Fatal human metapneumovirus and influenza B virus coinfection in an allogeneic hematopoietic stem cell transplant recipient

Human metapneumovirus (hMPV) infection can occur in all age groups with significant morbidity and mortality. Coinfection with influenza virus occurs mainly with influenza type A and all reported cases recovered completely. We report the case of a 61‐year‐old man who had hematopoietic stem cell transplant for myelodysplastic syndrome. He was admitted to hospital for septic shock and neutropenia, and blood culture was positive for Pseudomonas aeruginosa. He rapidly developed respiratory failure and required ventilator support. His respiratory culture grew P. aeruginosa and hMPV. His course was complicated by persistent shock requiring vasopressor support, and repeat nasopharyngeal swab was positive for influenza type B and hMPV. His condition rapidly deteriorated, his family elected comfort care, and the patient died shortly thereafter. Coinfection with hMPV and influenza virus type B may have a poor outcome and can be fatal, especially in immunocompromised patients.     

人偏肺病毒研究进展

2001年荷兰学者van den Hoogen等[1]发现一种新的呼吸道病毒,并暂时命名为人偏肺病毒(human matapneumo virus,hMPV).随后5年里世界各地学者相继投入到这种呼吸道病毒的研究中,不断发现新的呼吸道病毒,如2003年发现SARS-CoV,2004年发现CoV-NL63,2005年发现CoV-HKU1,但仍有许多问题围绕着hMPV有待明了,本文就此展开探讨.     

Asthma exacerbations in children associated with rhinovirus but not human metapneumovirus infection

Children with asthma were studied during the Southern hemisphere winter and summer of 2001-2002. Human rhinovirus (hRV) was significantly associated (P=.0001) with asthma exacerbations in winter and spring/summer, but not in intervening asymptomatic periods. Although hRV was also found in children with upper respiratory tract infection (URTI) who underwent sampling at the same time, it was present in significantly higher numbers of children with symptomatic asthma (P<.0001). Human metapneumovirus was also found in small numbers of children with URTI, but significantly less frequently in children with asthma.     

人偏肺病毒与呼吸道合胞病毒感染后细胞因子改变的比较

人偏肺病毒与呼吸道合胞病毒是呼吸道感染的常见病原体,其感染后的发病机制尚不完全清楚,广泛接受的假说是引起机体固有免疫反应.大量研究显示两者产生不同的细胞因子效应,也提示人偏肺病毒感染的发病机制可能有别于呼吸道合胞病毒.本文就目前国内外对人偏肺病毒感染后与呼吸道合胞病毒细胞因子改变的比较研究进行综述.     

Pneumococcal infections after human bone-marrow transplantation.

Seven of 26 long-term survivors (greater than 7 months post-transplant) of bone-marrow transplantation developed penicillin-sensitive pneumococcal infections more than 7 months after transplantation. One patient had two infections. Six of eight infections were associated with pneumococcal bacteremia, and Streptococcus pneumoniae type 6A was isolated in three cases. Two infections were fatal. All patients had normal nematopoietic function, and none was receiving immunosuppressive therapy. The development of pneumococcal infection was significantly associated with males and with abnormally low or high serum IGG and IgM levels but not with graft-versus-host disease. Serum opsonic activity for S. pneumoniae type 6A was decreased in six of the seven patients when compared to normal pooled serum in an in-vitro bactericidal assay. Four of the six patients with impaired opsonic activity had low serum antibody levels for S. pneumoniae type 6A capsular polysaccharide, while the other two patients had low serum CH100 complement activity. Bone-marrow transplant recipients have an increased susceptibility to pneumococcal infections and should be evaluated for prophylactic penicillin or pneumococcal vaccination.     

Neurological manifestations of coinfection with HIV and human T-lymphotropic virus type 1

HIV-individuals are at risk for human T-lymphotropic virus (HTLV) coinfection and neurological diseases. Little is known about the impact of HAART among coinfected patients. In this study, 47 out of 428 HIV individuals were coinfected with HTLV (10.9%). Coinfection was an independent variable associated with neurological outcome (odds ratio 8.73). Coinfection was associated with myelopathy [chi square (X(2)) = 93, P < 0.001], peripheral neuropathy (X(2) = 6.5, P = 0.01), and hepatitis C virus infection (X(2) = 36.5, P < 0.001). HAART did not appear to protect against neurological diseases and had no impact on HTLV proviral load.     

