Lower Respiratory Tract Infection with Human Metapneumovirus: Chest CT Imaging Features and Comparison with Other Viruses. Issue 128 (July 2020)

• Record Type: Journal Article
• Authors: Marinari, Lawrence A.; Danny, Madeline A.; Simpson, Scott A.; Schmitt, James E.; Miller, Wallace T.
• Is Part Of: European journal of radiology. Issue 128(2020)
• Publication Date: 2020-07
• Subjects: BWT bronchial wall thickening -- GGO ground glass opacities -- hMPV human metapneumovirus -- LRTI lower respiratory tract infection -- PIV parainfluenza virus -- RSV respiratory syncytial virus -- RT-PCR reverse transcription polymerase chain reaction -- TIB tree-in-bud; Metapneumovirus -- Respiratory Tract Infections -- pneumonia -- Tomography -- Spiral Computed -- Diagnostic imaging; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.108988
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Metapneumovirus(hMPV) often causes bronchopneumonia resembling bacterial pneumonia hMPV CT findings are tree-in-bud opacities and bronchocentric consolidation or GGO Paramyxoviridea, hMPV, RSV and parainfluenza, cause airway centric lung infections Abstract: Purpose: Human metapneumovirus has been increasingly identified as a cause of lower respiratory tract infection in adults worldwide. The CT imaging features of human metapneumovirus in adults have not been characterized. The purpose of this paper is to determine the imaging features of human metapneumovirus and to compare them with features of other viruses. Methods: Two clinicians retrospectively reviewed the medical records of 104 adults with lower respiratory tract infection due to human metapneumovirus at four hospitals in the northeast USA over 32 months. CT images were evaluated by two chest radiologists for airspace consolidation, bronchiectasis, bronchial wall thickening, ground-glass opacities, pleural effusion and tree-in-bud opacities and the dominant imaging pattern. Results for human metapneumovirus were compared with results previously reported for other viruses. Results: Human metapneumovirus predominantly caused an airway-centric pattern (71-81/104, 68-77%) of infection characterized by bronchial wall thickening, tree-in-bud opacities, peri-bronchial consolidation and/or peri-bronchial ground-glass opacities. The airway-centric pattern has been previously reported with other paramyxoviridae (parainfluenza virus and respiratory syncytial virus). However, human metapneumovirus was significantly more likely (p = 0.03-0.001) to cause bronchopneumonia (46-55%) than parainfluenza virus (17%) or respiratory syncytial virus (21%). Follow-up CT in 41 (39%) patients with hMPV revealed resolution of findings in 38/41 (91%). Conclusion: The paramyxoviridae, including human metapneumovirus, are known to have a propensity to infect ciliated respiratory cells and we have demonstrated this leads to a propensity to cause bronchitis, bronchiolitis and bronchopneumonia on CT scans. Of these, human metapneumovirus is most likely to cause bronchopneumonia. Healthcare providers should consider human metapneumovirus as a cause of pneumonia on chest CT.