Human  metapneumovirus
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Human metapneumovirus

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What is human metapneumovirus ,features,presentation ,diagnosis ,treatment and prevention

What is human metapneumovirus ,features,presentation ,diagnosis ,treatment and prevention

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Human  metapneumovirus Human metapneumovirus Presentation Transcript

  • Human Metapneumovirus Prof. Dr. Saad S Al Ani Senior Pediatric Consultant Head of Pediatric Department Khorfakkan Hospital Sharjah ,UAE [email_address]
  • Human Metapneumovirus (hMPV)
    • hMPV is associated with a substantial number of upper respiratory infections ( URI ) and episodes of acute otitis media ( AOM ).
    Williams JV, Wang CK, Yang CF, et al :  The role of human metapneumovirus in upper respiratory tract infections in children: a 20-year experience.   J Infect Dis   2006; 193:387-395
  • Cont.
    • hMPV was first described in 2001 by Dutch investigators. (1)
    • It is a member of the Pneumovirus subfamily of the Paramyxoviridae that includes respiratory syncytial virus (RSV) .
    ( 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.   Nat Med  2001; 7:719-724.
  • Cont.
    • It is pleomorphic with a lipid envelope.
    • Single-stranded RNA genome
    ( 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.   Nat Med  2001; 7:719-724.
  • Cont.
    • These illnesses are neither clinically nor radiographically distinct from the same clinical syndromes caused by other common respiratory viruses .
    • hMPV can cause severe infections in immunocompromised hosts
    • Transmission of hMPV likely occurs via respiratory droplets and secretions, similar to RSV
    van den Hoogen BG, de Jong JC, Groen J, et al :  A newly discovered human pneumovirus isolated from young children with respiratory tract disease .   Nat Med   2001; 7:719-724.
  • Cont.
    • Clinical manifestations of hMPV infection are generally similar to those caused by other respiratory viruses and include:
    • * Bronchiolitis
    • * Croup
    • * Pneumonia
    • * Asthma exacerbation.
    Osterhaus A, Fouchier R :  Human metapneumovirus in the community.   Lancet   2003; 361:890-891.
  • Cont.
    • Hospitalizations occur more common in children or adults with underlying conditions such as:
    • * Prematurety
    • * Asthma
    • * Immune compromisation
    • * Cardiopulmonary disease s .
    Williams JV, Tollefson SJ, Heymann PW, et al :  Human metapneumovirus infection in children hospitalized for wheezing.   J Allergy Clin Immunol   2005; 115:1311-1312
  • Bar in the image represents 10 nm. Glycoprotein spikes are visible in viral membrane and extruded nucleocapsid is visible below Human Metapneumovirus
  • Epidemiology
    • Annual epidemics during the late winter and early spring months in temperate locations
    • The peak incidence of hMPV usually occurs 1 to 2 months later than the peak of RSV .
    • The percentage of hMPV detection varies from 6% to 15% among patients with acute respiratory tract infection
    • van den Hoogen BG, van Doornum GJ, Fockens JC, et al: Prevalence and clinical symptoms of human metapneumovirus infection in hospitalized patients.   J Infect Dis   2003; 188:1571-1577.
    • Esper F, Martinello RA, Boucher D, et al: A 1-year experience with human metapneumovirus in children aged < 5 years. J Infect Dis 2004; 189:1388-1396
    • Osterhaus A, Fouchier R: Human metapneumovirus in the community.   Lancet   2003; 361:890-891 .
  • Cont.
    • Peak age of hospitalization for hMPV occurs between 6 and 12 months of age
    • hMPV - infected children have higher rates of underlying disease than RSV - infected children .
