HMPV in Immunocompromised Patients: Frequency and Severity in Pediatric Oncology Patients
Abstract
:1. Childhood Cancer Global Situation
2. Complications Due to Respiratory Viral Infection in Pediatric Oncology
3. Human Metapneumovirus
4. Frequency of Human Metapneumovirus in Pediatric Patients
5. Distribution of Respiratory Viruses in Pediatric Cancer
Virus | Distribution of Viral Agents Found in Nasal Samples (%) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Rhinovirus | 33.1 | 10.0 | 37.0 | 30.8 | 36.5 | 36.8 | -- | 23.1 | 62.7 | 22.7 | -- |
Respiratory Syncytial Virus A/B | 9.5 | 46.0 | 21.7 | 33.3 | 19.5 | 13.6 | 31.0 | 8.7 | 15.0 | 2.1 | 0.0 |
Metapneumovirus A/B | 3.3 | 5.0 | 6.5 | 7.4 | 7.3 | 7.4 | 10.0 | 2.9 | 3.6 | 13.5 | 100 |
Coronavirus (unspecified) | -- | 1.0 | 8.7 | -- | 19.5 | -- | -- | -- | 11.4 | -- | -- |
Coronavirus 63 | 3.7 | -- | -- | -- | -- | 2.5 | -- | 1.0 | -- | -- | -- |
Coronavirus 229 | 3.7 | -- | -- | 24 | -- | 1.2 | -- | 2.9 | -- | -- | -- |
Coronavirus 43 | 7.0 | -- | -- | 1.2 | -- | 1.2 | -- | 2.9 | -- | -- | -- |
Coronavirus HKU | 2.6 | -- | -- | -- | -- | 7.4 | -- | -- | -- | -- | -- |
Cytomegalovirus | -- | -- | -- | 12.8 | -- | ||||||
Influenza (unspecified) | -- | -- | -- | -- | 9.7 | -- | 36.0 | -- | -- | -- | 0.0 |
Influenza A | -- | 2.0 | 2.2 | 11.1 | -- | 11.1 | -- | 1.9 | 8.8 | 14.2 | -- |
Influenza A/H1N1 | 7.7 | 5.0 | -- | -- | -- | -- | -- | 1.0 | -- | -- | -- |
Influenza B | 3.3 | 1.0 | 0.0 | 7.4 | -- | -- | -- | 2.9 | -- | -- | -- |
Influenza C | -- | 1.0 | -- | -- | -- | -- | -- | -- | -- | -- | -- |
Parainfluenza (unspecified) | -- | -- | 30.4 | -- | 9.7 | -- | 18.0 | -- | 16.1 | -- | 0.0 |
Parainfluenza 1 | 1.8 | 5.0 | -- | 3.7 | -- | 0 | -- | -- | -- | 0.7 | -- |
Parainfluenza 2 | 0.5 | -- | -- | 1.2 | -- | 2.5 | -- | 1.0 | -- | 0 | -- |
Parainfluenza 3 | 12.5 | 9.0 | -- | 11.1 | -- | 4.9 | -- | 1.0 | -- | 3.5 | -- |
Parainfluenza 4 | 3.7 | -- | -- | -- | -- | 4.9 | -- | 1.0 | -- | -- | -- |
Bocavirus | 4.8 | 13.0 | 0.0 | -- | 2.4 | 2.5 | -- | -- | 7.8 | 2.8 | -- |
Adenovirus | 3.7 | 2.0 | 4.3 | 3.7 | 7.3 | 3.7 | 0.7 | -- | 4.7 | 14.9 | 0.0 |
Enterovirus | 1.2 | -- | -- | -- | 4.8 | 11.1 | -- | -- | 0.5 | -- | -- |
Herpes simplex virus | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
Varicella zoster virus | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
Codetection of more than one virus | -- | 8.0 | 10.9 | 45.0 | 19.5 | 26.0 | 5.0 | 49.7 | -- | 19.8 | 0.0 |
Samples | NA NPS | NPA G BAL | NPS | S | NS | TS | NPS NPW TA BAL | NPA | NPW TA BAL | TNA PB | NPA |
Condition | ARI | URTI LRTI | RI | RI in ALL survi-vors | RI | ARI | ARI | ARI | URTI LRTI | LRTI and no RI | RI |
Reference | [25] | [24] | [21] | [28] | [22] | [20] | [23] | [19] | [26] | [18] | [27] |
6. Frequency of HMPV Infection in Pediatric Oncology
Underlying Pathology | Type of Study, Number of Patients, Number of Episodes and Age | Infections with Viral Etiology | HMPV Frequency | Co-infections with Other Viruses or Bacteria in HMPV Positive Samples | Fatal Cases with Viral Infection, or Deaths Attributable to Virus | Ref. |
---|---|---|---|---|---|---|
ALL, AML, RB, NHL, NB, rhabdomyosarcoma, JMML. | Prospective 118 patients; 81 patients with FN and ARI; 37 episodes with FN without ARI; inter quartile range 3.2–8 years; Median 4.5 years | 80/118 (67.8%) had at least one virus | 6/118 (5.1%) | 21/118 (17.8%) with two or more viruses | 1 case of influenza H1N1, Klebsiella pneumoniae, and Acinetobacter species; 1 case of HRSV; 1 case of adenovirus plus rhinovirus. | [20] |
