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Pediatric Viral Pneumonia
Published in Sunit K. Singh, Human Respiratory Viral Infections, 2014
Human metapneumovirus was recognized 10–15 years ago,18 and shares many properties with RSV, including human beings as the only hosts, a similar seasonality, a similar age distribution, and nearly identical clinical and laboratory features.19 Human metapneumovirus can be identified by culture, PCR and antibody assays. Sero-epidemiological studies have indicated that virtually all children are infected with human metapneumovirus by school age.20 The clinical picture of human metapneumovirus infection has varied from mild common cold to severe pneumonia with high fever and generalized symptoms.19 In the United States, pneumonia has been diagnosed in about 10% of infants admitted for human metapneumovirus infection.18,19 Human metapneumovirus was identified by PCR in 8% of 1296 Israeli children with CAP,21 and an antibody response to hMPV in paired sera was documented in 5% of 101 Italian children with CAP.22 Without any doubt, human metapneumovirus is an etiological agent in pediatric CAP, but the prevalence is less than 10% of viral CAP, and the role is limited to infants and young children.
Disseminated infection to immune activation
Published in Baylor University Medical Center Proceedings, 2018
A 61-year-old woman with rheumatoid arthritis on infliximab presented with fever and cough, for which a course of levofloxacin was completed. Symptoms persisted 1 month later, and the patient developed painless jaundice, prompting return to the hospital. On admission, she was febrile with a temperature of 39°C and tachycardic with a heart rate of 111 beats per minute. On physical examination, scleral icterus was present, her skin was jaundiced, and enlargement of the liver was noted. Computed tomography of the abdomen revealed hepatosplenomegaly, and computed tomography of the thorax demonstrated bilateral perihilar ground-glass opacities. Hepatitis A, B, and C serology was negative. A respiratory panel was positive for metapneumovirus. Broad-spectrum antibiotics were started with vancomycin and piperacillin/tazobactam, but all cultures remained negative for the first week of hospitalization. The patient developed worsening cytopenias throughout her hospitalization, with a low fibrinogen level of 82 mg/dL and elevated triglyceride level of 453 mg/dL. Ferritin was initially elevated and serial levels showed an upward trend to >20,000 ng/mL.
Treatment of infections in cancer patients: an update from the neutropenia, infection and myelosuppression study group of the Multinational Association for Supportive Care in Cancer (MASCC)
Published in Expert Review of Clinical Pharmacology, 2021
Bernardo L. Rapoport, Tim Cooksley, Douglas B. Johnson, Ronald Anderson, Vickie R. Shannon
Cancer and its therapy frequently induce functional and absolute lymphopenia. Most induction chemotherapy regimens exert their effects through the depletion of lymphocytes [117]. Lymphocyte-depleting agents, including anti-thymocyte agents, calcineurin inhibitors, monoclonal antibodies (alemtuzumab, rituximab), rapamycin (mTOR) inhibitors (sirolimus, everolimus) are notorious causes of lymphopenia. Conventional radiation therapy and treatment of GVHD following allogeneic HSCT are other known causes of lymphopenia [118,119]. Immune reconstitution may take a year or longer after HSCT, and other lymphocyte-depleting therapies have been completed [120,121]. Impaired lymphocyte function has been reported following viral illnesses caused by influenza and RSV in previously healthy individuals [122]. Severe lymphopenia, defined as absolute lymphocyte count <200 cells/mL, is identified as an independent risk factor for severe pneumonia caused by a variety of viral pathogens, including CMV, respiratory syncytial virus (RSV), influenza virus, parainfluenza virus (PIV), human rhinovirus (HRV), human enterovirus (HEV), and coronavirus (CoV), particularly among patients with hematologic malignancies and recipients of HSCT [123–127]. Community-acquired pneumonia associated with human metapneumovirus (hMPV) was first reported in 2001 and is now recognized as a leading cause of upper and lower respiratory tract infections, particularly in children, elderly adults, and immunocompromised hosts. Although most patients present with mild disease, fatal cases of hMPV pneumonia have been reported [128,129]. Like many of the other viruses, lymphopenia appears to be the most important risk factor for progression to lower respiratory tract disease progression.
Progress in the development of virus-like particle vaccines against respiratory viruses
Published in Expert Review of Vaccines, 2020
Fu-Shi Quan, Swarnendu Basak, Ki-Back Chu, Sung Soo Kim, Sang-Moo Kang
Another important respiratory virus is human metapneumovirus (HMPV) which is also a leading cause of acute lower respiratory tract infection globally. Pediatric population and immunocompromised patients are greatly susceptible to HMPV, causing substantial morbidity and mortality worldwide [11,12]. However, there is currently no HMPV-specific vaccine available.