    • Thanasugarn W, Samransamruajkit R, Vanapongtipagorn P, et al :  Human metapneumovirus infection in Thai children.   Scand J Infect Dis   2003; 35:754-756
    • Bosis S, Esposito S, Niesters HG, et al :  Impact of human metapneumovirus in childhood: comparison with respiratory syncytial virus and influenza viruses.   J Med Virol   2005; 75:101-104.
  • Clinical Manifestations
    • * Upper respiratory tract symptoms, including:
    • - Rhinorrhea
    • - Cough
    • - Fever .
    • - Conjunctivitis
    • - Vomiting, Diarrhea , Rash are occasionally
    • reported
    Noyola DE, Alpuche - Solis AG, Herrera - Diaz A, et al :  Human metapneumovirus infections in Mexico: epidemiological and clinical characteristics.   J Med Microbiol   2005; 54:969-974
  • Cont.
    • * Lower respiratory tract syndromes most frequently associated with hMPV infection are:
    • - bronchiolitis
    • - croup
    • - pneumonia
    • - asthma exacerbation .
    Noyola DE, Alpuche - Solis AG, Herrera - Diaz A, et al :  Human metapneumovirus infections in Mexico: epidemiological and clinical characteristics.   J Med Microbiol   2005; 54:969-974
    • Infancy
    • 1.Bronchiolitis
    • 2.Pneumonia 
    • 3.Croup 
    • 4.Exacerbation of asthma 
    • 5. Upper respiratory tract infection 
    • 6.Acute otitis media
    Clinical Manifestations at Various Ages Takao S, Shimozono H, Kashiwa H, et al :  Clinical study of pediatric cases of acute respiratory diseases associated with human metapneumovirus in Japan.   Jpn J Infect Dis   2003; 56:127-129.
  • Cont.
    • Older children / adults
    • 1. Croup
    •   2. Laryngitis 
    •   3. Bronchitis 
    •   4. Asthma exacerbation 
    •   5. Pneumonia (elderly) 
    •   6.Exacerbation of chronic obstructive pulmonary
    • disease (elderly)
    Takao S, Shimozono H, Kashiwa H, et al :  Clinical study of pediatric cases of acute respiratory diseases associated with human metapneumovirus in Japan.   Jpn J Infect Dis   2003; 56:127-129.
  • Diagnosis
    • There is no commercially available rapid antigen test for hMPV
    • In general, reliable diagnosis of hMPV currently depends on molecular techniques based on standard or real-time RT-PCR assays.
    • Bellau - Pujol S, Vabret A, Legrand L, et al :  Development of three multiplex RT - PCR assays for the detection of 12 respiratory RNA viruses .   J Virol Methods   2005; 126:53-63.
    • Lopez - Huertas MR, Casas I, Acosta - Herrera B, et al :  Two RT - PCR based assays to detect human metapneumovirus in nasopharyngeal aspirates.   J Virol Methods   2005; 129:1-7.
  • Treatment
    • The majority of children infected with hMPV can be managed at home with supportive care.
    • For hospitalized infants and children the primary therapies are supplementary oxygen and intravenous hydration.
    • Bronchodilators and corticosteroids ?
    • Ribavirin and polyclonal human immunoglobulin?(1)
    (1)Hamelin ME, Prince GA, Boivin G :  Effect of ribavirin and glucocorticoid treatment in a mouse model of human metapneumovirus infection.   Antimicrob Agents Chemother   2006; 50:774-777.
  • Prevention
    • Recombinant hMPV strains that lack various genes
    • Highly immunogenic, inducing neutralizing antibodies and protection against challenge with wild-type hMPV.
    • Several potential vaccine candidates are in development within 3 years of the discovery of hMPV,
    • Tang RS, Mahmood K, Macphail M, et al :  A host - range restricted parainfluenza virus type 3 ( PIV3 ) expressing the human metapneumovirus (hMPV) fusion protein elicits protective immunity in African green monkeys.   Vaccine   2005; 23:1657-1667.
    • Biacchesi S, Skiadopoulos MH, Yang L, et al: Recombinant human metapneumovirus lacking the small hydrophobic SH and/or attachment G glycoprotein: deletion of G yields a promising vaccine candidate. J Virol 2004; 78:12877-12887 .
    • Thank you