Anja Wilkesmann

Hospitalized children with respiratory syncytial virus infection and neuromuscular impairment face an increased risk of a complicated course

Background: Respiratory syncytial virus (RSV) infection is an important cause of viral respiratory tract infection in children. In contrast to other confirmed risk factors that predispose to a higher morbidity and mortality, the particular risk of a preexisting neuromuscular impairment (NMI) in hospitalized children with RSV infection has not been prospectively studied in a multicenter trial. Methods: The DMS RSV Paed database was designed for the prospective multicenter documentation and analysis of all clinically relevant aspects of the management of inpatients with RSV infection. Patients with clinically relevant NMI were identified according to the specific comments of the attending physicians and compared with those without NMI. Results: This study covers 6 consecutive seasons; the surveillance took place in 14 pediatric hospitals in Germany from 1999 to 2005. In total, 1568 RSV infections were prospectively documented in 1541 pediatric patients. Of these, 73 (4.7%) patients displayed a clinically relevant NMI; 41 (56%) NMI patients had at least 1 additional risk factor for a severe course of the infection (multiple risk factors in some patients; prematurity in 30, congenital heart disease in 19, chronic lung disease 6 and immunodeficiency in 8). Median age at diagnosis was higher in NMI patients (14 vs. 5 months); NMI patients had a greater risk of seizures (15.1% vs. 1.6%), and a higher proportion in the NMI group had to be mechanically ventilated (9.6% vs. 1.9%). Eventually, the attributable mortality was significantly higher in the NMI group (5.5% vs. 0.2%; P < 0.001 for all). Multivariate logistic regression confirmed that NMI was independently associated with pediatric intensive care unit (PICU) admission (OR, 4.94; 95% CI, 2.69–8.94; P < 0.001] and mechanical ventilation (OR, 3.85; 95% CI, 1.28–10.22; P = 0.017). Conclusion: This is the first prospective multicenter study confirming the hypothesis that children with clinically relevant NMI face an increased risk for severe RSV-disease. It seems reasonable to include NMI as a cofactor into the decision algorithm of passive immunization.

Human Metapneumovirus RNA in Encephalitis Patient

We describe a fatal case of encephalitis that might be correlated with primary human metapneumovirus (HMPV) encephalitis. Postmortem HMPV RNA was detected in brain and lung tissue samples from the patient. Furthermore, HMPV RNA was found in culture fluids from cells coincubated with lung tissue.

The human metapneumovirus: biology, epidemiological features, and clinical characteristics of infection

In 2001 a hitherto unknown, and important human virus pathogen, human metapneumovirus (hMPV) was identified. This virus was classified as the single human member of the Metapneumovirus genus of the family Paramyxoviridae. hMPV is related to avian metapneumoviruses and respiratory syncytial virus (RSV). Similar to the latter, hMPV is the aetiological agent of a large number of acute respiratory tract illnesses in both children and adults. In infected humans, hMPV causes mild-to-severe respiratory tract diseases, including bronchitis, bronchiolitis, and pneumonia. Infections caused by hMPV have been linked to an increased risk of asthma exacerbations and, according to some preliminary data, may also contribute to the development of acute neurological conditions. Laboratory diagnosis of hMPV infection is based on virus isolation in cell cultures and/or detection of viral RNA by PCR. Reported animal models of hMPV infection, including mice, cotton rats, hamsters, and primates, appear to be extremely useful for investigation of many characteristics of hMPV infection, including pathogenesis and antiviral immunity. Most recent studies based on the use of the reverse genetic technique reported the development of several experimental hMPV vaccine prototypes. These vaccines candidates were able to induce neutralizing serum antibodies and conferred protection of hamsters or non-human primates against subsequent challenge with wild-type hMPV.