DOI QR코드

DOI QR Code

젊은 성인 환자에서 인간 메타뉴모바이러스 폐렴에 의한 급성 호흡곤란증후군

A Case of Metapneumovirus Pneumonia-Related Acute Respiratory Distress Syndrome in a Young Adult Patient

  • 김태완 (중앙대학교 의과대학 중앙대학교병원 호흡기알레르기내과) ;
  • 김원영 (중앙대학교 의과대학 중앙대학교병원 호흡기알레르기내과)
  • Tae Wan Kim (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Won-Young Kim (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine)
  • 투고 : 2023.07.20
  • 심사 : 2023.09.07
  • 발행 : 2024.04.01

초록

hMPV는 모든 연령에서 급성 호흡기 질환의 중요한 원인이며 고령, 면역 저하, 특정 동반 질환이 없는 건강한 환자에서도 ARDS를 동반한 중증 폐렴을 유발할 수 있다. 따라서 임상의는 젊고 면역력이 정상인 ARDS 환자에서도 hMPV 감염을 의심할 필요가 있다.

Human metapneumovirus (hMPV) infections commonly present as mild upper respiratory tract infections in healthy adults, although severe respiratory complications have been observed, particularly in elderly and immunocompromised patients. We report a case in whom pneumonia caused by hMPV progressed to acute respiratory distress syndrome (ARDS) in a healthy adult without underlying diseases. A 31-year-old female presented with fever and dyspnea, prompting transfer to our hospital for mechanical ventilation 3 days after symptom onset. Auscultation revealed coarse breath sounds and crackles in both lung fields, and chest X-ray showed non-specific infiltrative nodules with poorly defined borders throughout both lungs. ARDS caused by community-acquired pneumonia was diagnosed. hMPV was identified via rapid testing of respiratory samples for genes that encode pneumonia pathogens and drug resistance markers; we employed reverse transcription polymerase chain reactions to these ends. Six days later, the patient was weaned off the mechanical ventilator, and discharged from the hospital in good clinical condition.

키워드

참고문헌

  1. van den Hoogen BG, de Jong JC, Groen J, et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 2001;7:719-724. https://doi.org/10.1038/89098
  2. Edwards KM, Zhu Y, Griffin MR, et al. Burden of human metapneumovirus infection in young children. N Engl J Med 2013;368:633-643. https://doi.org/10.1056/NEJMoa1204630
  3. Boivin G, De Serres G, Hamelin ME, et al. An outbreak of severe respiratory tract infection due to human metapneumovirus in a long-term care facility. Clin Infect Dis 2007;44:1152-1158. https://doi.org/10.1086/513204
  4. Hamelin ME, Cote S, Laforge J, et al. Human metapneumovirus infection in adults with community-acquired pneumonia and exacerbation of chronic obstructive pulmonary disease. Clin Infect Dis 2005;41:498-502. https://doi.org/10.1086/431981
  5. Englund JA, Boeckh M, Kuypers J, et al. Brief communication: fatal human metapneumovirus infection in stem-cell transplant recipients. Ann Intern Med 2006;144:344-349. https://doi.org/10.7326/0003-4819-144-5-200603070-00010
  6. Hwang H, Kim Y, Park JW, Jeong SH, Kyung SY. A retrospective study investigating risks of acute respiratory distress syndrome and mortality following human metapneumovirus infection in hospitalized adults. Korean J Crit Care Med 2017;32:182-189. https://doi.org/10.4266/kjccm.2017.00038
  7. Widmer K, Griffin MR, Zhu Y, Williams JV, Talbot HK. Respiratory syncytial virus- and human metapneumovirus-associated emergency department and hospital burden in adults. Influenza Other Respir Viruses 2014;8:347-352. https://doi.org/10.1111/irv.12234
  8. van Someren Greve F, Juffermans NP, Bos LDJ, et al. Respiratory viruses in invasively ventilated critically ill patients-a prospective multicenter observational study. Crit Care Med 2018;46:29-36. https://doi.org/10.1097/CCM.0000000000002752
  9. Hasvold J, Sjoding M, Pohl K, Cooke C, Hyzy RC. The role of human metapneumovirus in the critically ill adult patient. J Crit Care 2016;31:233-237. https://doi.org/10.1016/j.jcrc.2015.09.035
  10. Vidaur L, Totorika I, Montes M, Vicente D, Rello J, Cilla G. Human metapneumovirus as cause of severe community-acquired pneumonia in adults: insights from a ten-year molecular and epidemiological analysis. Ann Intensive Care 2019;9:86.
  11. Murphy CN, Fowler R, Balada-Llasat JM, et al. Multicenter evaluation of the BioFire FilmArray pneumonia/pneumonia plus panel for detection and quantification of agents of lower respiratory tract infection. J Clin Microbiol 2020;58:e00128-20.
  12. Raza K, Ismailjee SB, Crespo M, et al. Successful outcome of human metapneumovirus (hMPV) pneumonia in a lung transplant recipient treated with intravenous ribavirin. J Heart Lung Transplant 2007;26:862-864. https://doi.org/10.1016/j.healun.2007.05.020
  13. Bonney D, Razali H, Turner A, Will A. Successful treatment of human metapneumovirus pneumonia using combination therapy with intravenous ribavirin and immune globulin. Br J Haematol 2009;145:667-669. https://doi.org/10.1111/j.1365-2141.2009.07654.x
  14. Chu HY, Renaud C, Ficken E, Thomson B, Kuypers J, Englund JA. Respiratory tract infections due to human metapneumovirus in immunocompromised children. J Pediatric Infect Dis Soc 2014;3:286-293. https://doi.org/10.1093/jpids/piu100
  15. Li H, Yang SG, Gu L, et al. Effect of low-to-moderate-dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia. Influenza Other Respir Viruses 2017;11:345-354. https://doi.org/10.1111/irv.12456
  16. RECOVERY Collaborative Group; Horby P, Lim WS, et al. Dexamethasone in hospitalized patients with covid-19. N Engl J Med 2021;384:693-704. https://doi.org/10.1056/NEJMoa2021436
  17. WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group; Sterne JAC, Murthy S, et al. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis. JAMA 2020;324:1330-1341. https://doi.org/10.1001/jama.2020.17023