Pneumococcal pneumonia with bacteraemia

Fourteen cases of pneumococcal pneumonia with bacteraemia have been studied. Thirteen of the patients were older than 50 years and in ten there was evidence of pre-existing disease. Pneumococci of six serotypes were responsible for these infections but type 3 was the commonest and was associated with three of the four fatal cases. The patients who died all had evidence of renal failure. Eight of the ten survivors had prerenal failure which responded to treatment. Hyponatraemia was a common finding. Despite prompt antibiotic treatment and intensive therapy there is still a high morbidity and mortality from this condition.     

SARS, avian influenza, and human metapneumovirus infection

Beginning in the 1950s respiratory viruses have been gradually discovered by isolation in cell cultures The last were the coronaviruses in the 1960s. No new respiratory viruses were discovered until 2001 when human metapneumovirus was found in respiratory specimens from children with bronchiolitis. A year later, in November 2002, severe acute respiratory syndrome (SARS) suddenly appeared as atypical pneumonia. A novel virus belonging to the Coronaviridae family was found to be a cause of this infection. In 2004, a second coronavirus was discovered (CoV-NL63) and in 2005 a third new coronavirus was described (CoV-HKU1). In addition, several subtypes of the influenza A virus, previously known to infect only poultry and wild birds, were recently found to have been directly transmitted to humans. Respiratory infection has been a considerable problem for humans for centuries. Now, in the 21st century, with new associated viruses continuously emerging, it remains an important field for work.     

Prevalence of coinfection with human immunodeficiency virus and hepatitis C virus in Japan

People with human immunodeficiency virus (HIV) infection are frequently infected with hepatitis C virus (HCV), because of the common transmission routes. Since the dissemination of hyperactive antiretrovirus therapy (HAART), the morbidity and mortality associated with HIV infection have declined. However, the reduction in mortality due to opportunistic infection has made HCV-associated liver diseases the leading cause of mortality in Western countries. A similar situation is assumed in Japan, but the status of coinfection with HIV and HCV is unclear. We conducted a nationwide survey to determine the prevalence of coinfection with HIV and HCV by distributing a questionnaire to the hospitals in the HIV/AIDS Network of Japan. Among 4877 patients reported to be HIV-positive, 935 (19.2%) were also positive for the anti-HCV antibody. Most (84.1%) of the patients coinfected with HIV and HCV were recipients of blood products. These data, for the first time, show the current status of coinfection with HIV and HCV in Japan. A detailed analysis of the progression and severity of liver diseases in the coinfected patients is expected.     

粤东地区喘息性疾病患儿中人偏肺病毒的检出与病原学初步研究

目的 了解人类偏肺病毒(hMPV)在粤东地区的感染情况与小儿感染的临床特征.方法 采用逆转录-聚合酶链式反应法(RT-PCR)对粤东地区喘息性疾病儿童和健康体检儿童共323例的鼻咽抽吸物及咽拭子进行hMPV基因筛查,然后随机挑选6份RT-PCR扩增阳性产物进行纯化测序,将测序结果与Genbank中的多株hMPV N蛋白基因序列进行比较和进化树分析.分析hMPV感染患儿的临床资料.结果 240份小儿喘息性疾病呼吸道标本中,检测到hMPV病毒阳性12例(阳性率5%),3、4月份为发病高峰.阳性均为年龄较小患儿.6份hMPV阳性标本目标基因部分核苷酸序列与GenBank中公布的多株hMPV N基因同源性达80.8%～98.4%.核苷酸序列基因进化树分析显示存在2种不同的基因型.12例hMPV阳性患儿均表现咳嗽、低热、及喘息等临床症状;临床诊断为毛细支气管炎8例、喘息型肺炎4例.83份健康体检儿童的呼吸道标本中均未检测到hMPV特异性基因片段.结论 hMPV是粤东地区婴幼儿喘息性疾病的重要病毒性病原体之一.粤东地区流行的hMPV株存在2种不同的基因型.     

High seroprevalence of human metapneumovirus among young children in Israel

Exposure to the newly discovered human metapneumovirus (HMPV) during the first 2 years of life was studied by longitudinal serological analysis in 40 healthy children in southern Israel. The seropositivity rate decreased to a minimum by age 13 months and increased to 52% by age 24 months. Evidence of new infection was detected in 13%, 23%, and 55% of children by ages 7, 13, and 24 months, respectively. The high exposure rates suggest that HMPV may be an important cause of community-acquired respiratory-tract infections in young children.