This viral assay is part of the Respiratory Viral Panel and is not available on an individual basis. The Respiratory Viral Panel was cleared by the FDA for in vitro diagnostic use as a panel only and must be ordered in its entirety.
Human Metapneumovirus (hMPV) was first discovered in 2001; poor growth in cell culture is the main factor for the virus’ delayed discovery. hMPV is distributed worldwide and is a major cause of respiratory tract illness, particularly in young children and immunocompromised patients. The clinical manifestations of hMPV infections are similar to respiratory syncytial virus (RSV) and range from mild upper-airway disease to severe pneumonia and respiratory failure.
See below for additional Human Metapneumovirus assay and pathogen-specific information. For online ordering methods click here or contact us .
Assay Sheet
Test ID
RV00 Respiratory Viral Panel (RVP)
CPT Code
87798
Clinical Utility
The Respiratory Viral Panel is a comprehensive assay for the detection of a broad range of viruses and subtypes representing the majority of circulating respiratory disease-causing pathogens of particular importance to children, elderly, and immunocompromised patients. Detection of these pathogens will lead to more efficient management of patients with respiratory infections, play a key role in surveillance, and aid in limiting the spread of respiratory viruses through infection control practices.
Procedure
Viral nucleic acid is extracted from the specimen, which undergoes reverse transcription to generate complementary DNA (cDNA). The target cDNA is amplified using polymerase chain reaction (PCR), then analyzed with Luminex® xTag™ technology to detect the presence or absence of each virus in the panel. The Respiratory Viral Panel (RVP) has been cleared by the FDA for in vitro diagnostic use.
Specimens
* Nasopharyngeal swab (NP swab): sterile swab placed in 1-2 ml sterile saline or viral transport media; ship ambient. **Nasopharyngeal aspirate (NP aspirate), tracheal aspirate, BAL: 2 ml; submitted in a sterile, screw-top tube; ship ambient.
Specificity
Detects 12 Respiratory viral targets: respiratory syncytial virus (RSV) A, respiratory syncytial virus (RSV) B, influenza A, influenza A subtype H1, influenza A subtype H3, influenza B, parainfluenza 1, parainfluenza 2, parainfluenza 3, human metapneumovirus (hMPV), rhinovirus, and adenovirus
Assay Range
Qualitative results (Positive/Not Detected) for: RSV A, RSV B, influenza A, influenza A subtype H1, influenza A subtype H3, influenza B, parainfluenza 1, parainfluenza 2, parainfluenza 3, hMPV, rhinovirus, and adenovirus
* NP swab has been cleared by the FDA for use in the RVP assay.
**In-house verification performed to establish as suitable specimen types.
Information derived from Respiratory Viral Panel Package Insert (Luminex Corporation).
Respiratory Viral Panel is a product of Luminex Corporation.
xTAG is a trademark of Luminex Corporation.
Luminex is a registered trademark of Luminex Corporation.
AS10-0108
Pathogen Overview
ABOUT THE HUMAN METAPNEUMOVIRUS
The human metapneumovirus (hMPV) is a negative-sense, single-stranded RNA virus of the Paramyxoviridae family. The virus was first discovered in 2001 from children in the Netherlands with respiratory tract illness similar to respiratory syncytial virus (RSV) infection. Serological evidence dating back more than four decades confirms that hMPV is newly identified rather than newly emerged. Poor growth in cell culture is the main factor for the virus’ delayed discovery. RSV is the closest human pathogen related to hMPV; both are members of the Pneumovirinae subfamily. Though still controversial, hMPV appears to be a single serotype with two subgroups, A and B, rather than two distinct serotypes. Data suggests that cross-protective immunity occurs after infection with one subgroup, which is equivalent to the case with RSV subgroups A and B. hMPV is distributed worldwide and is the causative agent of respiratory tract illness, particularly in young children and immunocompromised patients. Approximately 90% of children are seropositive for hMPV infection by the age of 5 years and nearly 100% by adulthood. The presence of maternally derived hMPV antibodies is indicated by a seroprevalence of greater than 90% in infants less than 3 months of age, however, the level of protection these antibodies provide is unknown.