ALL, AML, Mixed ALL/AML, lymphoma, CNS tumor, NB, nephroblastoma, soft tissue sarcoma, bone tumors and HSCT | Prospective 224 patients; range 3–11 years; median 5 years | 86/224 (38.4%) of cases had at least one virus | 5/224 (2.2%) | 18/224 (8.0%) with two or more viruses | 5 cases of influenza, parainfluenza, and HRSV | [24] |
ALL, AML, NHL, JMML, Mixed phenotype acute leukemia | Retrospective 74 patients; 93 episodes of respiratory illnesses; range 0–18 years; median 12 years | 46/93 (49.4%) | 3/93 (3.2%) | 21/93 (22.6%) co-infection with bacteria and other pathogens. Co-infection with HMPV is not specified | No | [21] |
ALL, AML, NHL, NB, sarcomas, nephroblastoma, Ewing sarcoma, osteosarcoma, hepatoblastoma, Burkitt lymphoma, HL, CNS tumor, LCH, and RB | Cross-sectional 108 patients; 219 episodes of URI; range 0.4–17 years; median 6.4 years | 170 (77.6%) episodes had at least one virus | 9/108 (3.3%) | None | No | [25] |
ALL survivors after 6 months of therapy | Retrospective 54 patients; 23/54 without RVI and 31/54 with 81 episodes of RVI; range 7.2–18.1 years; median 11.2 years | 31/54 (57%) | 6/81 (7.4%) | No | No | [28] |
AA, AML, ALL CML CLL. HL, NHL, MDS, MM, and solid tumors (unspecified) | Retrospective 90 patients; 181 ARI episodes; range 1–88 years; median 59 years | 181 (100%) | 181 (100%) | 2 (1.1%) co-infected with Stenotrophomonas maltophilia, and Aspergillus terreus | 12 cases positive for HMPV were fatal; 4 deaths were probably associated with HMPV; 2 of them were positive for Stenotrophomonas maltophilia, and Aspergillus terreus | [31] |
Cancer (not specified) | Prospective 48 patients; 72 episodes of acute respiratory symptoms; range 0.6–18 years; median 8 years | 41/72 (57%) | 3/72 (5.5%) | 1/72 (1.4%) adenovirus | No | [22] |
ALL | Retrospective 223 patients; 133 ARI episodes; range 0–18 years; median NR | 95/223 (42.6%) patients with ARI of viral etiology | 13/133 (9.6%) | 1/133 (2.2%) influenza A | No | [23] |
ALL, AML, HL, NHL | Prospective 54 patients; 87 episodes of FN; range 0.5–17.7 years; median 7.0 years | 39/87 (44.8%) With at least one virus | 2/87 (2.2%) | No | No | [29] |
Cancer (not specified) | Prospective 637 samples from patients with RTI; range 0.08–15.1 years; median 1.4 years (both for HMPV positive patients); 3 patients with cancer | 637/637 (100%) | 114/637 (17.9%) 88 patients 3/3 (100%) | 39/88 (44.31%) with other viruses | No | [33] |
Leukemia, lymphoma, and solid tumor (unspecified) | Prospective 525 patients; 1044 FN episodes; range 3–11 years; median NR | 480/1044 (46%) | 12/1044 (1.1%) | 4/1044 (0.4%) rhinovirus 3/1044 (0.3%) HRSV 1/1044 (0.1%) rhinovirus and bocavirus | 2 cases positive for rhinovirus and influenza | [34] |
ALL, HR-NHL, AML, NHL, HR-NHL, HL, Sarcoma, CNS tumor, NB, nephroblastoma, LCH, CML, glioma, osteosarcoma, and hemophagocytic syndrome | Cross-sectional 48 patients; 104 fever and/or respiratory episodes; range NR; median 12 years | NR | 3/104 (2.9%) | 15/104 (14.4%) human rhinovirus | No | [19] |
ALL, Wilms tumor, osteosarcoma, and ovarian cancer, HSCT | Retrospective 55 patients; range 0.4–19 y; median 5 years | 55/55 (100%) | 55 (100%) | 3/55 (5%) 1/55 (2%) Staphylococcus 3/55 (7%) Other 3/55 (7%) | 3 deaths for respiratory failure related to hMPV pneumonia; 2 of them were HSCT recipients, and they were treated with ribavirin and IVIG | [35] |
