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Al-Hamoud A, Pansu N, Brun AL, Etienne N, Farfour E, Avettand-Fenoel V, Rouzaud C, Roux A, Suarez F, Salvator H, Serris A, Catherinot E, Lortholary O. Determinants of radiological patterns and severity in immunocompromised adults with Metapneumovirus infection. Respir Med 2024; 227:107604. [PMID: 38492818 DOI: 10.1016/j.rmed.2024.107604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/05/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Human Metapneumovirus (HMPV) belongs to the Pneumoviridae family and is responsible for respiratory infections. Mild infections are well-recognized in children, while its precise impact in various categories of immunocompromised adults has not been well addressed. RESEARCH QUESTION We retrospectively studied HMPV infections in immunocompromised adults followed in two large French university medical centers. STUDY DESIGN AND METHODS We identified immunocompromised adults with positive HMPV Polymerase Chain Reaction (PCR) for 36 months and reviewed their medical charts. For lung transplant recipients (LTR), FEV1 was collected at baseline, during and after infection. Imaging was centralized and chest involvement was categorized by dominant CT patterns. We compared severe patients (requiring oxygen or ventilation) and non hypoxemic patients. RESULTS Seventy-two patients were included, 27 were LTR, 25 had a hematological malignancy or were hematopoietic stem cell recipients, 20 had another immunocompromised status. Twenty patients (28%) presented a hypoxemic infection, requiring hospitalization and intensive care units transfers in 50/72 (69.4%) and 9/72 (12.5%) respectively, with only one death. Hypoxemia was less pronounced in LTRs (p = 0.014). Finally, age and dyspnea remained independent factors associated with hypoxemia (p < 0.005). The most frequent radiological patterns were bronchopneumonia (34.2%) and bronchiolitis (39.5% and 64.3% in the overall population and in LTRs respectively, p = 0.045). FEV1 improved in LTRs at one month and 85% had recovered their baseline FEV1 within 6 months. INTERPRETATIONS In immunocompromised adults, HMPV infections required frequent hospitalizations and ICU transfers, while mortality is low. In LTRs, bronchiolitis pattern was predominant with short and long-term favorable outcome.
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Affiliation(s)
- A Al-Hamoud
- Service de Pneumologie, Hôpital Foch, Suresnes, France
| | - N Pansu
- Université Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A-L Brun
- Service d'Imagerie Médicale, Hôpital Foch, Suresnes, France
| | - N Etienne
- Université Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - E Farfour
- Laboratoire de Microbiologie, Hôpital Foch, Suresnes, France
| | - V Avettand-Fenoel
- Laboratoire de Virologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
| | - C Rouzaud
- Université Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A Roux
- Service de Pneumologie, Hôpital Foch, Suresnes, France; Université Versailles Saint Quentin, UMR0892 INRAe-UVSQ, Faculté des Sciences de la Vie Simone Veil, Montigny le Bretonneux, France
| | - F Suarez
- Service d'Hématologie, Hôpital Necker-Enfants Malades, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - H Salvator
- Service de Pneumologie, Hôpital Foch, Suresnes, France; Université Versailles Saint Quentin, UMR0892 INRAe-UVSQ, Faculté des Sciences de la Vie Simone Veil, Montigny le Bretonneux, France
| | - A Serris
- Université Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - E Catherinot
- Service de Pneumologie, Hôpital Foch, Suresnes, France.
| | - O Lortholary
- Université Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Paris, France
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Febbo J, Revels J, Ketai L. Viral Pneumonias. Infect Dis Clin North Am 2024; 38:163-182. [PMID: 38280762 DOI: 10.1016/j.idc.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Viral pneumonia is usually community acquired and caused by influenza, parainfluenza, respiratory syncytial virus, human metapneumovirus, and adenovirus. Many of these infections are airway centric and chest imaging demonstrates bronchiolitis and bronchopneumonia, With the exception of adenovirus infections, the presence of lobar consolidation usually suggests bacterial coinfection. Community-acquired viral pathogens can cause more severe pneumonia in immunocompromised hosts, who are also susceptible to CMV and varicella infection. These latter 2 pathogens are less likely to manifest the striking airway-centric pattern. Airway-centric pattern is distinctly uncommon in Hantavirus pulmonary syndrome, a rare environmentally acquired infection with high mortality.
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Affiliation(s)
- Jennifer Febbo
- University of New Mexico, 2211 Lomas Boulevard NE, Albuquerque, NM 87106, USA.