HUMAN METAPNEUMOVIRUS CLINICAL MANIFESTATIONS
The clinical manifestations of hMPV infections in children are similar to RSV and range from mild upper-airway disease to severe pneumonia and respiratory failure. Symptoms include cough, fever, myalgia, rhinorrhea, nasal congestion, pharyngeal erythema, otitis media, wheeze, dysphonia, stridor, bronchitis and pneumonia. Chest radiograph findings include infiltrates, hyperinflation and peribronchial cuffing. Apnea in preterm infants has been reported. Children less than 2 years of age are most likely to be hospitalized due to complicated lower respiratory tract infections. hMPV is a leading cause of bronchiolitis in early childhood. The role of hMPV in the initiation and progression of asthma remains unclear and controversial. Asymptomatic infection in children is rare. In adults, though to a lesser extent than children, hMPV has been associated with bronchitis, pneumonia and exacerbations of asthma and chronic obstructive pulmonary disease (COPD). Dyspnea is more common in the elderly.
hMPV has been associated with prolonged and serious infections in the immunocompromised patient population. The infection rate of hMPV seems comparable to the observed rates for RSV, parainfluenza and influenza. One study in hematopoietic stem cell transplant (HSCT) recipients noted that hMPV infection was initially characterized by fever, nasal congestion and cough. Pneumonia quickly developed and patients experienced rapidly progressive pulmonary infiltrates accompanied by hypotension and/or septic shock. Diffuse alveolar hemorrhage was also common. Another study in HSCT recipients detected hMPV in nasal specimens without clinical disease. A study of hMPV infection in lung transplant recipients showed clinical symptoms varied from no symptoms to severe pneumonia or acute graft rejection to death. Replication of hMPV significantly correlated with rejection symptoms in this study, suggesting that hMPV is associated with allograft rejection. Additional studies must be performed to determine an accurate frequency of complications, morbidity and mortality rates and distinct clinical characteristics of infection in the immunocompromised patient population.
HUMAN METAPNEUMOVIRUS LABORATORY DIAGNOSIS
hMPV predominately circulates in the United States from January to April; while later than RSV’s peak season, the existing overlap and common clinical characteristics make distinction between the two viruses and identification of coinfection unfeasible without laboratory confirmation. Culture is not used in the diagnosis of hMPV, due to the virus’ poor growth in cell culture. hMPV-specific antibodies have been developed for immunofluorescence assays, though the lack of sensitivity is a significant limitation of this method. The most common technique for diagnosis is PCR, which has been shown to be a rapid, sensitive and specific method for detecting hMPV.
HUMAN METAPNEUMOVIRUS TREATMENT
Studies have shown that hMPV cases are clustered in an epidemic manner, in which community acquired infection and nosocomial infection are both believed to contribute. The incubation period, duration of viral shedding and modes of transmission, have not been well defined for hMPV but are likely to be similar to RSV. Thus, preventative actions, such as hand hygiene practices and isolation measures, will help prevent the spread of infection.
Similar to RSV, antiviral therapy for hMPV is limited and controversial. Ribavirin has been shown to have effectiveness in inhibiting replication of hMPV comparable to that of RSV. Limited data on the pathogenesis of hMPV in the natural host impedes treatment strategies.
Selected References
Dare R, Sanghavi S, Bullotta A, et al. Diagnosis of human metapneumovirus infection in immunosuppressed lung transplant recipients and children evaluated for pertussis. J Clin Microbiol. 2007;45(2):548-552.
Englund J, Boeckh M, Kuypers J, et al. Brief communication: fatal human metapneumovirus infection in stem-cell transplant recipients.
Ann Intern Med. 2006;(144):344-349.
Kahn JS. Epidemiology of human metapneumovirus. Clin Microbiol Rev. 2006;19(3):546-557.
Knipe D, Howley P. Fields Virology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.
Larcher C, Geltner C, Fisher H, et al. Human metapneumovirus infection in lung transplant recipients: clinical presentation and epidemiology. J Heart Lung Transplant. 2005;24(11):1891-1901.
Lee I, Barton TD. Viral respiratory tract infections in transplant patients: epidemiology, recognition and management. Drugs. 2007;67(10):1411-1427.
Mahoney J, Chong S, Merante F, et al. Development of a respiratory virus panel (RVP) test for the detection of twenty human respiratory viruses using multiplex PCR and a fluid microbead-based assay. J Clin Microbiol. 2007;45(9):2965-2970.
Ordas J, Boga J, et al. Role of metapneumovirus in viral respiratory infections in young children. J Clin Microbiol. 2006;44(8):2739-2742.
2-3 ml separated from whole blood collected in EDTA (lavender top) tube.
Ship at ambient temperature Monday-Friday
Whole Blood
3-5 ml collected in EDTA (lavender top) tube. Do not freeze.
Ship at ambient temperature Monday-Friday
ImmuKnow®Specimens- Whole Blood
2-3 ml collected in a sodium heparin (green top) tube. Maintain temperature by shipping the specimen in 2 inch thick styrofoam with specimen surrounded by ambient temperature gel packs.
Ship ambient for priority overnight delivery Monday‐Friday
Specimen must arrive at ViraCor within 30 hours of collection.
