Metapneumovirus - hMPV

  • Diagnosis
  • Background
  • Lab Tests
  • References
  • Related Topics

Indications for Testing

  • Immunocompromised patients, older adults, and children with severe respiratory illness

Laboratory Testing

  • Collection of high-quality, cellular respiratory specimen required for best results
  • Direct fluorescent antibody (DFA) staining – most rapid and useful test
  • Polymerase chain reaction – most sensitive test
    • Use to confirm negative DFA in cases with suspicion
  • Culture – not recommended because organism cannot be isolated from conventionally used cell lines
  • Consider concurrent viral testing for influenza, RSV, adenovirus, bocavirus
    • May also consider testing for atypical pneumonia agents – Mycoplasma pneumoniae, Chlamydophila pneumoniae

Differential Diagnosis

The human metapneumovirus (hMPV) is a recently (2001) discovered agent of viral respiratory infections.

Epidemiology

  • Prevalence – accounts for 5-10% of respiratory infections in hospitalized children and 10-20% of infections in outpatient clinics
  • Age – usually in children <10 years
    • By 5 years, nearly all children show evidence of past infection
  • Occurrence – peak season November through May
  • Transmission – airborne droplet, close contact

Organism

  • Single-stranded RNA virus
  • Member of the Paramyxoviridae family
  • Strains A and B concurrent
  • Reinfection circulate possible

Risk Factors

  • Age – children <10, adults >55
  • Compromised immune system
  • Chronic medical condition (cardiac, pulmonary, hepatic)

Clinical Presentation

  • Clinical symptoms indistinguishable from respiratory syncytial virus (RSV)
  • Symptoms range from common cold to severe lower respiratory tract infections such as bronchitis and pneumonia
  • Usual symptoms include coughing/wheezing, hypoxia, fever
  • May exacerbate asthma and may play an etiological role in its development
  • Coinfection with RSV and adenovirus common and usually associated with more severe disease
Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Human Metapneumovirus DFA 0060779
Method: Direct Fluorescent Antibody Stain

Limitations 

Sample requires adequate amount of intact cells

Human Metapneumovirus by RT-PCR 0060784
Method: Qualitative Polymerase Chain Reaction

Limitations 

Negative result does not rule out the presence of PCR inhibitors in the patient specimen or human metapneumovirus nucleic acid concentrations below the level of assay detection

General References

Hermos CR, Vargas SO, McAdam AJ. Human metapneumovirus. Clin Lab Med. 2010; 30(1): 131-48. PubMed

Kahn JS. Newly identified respiratory viruses. Pediatr Infect Dis J. 2007; 26(8): 745-6. PubMed

Kroll JL, Weinberg A. Human metapneumovirus. Semin Respir Crit Care Med. 2011; 32(4): 447-53. PubMed

Schildgen V, van den Hoogen B, Fouchier R, Tripp RA, Alvarez R, Manoha C, Williams J, Schildgen O. Human Metapneumovirus: lessons learned over the first decade. Clin Microbiol Rev. 2011; 24(4): 734-54. PubMed

The National Respiratory and Enteric Virus Surveillance System (NREVSS). Human Metapneumovirus (HMPV) Clinical Features. Center for Disease Control and Prevention. Atlanta, GA [Last Updated Feb 2016; Accessed: May 2016]

References from the ARUP Institute for Clinical and Experimental Pathology®

Couturier MR, Barney T, Alger G, Hymas WC, Stevenson JB, Hillyard D, Daly JA. Evaluation of the FilmArray® Respiratory Panel for clinical use in a large children's hospital. J Clin Lab Anal. 2013; 27(2): 148-54. PubMed

Medical Reviewers

Last Update: September 2016