Human Metapneumovirus Causing Pertussis-like Syndrome

1Barcroft M, 1Bland (Farber) S, 2Sahhar, M.D. H
1Edward Via College of Osteopathic Medicine- Carolinas Campus, Spartanburg, SC, United states; 2VCOM, Spartanburg, SC, United states

Respiratory illness has an array of bacterial and viral etiologies. In the pediatric population, infectious agents typically yield distinct symptomatology, revealing a diagnosis with minimal laboratory testing required. Challenges arise when the infectious agents produce unique symptomatology, resulting in overlap between causative species and their respective clinical presentation. In this case, we discuss an infant with pertussis-like syndrome, who had negative Bordetella pertussis testing with confirmed Human metapneumovirus (hMPV). In literature to date, no cases have been reported of pertussis-like syndrome caused by hMPV alone.
An infant presented to the hospital with cough and respiratory distress. Illness began 19 days prior with respiratory symptoms. Clinical progression led to a diagnosis of acute bronchiolitis. After receiving outpatient treatment with no improvement the patient was seen in the emergency department for increased breathing difficulties, including cough episodes followed by apneic periods. Upon admission the patient continued to have a paroxysmal cough, along with wheezing, hypoxia, and febrile periods. Three separate specimen cultures were all without evidence of B. pertussis. These results in combination with a sole positive hMPV upon FilmArray respiratory panel and a clinical presentation of pertussis-like syndrome were conclusive for diagnosis.
Human metapneumovirus typically presents with symptoms resembling respiratory syncytial virus or influenza virus, including mucus production, fever, and wheezing1,2. Another common cause of respiratory illness, B. pertussis, presents with a classic “whooping cough” that is characterized by severe, spasmodic, coughing episodes. Similarly, manifestations of pertussis-like syndrome include “whooping cough” episodes without evidence of B. pertussis infection3. In pertussis-like syndrome patients typically test positive for a bacterial or viral infectious agent. The unusual aspect in this case is the presentation of pertussis-like syndrome due to sole hMPV infection.
When evaluating an infant with respiratory disease, it is of the utmost importance to include uncommon infective agents in the diagnostic evaluation and treatment plan. This yields an opportunity for successful prevention of serious illness and death, due to early diagnosis and intervention. As demonstrated by this case, appropriate care was initiated due to early diagnosis of pertussis-like syndrome in the absence of commonly suspected viruses and thus serious complications were avoided.
1. Principi N, et al. Human metapneumovirus in paediatric patients. Clin Microbiol Infect. 2006;12(4):201-308.
2. Brodzinski H, Ruddy RM. Review of New and Newly Discovered Respiratory Tract Viruses in Children. Pediatr Emerg Care. 2009;25(5):352-60.
3. Sarbay H, et al. Pertussis-like Syndrome Associated with Adenovirus Presenting with Hyperleukocytosis: Case Report. North Clin Istanb. 2016;3(2);140–2.