| | - Jonathan Revels
- University of New Mexico, 2211 Lomas Boulevard NE, Albuquerque, NM 87106, USA
| | - Loren Ketai
- Department of Radiology, MSC 10 5530, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
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Riccò M, Corrado S, Palmieri S, Marchesi F. Respiratory Syncytial Virus: A Systematic Review and Meta-Analysis of Tomographic Findings (2000-2022). CHILDREN (BASEL, SWITZERLAND) 2023; 10:1169. [PMID: 37508666 PMCID: PMC10378054 DOI: 10.3390/children10071169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
Human respiratory syncytial virus (RSV) is a main cause of medical referrals and hospitalizations in all infants, particularly among newborns. Nevertheless, relatively limited evidence on chest tomography (CT) findings has been collected. According to the PRISMA statement, Pubmed, Embase, and medRxiv were searched for eligible observational studies published up to 31 December 2022. Cases were categorized in children and adolescents (age < 18 years), adults and elderly (age ≥ 18 years), and immunocompromised patients, and then pooled in a random-effects model. Heterogeneity was assessed using the I2 statistics, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 10 studies (217 RSV cases) were retrieved (children, 37.3%; immunocompromised, 41.0%; adults, 21.7%). The most common features were signs of organizing pneumonia (33.65%, 95% confidence interval [95% CI] 22.39-47.27), followed by septal thickening (33.19%, 95% CI 21.76-47.03), ground glass opacities (GGOs; 28.03%, 95% CI 14.69-46.82), and tree-in-bud (TIB, 27.44%, 95% CI 15.04-44.68). Interestingly, up to 16.23% (95% CI 8.17-29.69) showed normal findings, while the large majority (76.06%, 95% CI 64.81-84.56) were characterized by bilateral involvement. Studies were highly heterogeneous without substantial reporting bias. Assuming children and adolescents as reference groups, healthy adults were characterized by a higher risk ratio [RR] for septal thickening (RR 3.878, 95% CI 1.253-12.000), nodular lesions (RR 20.197, 95% CI 1.286-317.082), and GGOs (RR 2.121, 95% CI 1.121-4.013). RSV cases are rarely assessed in terms of CT characteristics. Our study identified some specificities, suggesting that RSV infections evolve heterogeneous CT features in children/adolescents and adults, but the paucity of studies recommends a cautious appraisal.
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Affiliation(s)
- Matteo Riccò
- Local Health Unit of Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Silvia Corrado
- UOC Pediatria, Dipartimento della Donna e Area Materno-Infantile, ASST Rhodense, 20024 Garbagnate Milanese, Italy
| | - Sara Palmieri
- Dipartimento Diagnostica per Immagini, ASST Spedali Civili di Brescia, Radiologia 1, 25123 Brescia, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Ketai L, Febbo J, Busby HK, Sheehan EB. Community-Acquired Pneumonia: Postpandemic, Not Post-COVID-19. Semin Respir Crit Care Med 2022; 43:924-935. [PMID: 36442476 DOI: 10.1055/s-0042-1755186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic upended our approach to imaging community-acquired pneumonia, and this will alter our diagnostic algorithms for years to come. In light of these changes, it is worthwhile to consider several postpandemic scenarios of community-acquired pneumonia: (1) patient with pneumonia and recent positive COVID-19 testing; (2) patient with air space opacities and history of prior COVID-19 pneumonia (weeks earlier); (3) multifocal pneumonia with negative or unknown COVID-19 status; and (4) lobar or sublobar pneumonia with negative or unknown COVID-19 status. In the setting of positive COVID-19 testing and typical radiologic findings, the diagnosis of COVID-19 pneumonia is generally secure. The diagnosis prompts vigilance for thromboembolic disease acutely and, in severely ill patients, for invasive fungal disease. Persistent or recurrent air space opacities following COVID-19 infection may more often represent organizing pneumonia than secondary infection. When COVID-19 status is unknown or negative, widespread airway-centric disease suggests infection with mycoplasma, Haemophilus influenzae, or several respiratory viruses. Necrotizing pneumonia favors infection with pneumococcus, Staphylococcus, Klebsiella, and anaerobes. Lobar or sublobar pneumonia will continue to suggest the diagnosis of pneumococcus or consideration of other pathogens in the setting of local outbreaks. A positive COVID-19 test accompanied by these imaging patterns may suggest coinfection with one of the above pathogens, or when the prevalence of COVID-19 is very low, a false positive COVID-19 test. Clinicians may still proceed with testing for COVID-19 when radiologic patterns are atypical for COVID-19, dependent on the patient's exposure history and the local epidemiology of the virus.
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Affiliation(s)
- Loren Ketai
- Department of Radiology, University of New Mexico HSC, Albuquerque, New Mexico
| | - Jennifer Febbo
- Department of Radiology, University of New Mexico HSC, Albuquerque, New Mexico
| | - Hellen K Busby
- Department of Internal Medicine, Pulmonary Division, University of New Mexico HSC, Albuquerque, New Mexico
| | - Elyce B Sheehan
- Department of Internal Medicine, Pulmonary Division, University of New Mexico HSC, Albuquerque, New Mexico
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Febbo JA, Ketai L. Emerging Pulmonary Infections in Clinical Practice. ADVANCES IN CLINICAL RADIOLOGY 2021; 3:103-124. [PMID: 38620910 PMCID: PMC8169325 DOI: 10.1016/j.yacr.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Jennifer Ann Febbo
- Department of Radiology, University of New Mexico, 2211 Lomas Boulevard Northeast, Albuquerque, NM 87106, USA
| | - Loren Ketai
- Department of Radiology, University of New Mexico, 2211 Lomas Boulevard Northeast, Albuquerque, NM 87106, USA
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