Das humane Metapneumovirus als Erreger von Atemwegsinfektionen bei hospitalisierten Kindern - eine Übersicht

Zusammenfassung

Besonders bei Säuglingen im zweiten Lebenshalbjahr und bei Kleinkindern scheint das im Jahr 2001 von van den Hoogen erstmals beschriebene humane Metapneumovirus (HMPV) eine herausragende Rolle als Erreger von Atemwegsinfektionen zu spielen. Vor dem Hintergrund der bis Anfang 2005 publizierten Studien und eigener, retrospektiv analysierter Daten aus zwei konsekutiven Winterperioden (2002-2004) wird in dieser Übersicht das HMPV aus der Perspektive der klinischen Pädiatrie, das heißt mit besonderem Augenmerk auf verfügbaren Informationen zu hospitalisierten Kindern vorgestellt. Dabei bestätigt sich, dass bei hospitalisierten Kindern ein erheblicher Anteil Risikofaktoren für einen komplizierten Verlauf aufweist. Besondere bei Frühgeborenen treten vermehrt Apnoen im Verlauf der HMPV-Infektion auf. Auch wenn die erste HMPV-Infektion in der Regel später auftritt als die RSV-Primärinfektion, verlaufen HMPV-Infektionen nicht generell milder. Klinische und radiologische Zeichen lassen keine ätiologische Zuordnung zu einem bestimmten Erreger zu, was die Bedeutung der gezielten virologischen Diagnostik mittels PCR unterstreicht. HMPV kann auch segmentale und lobäre Pneumonien auslösen. Kinder mit Exazerbation eines Asthma bronchiale oder einer zystischen Fibrose sollten in den Wintermonaten nicht nur auf RSV, sondern auch auf HMPV getestet werden. Prospektive Studien zu therapeutischen Interventionen und zur Bedeutung und Prävention nosokomialer HMPVInfektionen werden erwartet. Obwohl bislang erst von einem Fall berichtet wurde, sollte bei unklarer Meningoenzephalitis auch eine HMPV-PCR durchgeführt werden.

Abstract

The human Metapneumovirus (HMPV) has been discovered by von den Hoogen et al. in 2001 and seems to play an important role as etiologic agent in childhood respiratory tract infections in particular involving infants after the 6th month of life and toddlers. Duly considering the hitherto published studies and retrospective analysis of two HMPV seasons (2002-2004) at our institution this review focuses on children, who had to be hospitalized due to HMPV infection. The analysis confirmed, that among those patients there is a high proportion of children with pre-existing risk factors for a complicated clinical course, a high proportion of children with bronchiolitis or pneumonia and a relevant proportion of children with HMPV related apnoeas, most prevalent in the prematurely born. Although the first HMPV infection takes place somewhat later in infancy, the data do not show that HMPV infection is in general milder than RSV infection in hospitalized children. Clinical symptoms and radiological signs do not permit tentative conclusions on the causative agent. This underlines the necessity of specific diagnostic efforts (in case of HMPV with PCR). HMPV may cause lobar or segmental pneumonias difficult to distinguish from bacterial lower respiratory tract infection. Children admitted to the hospital with an acute exacerbation of asthma bronchiale or cystic fibrosis should not only be tested for RSV but also for HMPV. Prospective studies investigating specific therapeutic interventions or describing the impact and prevention of nosocomial HMPV in fection are awaited for. There has been one report of a meningoencephalitis possibly related to HMPV. Thus, liquor samples in such cases should be tested for HMPV too.

Schlüsselwörter

Humanes Metapneumovirus - hospitalisierte Patienten - Pneumonie - Bronchiolitis

Key words

human metapneumovirus - hospitalized patients - pneumonia - bronchiolitis

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