# Severe Manifestations of Human Metapneumovirus With Co-infections: A Case Series and Literature Review

## TL;DR

This paper reports three cases of severe hMPV infections in children, often with co-infections, leading to serious complications and the need for ICU care.

## Contribution

The novelty lies in highlighting the severe clinical outcomes and extrapulmonary effects of hMPV co-infections in immunocompetent children.

## Key findings

- hMPV co-infections led to severe pneumonia, respiratory failure, and systemic complications in children.
- Extrapulmonary manifestations like dystonia and optic atrophy were observed, indicating systemic effects of hMPV.
- Rapid molecular diagnostics, such as BioFire®, were crucial for timely diagnosis and targeted treatment.

## Abstract

Human metapneumovirus (hMPV) causes severe pediatric respiratory infections, often with co-infections. This report details three immunocompetent children with hMPV co-infected with adenovirus, SARS-CoV-2, Streptococcus pneumoniae, and Acinetobacter baumannii, causing pneumonia, respiratory failure, and systemic complications (hypertension, cardiac arrest, neurological sequelae), requiring prolonged mechanical ventilation and broad-spectrum antimicrobials in the ICU. Diagnostic delays from overlapping features required BioFire® (BioFire Diagnostics, Salt Lake City, UT) testing. Studies link hMPV co-infections to heightened severity, prolonged hospital stays, and ICU admissions, yet guidelines are lacking. Rapid molecular diagnostics guide targeted therapy and antimicrobial stewardship. Extrapulmonary manifestations (dystonia, optic atrophy) reflect hMPV’s systemic effects. These three cases highlight clinical vigilance and urgent research into antivirals/vaccines for vulnerable populations.