2009/05/01 by Rolando Ulloa‐Gutiérrez, Félix Vargas-Jiménez, Adriana Mora-Chavarría +3 · 1 voice · 1 citation
Medicine · #Respiratory viral infections research #Congenital Diaphragmatic Hernia Studies #Tracheal and airway disorders
paper · doi:10.1097/inf.0b013e31819d0c64
openalex publication_date 2009/05/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/31
To the Editors: The impact of human metapneumovirus (hMPV) in Latin America is unknown. The first pediatric reports were from South America (Brazil and Argentina)1,2; since then, hMPV has been reported also in México, Chile, Uruguay, Perú, and Cuba.3 After reviewing the English language indexed literature, we found no previous reports in children or adults from Central America. We describe the first 9 pediatric cases of hMPV disease in Costa Rica. These patients were admitted to the only pediatric tertiary referral and teaching hospital of Costa Rica, between November 3 and December 23, 2008. This is the only site where hMPV testing is performed, and direct immunofluorescence assay (DFA) (Light Diagnostics, Chemicon) is the only available technique for hMPV detection at our center. It was implemented at the end of October 2008, following September’s peak of respiratory syncytial virus (RSV). All samples were obtained by nasopharyngeal aspirate washings and were tested by DFA for respiratory syncytial virus, adenovirus, hMPV, influenza A and B, and parainfluenza types 1, 2, and 3. Nine patients were documented to have hMPV infection. Five patients (55.5%) were boys and the ages ranged from 24 days to 25 months of life. Mean length of hospitalization was 4.6 (range 2–11) days. Three patients had past medical problems, which included epilepsy, prematurity, low birth weight, bronchopulmonary dysplasia, and previous hospitalizations for acute bronchiolitis. Household sick contacts were reported in 5 patients. The 3 most common symptoms were cough, fever, and respiratory distress in 8, 8, and 7 patients, respectively; the number of days of symptoms ranged from 2 to 15. Physical findings included tachypnea in 9, retractions in 9, tachycardia in 8, crepitations in 5, pharyngeal erythema in 4, and wheezing in 3 patients. A clinical diagnosis of acute bronchiolitis and viral pneumonia was made in 7 and 2 patients, respectively. No dual viral infection was documented. Case 8, in whom a pertussis-like cough and cyanosis were described, had negative PCR testing for Bordetella pertussis and B. parapertussis. Mean leukocyte count was 13, 342 cells/mm3 (range, 4810–19,220). Chest radiographic findings included pulmonary infiltrates in 5 and air trapping in 4 patients. All children required oxygen administration, but none required mechanical ventilation or admission to the pediatric intensive care unit. Intravenous dexamethasone and nebulized salbutamol were required in 1 (11%) and 6 (67%) patients, respectively. The current standard test for laboratory diagnosis of hMPV is reverse transcription PCR. However, it may not be available in many laboratories around the world. Therefore, DFA is a satisfactory alternative, with recent studies supporting its adequate sensitivity and specificity.4,5 Rolando Ulloa-Gutierrez, MD Servicio de Infectología Pediátrica Hospital Nacional de Niños de Costa Rica “Dr. Carlos Sáenz Herrera” San José, Costa Rica Félix Vargas-Jiménez, MD Adriana Mora-Chavarría, MD Maria A. Umaña, MD Mónica Calvo-Espinoza, MD Departamento de Medicina Hospital Nacional de Niños de Costa Rica “Dr. Carlos Sáenz Herrera” San José, Costa Rica Wilbert Alfaro-Bourrouet, MSc División de Laboratorio de Inmunología Hospital Nacional de Niños de Costa Rica “Dr. Carlos Sáenz Herrera” San José, Costa Rica