Leukemia, lymphoma, solid tumor (unspecified,) HSCT, and brain tumor | Prospective 253 patients; 193 ARI episodes; range 0–18 years; median 6 years | 193/253 (76.3%) | 7/193 (3.6%) | 1/253 (0.4%) rhinovirus, bocavirus, and C. pneumoniae | No | [26] |
Leukemia, NB, rhabdomyosarcoma, hepatoblastoma, nasopharyngeal sarcoma, undifferentiated sarcoma, and HSCT | Retrospective 30 patients; range 0–18 years; median 4.5 years | NR | 30/30 (100%) | 6/30 (20%) Staphylococcus and Streptococcus pneumonia (detected in blood) | No | [32] |
ALL, AML, NHL, histiocytosis, LMC, SD, Ewing sarcoma, soft tissue sarcoma, CNS tumor, system, hepatoblastoma, solid tumor (unspecified), rhabdoid intestinal tumor | Retrospective 35 patients; 37 ARI episodes; range 1–17 years; median 8 years | 35/35 (100%) Acute lung injury | 2/35 (5.7%) | 1/35 (2.9%) HRSV | No | [36] |
FN patients including leukemia, lymphoma, and solid tumor (not specified). | Prospective 190 episodes of FN; range 4–12 years; median 7 years | NR | 14/190 (7.4%) | HMPV only infection 2.1%; co-infection with other viruses 3.6%; and co-infection with bacteria in 1.6%. | 1 influenza A | [37] |
ALL. AML HL, NHL, Ewing sarcoma, rhabdomyosarcoma, nephroblastoma, chronic leukemias, lymphomas, solid tumors, hematological diseases, inherited genetic disorders, and primary immunodeficiencies | Prospective 141 patients with or without LRTI with or without respiratory symptoms; range 0.4–17.6 years; mean 10.9 years | 141/141(100%) | 19/141 (13.5%) | 5/141 (3.5%) co-infection with HRSV, influenza A, bocavirus, rhinovirus, or cytomegalovirus | No | [18] |
AML, hemophagocytic lymphohistiocytosis among other hemato-oncological diseases not specified | Retrospective 15 patients; range 0.3–7 years; median 1.6 years | 15/15 (100%) | 15/15 (100%) | No | No | [27] |
ALL | Prospective 51 patients; 138 febrile episodes; range 0.4–15.2 years; mean 5.9 years | NR | 61/138 (44.2%) | 12/138 (8.6%) | 2 rhinovirus and Aspergillus; rhinovirus and Streptococcus mitis | [37] |
Hematological cancer and solid tumors (not specified) | Prospective 66 patients; 250 febrile episodes; Pediatric age (unspecified) | 19/250 (7.6%) | 1/250 (0.4%) | None | 1 (5.5%) death for HRSV pneumonia | [38] |
AML, ALL, CML, CLL, MDS Lymphoma MM, NB, Wiskott–Aldrich Syndrome, SCID, Fanconi anemia, Amyloidosis, Solid tumor (Breast, genitourinary, brain, lung and others) and patients with HSCT | Retrospective and prospective 1899 patients; range NR median 35.9 years; 37% patients were ≤21 years | NR | 51/1899 (2.7%) | NR | None | [39] |
ALL | Retrospective 2 patients with ALL out of 12 pediatric patients hospitalized for respiratory conditions <5 years; median 1.3 years | 2/2 (100%) | 2/2 (100%) | NR | 1 patient with ALL died of ARDS probably due to HMPV | [40] |
Head and neck Burkitt lymphoma | Case report 1 patient of 2 years | NR | One case | No | No patient was treated with ribavirin and IVIG | [41] |
Burkitt lymphoma | Case report 1 patient of 8 years | NR | One case | No | No patient was treated with ribavirin and IVIG | [42] |
ALL | Case report 1 patient of 4 years | NR | One case | No | No patient was treated with ribavirin and IVIG | [43] |
ALL | Case report 1 patient of 0.6 years | -- | One case | No | Patient died probably for HMPV | [44] |
7. Fatal Cases Due to HMPV Infection in Pediatric Patients with an Underlying Oncology Condition
Transplant and Underlying Condition | Type of Study, Number of Patients, and Age | Infections with Viral Etiology | hMPV Frequency/Fatal Cases Due to HMPV Infection | Reference |
