RESUMO
Human metapneumovirus infections are increasingly recognized among adult patients and the aim of this report is to present a series of 4 cases admitted during the winter of 2010. All were detected by direct fluorescence anti-bodies assay of respiratory samples and all were female patients with an age range of 79 to 95 years, including two bedridden cases, one with dementia and three with chronic obstructive pulmonary disease. One patient presented with parainfluenza 3 virus coinfection. Patients presented with pneumonía in 3 cases (interstitial pattern in 2 and lobar consolidation in the other) or acute exacerbation of chronic bronchitis in the remaining case. Symptoms were present for 3 to 7 days before admission and 3 have wheezing. All had hypoxemic or global respiratory failure and lymphopenia (< 1.000/mm³). Hospitalization lasted for 5 to 20 days, marked in the 3 cases that survived by prolonged bronchial obstructive manifestations. Two cases required non invasive mechanical ventilation. Human metapneumovirus infections can decompensate elderly patients with chronic respiratory diseases generating hospital admission and a prolonged morbidity marked by obstructive manifestations and sometimes can become into death.
Assuntos
Bronquite Crônica/virologia , Metapneumovirus/isolamento & purificação , Infecções por Paramyxoviridae/virologia , Pneumonia Viral/virologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Técnica Direta de Fluorescência para Anticorpo , Hospitalização , HumanosRESUMO
Human metapneumovirus infections are increasingly recognized among adult patients and the aim of this report is to present a series of 4 cases admitted during the winter of 2010. All were detected by direct fluorescence anti-bodies assay of respiratory samples and all were female patients with an age range of 79 to 95 years, including two bedridden cases, one with dementia and three with chronic obstructive pulmonary disease. One patient presented with parainfluenza 3 virus coinfection. Patients presented with pneumonía in 3 cases (interstitial pattern in 2 and lobar consolidation in the other) or acute exacerbation of chronic bronchitis in the remaining case. Symptoms were present for 3 to 7 days before admission and 3 have wheezing. All had hypoxemic or global respiratory failure and lymphopenia (< 1.000/mm³). Hospitalization lasted for 5 to 20 days, marked in the 3 cases that survived by prolonged bronchial obstructive manifestations. Two cases required non invasive mechanical ventilation. Human metapneumovirus infections can decompensate elderly patients with chronic respiratory diseases generating hospital admission and a prolonged morbidity marked by obstructive manifestations and sometimes can become into death.
Las infecciones por metapneumovirus (MPVH) son poco conocidas en pacientes adultos y el objetivo de esta publicación es presentar una serie de 4 casos observados en pacientes hospitalizados durante el invierno de 2010. Los casos se identificaron por inmunofluorescencia directa en muestras respiratorias. Todos los pacientes fueron de sexo femenino con un rango de edad 79 a 95 años, dos de ellos postrados, uno con demencia y 3 con enfermedad pulmonar obstructiva crónica. La manifestación clínica correspondió a neumonía en 3 casos (2 de tipo intersticial y una con consolidación lobar) y bronquitis crónica reagudizada en el caso restante, con una duración sintomática de 3 a 7 días antes de la hospitalización. Un caso presentó co-infección con virus parainfiuenza 3. Las sibilancias estuvieron presentes en 3 casos y todos presentaron falla respiratoria hipoxémica o global con linfopenia (< 1.000/mm³). La hospitalización tuvo una duración de 5 a 20 días, marcada en los 3 casos que sobrevivieron por una signología obstructiva prolongada. Dos pacientes requirieron ventilación mecánica no invasora. Las infecciones por MPVH representan una causa de hospitalización por descompensación de patologías respiratorias crónicas en pacientes adultos ancianos, tienen una morbilidad prolongada con signología obstructiva marcada y pueden ocasionar la muerte.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Bronquite Crônica/virologia , Metapneumovirus/isolamento & purificação , Infecções por Paramyxoviridae/virologia , Pneumonia Viral/virologia , Técnica Direta de Fluorescência para Anticorpo , HospitalizaçãoRESUMO
Chronic obstructive bronchitis with inadequate response to inhaled steroid and bronchodilator therapy is a rather rare disorder in children. Persistence of an adenoviral infection has been described as a possible cause of unremitting airway obstruction. We studied a group of 11 children with the clinical feature of chronic bronchial obstruction. A high-resolution computed tomography (HR-CT) scan was performed and typically showed hyperinflation and ground-glass-like opacities. All children underwent either bronchoscopic transbronchial or open lung biopsy. Biopsy specimens were stained with monoclonal antibodies detecting adenoviral antigen and analyzed by light-microscopy. Bronchoalveolar lavage (BAL) fluid was cultured for adenovirus, and antigen detection tests were performed. While some children had a history of proven adenoviral infection at the onset of their disease, in none of the cases could a persistence of adenovirus be shown. We conclude that adenoviral infection might act as a starter of chronic obstructive bronchitis in children, but that pathogenetic mechanisms other than persistent infection must be responsible for the chronicity of the disease.
