• Janet A Englund, Michael Boeckh, Jane Kuypers, W Garrett Nichols, Robert C Hackman, Rhoda A Morrow, David N Fredricks, and Lawrence Corey.
• Children's Hospital and Regional Medical Center, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, Washington 98105, USA. janet.englund@seattlechildrens.org
• Ann. Intern. Med. 2006 Mar 7; 144 (5): 344-9.

BackgroundHuman metapneumovirus (hMPV), a recently discovered respiratory virus, is associated with clinical disease in young and elderly persons.ObjectiveTo determine the importance of hMPV in hematopoietic stem-cell transplant recipients.DesignRetrospective survey of patients with consecutive residual bronchoalveolar lavage (BAL) samples.SettingReferral cancer center.PatientsHematopoietic stem-cell transplant recipients who underwent BAL because of lower respiratory tract disease.MeasurementsBronchoalveolar lavage specimens were assayed by quantitative real-time polymerase chain reaction methods.ResultsHuman metapneumovirus was detected in BAL specimens from 5 of 163 patients (3.0%). Persistent viral infection was noted in 3 patients with several samples, and hMPV was detected in 1 of 2 lung specimens tested. Infected patients became symptomatic within the first 40 days after transplantation. Initial symptoms included fever, cough, nasal congestion, and sore throat. Clinical findings included respiratory failure, pulmonary hemorrhage, and culture-negative septic shock. Four of 5 patients died with acute respiratory failure.LimitationsThis retrospective study did not evaluate asymptomatic patients or those with mild disease.ConclusionHuman metapneumovirus infection in the lower respiratory tract is associated with respiratory failure in immunocompromised adults who were previously considered to have "idiopathic pneumonia." The infection may result in fulminant respiratory decompensation and shock after transplantation.

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