Hepatitis Specimens- Whole Blood
7-10 ml in EDTA, ACD Solution A, or PPT sterile tube. Minimum specimen requirement is 2 ml plasma. Separate plasma from cells within 4 hours of collection and freeze. To remove plasma from cells, centrifuge at 1000 xg for 10-15 minutes. Do not clarify by filtration or further centrifugation. If specimen was collected in PPT tube, the entire tube can be frozen if desired following centrifugation.
Ship ambient or frozen
Monday-Friday
Body fluid other than blood or urine
Collect 2-3 ml in a sterile screw-cap tube.
Ship at ambient temperature Monday-Friday
Bone Marrow
1-2 ml, collected in an EDTA (lavender top) tube. Do not freeze.
Ship at ambient temperature Monday-Friday
Bronchial Lavage/Bronchial Wash
2-3 ml, collected in sterile screw-cap tube.
Ship at ambient temperature Monday-Friday
CSF
1-1.5 ml in sterile screw-cap tube. Freeze prior to shipment.
Ship on DRY ICE
Monday-Friday
Eye swab
Swab the inflamed conjunctiva or corneal lesions. Place swab in 1-2 ml sterile saline or viral transport media in sterile screw-cap tube.
Ship at ambient temperature Monday-Friday
Fecal
Sterile swab (plastic shaft only) or very small (pea size) fecal sample placed in 1-2 ml sterile saline or viral transport in sterile screw-cap tube.
Ship at ambient temperature Monday-Friday
Nasopharyngeal Aspirate/Tracheal Aspirate
2-3 ml collected in sterile saline in sterile screw-cap tube.
Ship at ambient temperature Monday-Friday
Nasopharyngeal Swab
Sterile swab (flexible shaft) placed in 1-2 sterile saline or viral transport media in sterile screw-cap tube. Do not use calcium alginate swab.
Ship at ambient temerpature Monday-Friday
Swab
Sterile swab (plastic shaft only) placed in 1-2 ml sterile saline or viral transport media in sterile screw-cap tube. Do not use calcium alginate swab.
Ship at ambient temperature Monday-Friday
Tissue
Place in a sterile screw-top container, add a small amount of saline to keep moist.
Ship at ambient temperature Monday-Friday Frozen tissue is acceptable
Urine
5 ml sample collected in a sterile urinalysis container. Transfer to a 15 ml sterile screw-cap tube for shipment.
Ship at ambient temperature Monday-Friday
Vesicular Lesion
Collect fluid and cellular material from the base of several fresh vesicles. Place swab in 1-2 mil sterile saline or viral transport media in sterile screw-cap tube. Do not use calcium alginate swab.
Ship at ambient temperature Monday-Friday
Other Specimen
Please inquire.
Shipping
All specimens must be labeled with patient's name and collection date.
A ViraCor Test Request Form must accompany each specimen.
Ship specimens FedEx Priority Overnight to: ViraCor Laboratories | 1001 NW Technology Dr | Lee's Summit MO 64086
PCR tests are performed pursuant to a license agreement with Roche Molecular Systems Inc.
ImmuKnow is a registered trademark of Cylex Incorporated.
Respiratory Viral Panel is a product of Luminex Corporation.
Abstracts & Publications
Dare R, Sanghavi S, Bullotta A, et al. Diagnosis of human metapneumovirus infection in immunosuppressed lung transplant recipients and children evaluated for pertussis. J Clin Microbiol. 2007;45(2):548-552.
Englund J, Boeckh M, Kuypers J, et al. Brief communication: fatal human metapneumovirus infection in stem-cell transplant recipients. Ann Intern Med. 2006;(144):344-349.
Kahn JS. Epidemiology of human metapneumovirus. Clin Microbiol Rev. 2006;19(3):546-557.
Knipe D, Howley P. Fields Virology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.
Larcher C, Geltner C, Fisher H, et al. Human metapneumovirus infection in lung transplant recipients: clinical presentation and epidemiology. J Heart Lung Transplant. 2005;24(11):1891-1901.
Lee I, Barton TD. Viral respiratory tract infections in transplant patients: epidemiology, recognition and management. Drugs. 2007;67(10):1411-1427.
Mahoney J, Chong S, Merante F, et al. Development of a respiratory virus panel (RVP) test for the detection of twenty human respiratory viruses using multiplex PCR and a fluid microbead-based assay. J Clin Microbiol. 2007;45(9):2965-2970.
Ordas J, Boga J, et al. Role of metapneumovirus in viral respiratory infections in young children. J Clin Microbiol. 2006;44(8):2739-2742.
This viral assay is part of the Respiratory Viral Panel and is not available on an individual basis. The Respiratory Viral Panel was cleared by the FDA for in vitro diagnostic use as a panel only and must be ordered in its entirety.
