and the difference was statistically significant (P<0.05). The main clinical manifestations of children with hMPV pneumonia were fever (85.0%), cough (96.4%), wheezing (39.8%) and pulmonary moist rales (74.0%). Extra-pulmonary manifestations such as vomiting were rare. One hundred and thirteen patients had bacterial infection, and Streptococcus pneumoniae was the commonest (54 cases). The rate of antibiotic use was higher in hospitalized children with hMPV pneumonia (50.7%, 283 cases). The proportion of wheezing, shortness of breath, wheezing sound, pleural effusion and atelectasis, the level of WBC and CRP in peripheral blood and the proportion of bacterial infection in the severe group were higher than those in the mild group, and the difference was statistically significant (P<0.05). Compared with the mild group, the proportion of oxygen therapy, alveolar lavage, antibiotics and systemic glucocorticoids use in the severe group was higher, the hospital stay was longer, and the difference was statistically significant (P<0.05). Binary logistic regression analysis showed that age <3 years old, wheezing, complicated underlying diseases and CRP≥25mg/L were risk factors for severe hMPV pneumonia (P<0.05). Conclusions The main manifestations of hMPV are fever, cough, wheezing and moist rale in the lungs which is easy to be complicated with bacterial infection, but extra-pulmonary complications are rare and the overall prognosis is good. However, for children < 3 years old, children with wheezing, underlying disease, and elevated CRP need to be alert to severe pneumonia.
Key words: human metapneumovirus; pneumonia; hospitalized; child
Xiaolan LIU , Xiaojuan LUO , Zhiguan FENG , Chunyan LIU , Yanmin BAO , Yuejie ZHENG . Clinical analysis of 558 hospitalized children with human metapneumovirus pneumonia[J]. Journal of Clinical Pediatrics, 2023 , 41(6) : 459 -463 . DOI: 10.12372/jcp.2023.22e0294
[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[J]. Nat Med, 2001, 7: 719-724. |
[2] | 花盛浩, 邵雪君, 徐俊. 新型冠状病毒肺炎常态化防控下儿童常见呼吸道病毒感染谱的变化[J]. 中华传染病杂志, 2021, 39(10): 621-625. |
[3] | Li L, Wang H, Liu A, et al. Comparison of 11 respiratory pathogens among hospitalized children before and during the COVID-19 epidemic in Shenzhen, China[J]. Virol J, 2021, 18: 202. |
[4] | 中华人民共和国国家健康委员会, 国家中医药局. 儿童社区获得性肺炎诊疗规范(2019年版)[J]. 中华临床感染病杂志, 2019, 12(1): 6-13. |
[5] | Sarkar S, Ratho RK, Singh M, et al. Comparative analysis of epidemiology, clinical features, and cytokine response of respiratory syncytial and human metapneumovirus infected children with acute lower respiratory infections[J]. Jpn J Infect Dis, 2022, 75(1): 56-62. |
[6] | Jongbloed M, Leijte WT, Linssen CFM, et al. Clinical impact of human metapneumovirus infections before and during the COVID-19 pandemic[J]. Infect Dis (Lond), 2021, 53: 488-497. |
[7] | Liu WK, Chen DH, Tan WP, et al. Paramyxoviruses respiratory syncytial virus, parainfluenza virus, and human metapneumovirus infection in pediatric hospitalized patients and climate correlation in a subtropical region of southern China: a 7-year survey[J]. Eur J Clin Microbiol Infect Dis, 2019, 38: 2355-2364. |
[8] | Lim YK, Kweon OJ, Kim HR, et al. Clinical features, epidemiology, and climatic impact of genotype-specific human metapneumovirus infections: long-term surveillance of hospitalized patients in South Korea[J]. Clin Infect Dis, 2020, 70: 2683-2694. |
[9] | Zhu R, Guo C, Zhao L, et al. Epidemiological and genetic characteristics of human metapneumovirus in pediatric patients across six consecutive seasons in Beijing, China.[J]. Int J Infect Dis, 2020, 91: 137-142. |
[10] | 胡倩, 郑跃杰, 王文建, 等. 儿童腺病毒肺炎541例临床特点分析[J]. 中华实用儿科临床杂志, 2021, 36(16): 1230-1234. |
[11] | Howard LM, Edwards KM, Zhu Y, et al. Clinical features of human metapneumovirus-associated community-acquired pneumonia hospitalizations[J]. Clin Infect Dis, 2021, 72(1): 108-117. |
[12] | Williams JV, Harris PA, Tollefson SJ et al. Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children[J]. N Engl J Med, 2004, 350(5): 443-450. |
[13] | Taniguchi A, Kawada JI, Go K, et al. Comparison of clinical characteristics of human metapneumovirus and respiratory syncytial virus infections in hospitalized young children[J]. Jpn J Infect Dis, 2019, 72: 237-242. |
[14] | Marinari LA, Danny MA, Simpson SA, et al. Lower respiratory tract infection with human metapneumovirus: chest CT Imaging features and comparison with other viruses[J]. Eur J Radiol, 2020, 128: 108988. |
[15] | 顾文婧, 季伟, 张新星, 等. 混合感染因素对呼吸道偏肺病毒感染临床特征的影响[J]. 中华实用儿科临床杂志, 2017, 32(10): 730-734. |
[16] | Evelyn O, Jaime FS, David M, et al. Prevalence, clinical outcomes and rainfall association of acute respiratory infection by human metapneumovirus in children in Bogotá, Colombia.[J]. BMC Pediatr, 2019, 19: 345. |
[17] | Schreiner D, Groendahl B, Puppe W, et al. High antibiotic prescription rates in hospitalized children with human metapneumovirus infection in comparison to RSV infection emphasize the value of point-of-care diagnostics[J]. Infection, 2019, 47: 201-207. |
[18] | Driscoll AJ, Deloria Knoll M, Hammitt LL, et al. The effect of antibiotic exposure and specimen volume on the detection of bacterial pathogens in children with pneumonia[J]. Clin Infect Dis, 2017, 64: S368-S377. |
[19] | Papenburg J, Alghounaim M. Unraveling the pneumonia burden associated with human metapneumovirus infection[J]. Clin Infect Dis, 2021, 72: 118-120. |
[20] | 崔爱利, 谢智博, 余鹏博, 等. 2009年至2021年我国9省份发热呼吸道症候群病例中人偏肺病毒感染情况及流行特征分析[J]. 中华实用儿科临床杂志, 2021, 36(24): 1861-1865. |
[21] | Kasundriya SK, Dhaneria M, Mathur A, et al. Incidence and risk factors for severe pneumonia in children hospitalized with pneumonia in Ujjain, India[J]. Int J Environ Res Public Health, 2020, 17: 13. |
[22] | Shan W, Shi T, Chen K, et al. Risk factors for severe community-aquired pneumonia among children hospitalized with CAP younger than 5 years of age[J]. Pediatr Infect Dis J, 2019, 38: 224-229. |
[23] | Cherchi C, Chiarini Testa MB, Deriu D, et al. All you need is evidence: what we know about pneumonia in children with neuromuscular diseases[J]. Front Pediatr, 2021, 9: 625751. |
/
〈 |
|
〉 |