---|---|---|---|---|
HSCT. Primary immune deficiency pathologies, leukemia, lymphoma, CNS tumor, solid tumor. | Retrospective study 39 cases of HMPV infection; range 0–18 years; median 6 years | 39 cases of HMPV infection | 39/39 (100%) no fatal cases | [53] |
HSCT. ALL AML, MDS, SAA, inherited marrow failure, primary immune deficiency, NHL, Hodgkin’s disease, CML, metabolic diseases, hemophagocytic lymphohistiocytosis, brain tumors, solid tumors, and thalassemia. | Retrospective study 844 HSCT cases; range 0.1–17.8 years; median 7.5 years | 96 respiratory viral infection | 2/844 (0.1%) no fatal cases | [54] |
HCT. Congenital hematologic disorders, congenital immunodeficiency diseases, paroxysmal nocturnal hemoglobinuria, AA, CML, myelodysplastic syndromes, leukemia and lymphoma, and other hematologic malignancies. | Retrospective and prospective 458 patients with HCT virus were determined before and after HCT 52 pediatric patients <18 years | Positive for virus after 100 days of HCT 27/342 (7.8%); originally negative, and 18/116 (15.5%) originally positive. | 1 fatal case—2 years old patient with AA | [55] |
HSCT. Hematological disease (unspecified) | Prospective 378 patients; range 0.1–17.8 years; median 7.5 years | 166 VRI in 131 out of 378 patients (34.6%) | 12/378 (3.17%) No fatal cases | [56] |
HSCT. AA, SCID, Ewing sarcoma ALL and osteopetrosis | Retrospective 55 patients; range 0.4–19 years; median 5 years | 55 cases of HMPV infection | 55/55 (100%) 2 fatal cases patients were treated with ribavirin and IVIG | [35] |
HSCT. ALD, SAA, PNH, ALL | Retrospective 769 patients; range 3–41 years; mean 18.3 years | 186 (24.6%) | 19/769 (2.5%) no fatal cases | [57] |
HSCT CML | Case report 10 years | 1 | 1 fatal case | [58] |
Autologous HSCT NB. MB, ependymoma, RB, primitive neuroectodermal tumor, Wilms tumor, atypical teratoid/rhabdoid tumor, germ cell tumor, osteosarcoma, T lymphoblastic lymphoma, diffuse large B-cell lymphoma, Ewing sarcoma, malignant fibrous histiocytoma, NHL, lymphoma, Yolk sac tumor. Allogenic HSCT AML, ALL, MPAL, JMML, AA, hemophagocytic lymphohistiocytosis, NB, B Wiskott–Aldrich syndrome, HL T-cell/histiocyte-rich large B-cell lymphoma, Fanconi anemia, MB, and myeloid sarcoma | Retrospective 176 HSCT recipients, Autologous HSCT range 0–19 years; mean 4 years Allogenic HSCT range 0–17 years; mean 6 years | 84/176 (47.7%) with respiratory symptoms | No fatal cases | [47] |
8. Conclusions
9. Methodology
Author Contributions
Funding
Conflicts of Interest
References
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Martinez-Rodriguez, C.; Banos-Lara, M.d.R. HMPV in Immunocompromised Patients: Frequency and Severity in Pediatric Oncology Patients. Pathogens 2020, 9, 51. https://doi.org/10.3390/pathogens9010051
Martinez-Rodriguez C, Banos-Lara MdR. HMPV in Immunocompromised Patients: Frequency and Severity in Pediatric Oncology Patients. Pathogens. 2020; 9(1):51. https://doi.org/10.3390/pathogens9010051
Chicago/Turabian StyleMartinez-Rodriguez, Cesar, and Ma. del Rocio Banos-Lara. 2020. "HMPV in Immunocompromised Patients: Frequency and Severity in Pediatric Oncology Patients" Pathogens 9, no. 1: 51. https://doi.org/10.3390/pathogens9010051
APA StyleMartinez-Rodriguez, C., & Banos-Lara, M. d. R. (2020). HMPV in Immunocompromised Patients: Frequency and Severity in Pediatric Oncology Patients. Pathogens, 9(1), 51. https://doi.org/10.3390/pathogens9010051