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.
We are pleased to provide our newsletter, The ViraCor View, intended to provide clinicians with pertinent information and insights into the diagnosis and management of pathogens that infect immunocompromised patients.
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.
Specimen type & specimen handling
**Bronchial Lavage/Bronchial Wash: 2 mls collected in a sterile, screw top tube. Ship at ambient temperature Monday thru Friday. Specimen must be received within 96 hrs of collection.
Sputum: 2 mls collected in a sterile container, then transferred to sterile, screw top tube for shipment. Ship at ambient temperature Monday thru Friday. Specimen must be received within 96 hrs of collection.
**Throat Gargle: 2 mls collected in a sterile container then transferred to sterile, screw top tube for shipment. Ship at ambient temperature Monday thru Friday. Specimen must be received within 96 hrs of collection.
**Upper respiratory aspirate (NP aspirate, nasal aspirate/wash, tracheal aspirate, etc.): 2 mls collected in a sterile, screw top tube. Ship at ambient temperature Monday thru Friday. Specimen must be received within 96 hrs of collection.
Upper respiratory swab (*NP swab, **throat swab): Sterile swab placed in 2 ml sterile saline, M4, or viral transport media in a sterile, screw top tube. Do not use calcium alginate swab or wood shafted swab. Ship at ambient temperature Monday thru Friday. Specimen must be received within 96 hrs of collection.
CSF: 2 mls collected in a sterile, screw top tube. Freeze and ship on dry ice Monday thru Friday. Specimen must be received within 96 hrs of collection.
All suction-type collection devices are inappropriate for specimen transport. Transfer specimen into sterile, leakproof tube for transport.
Call ViraCor for authorization prior to sending any specimen type other than those listed above.
If another specimen type has received authorization for testing the following comment will appear in the final report: "The clinical utility of this result has not yet been demonstrated in the peer reviewed literature and is therefore unknown."
Causes for rejection
Specimens other than those listed above that were sent without prior authorization.
Wood shafted swab, calcium alginate swab.
Call ViraCor at 800-305-5198 if specimen is greater than 96 hrs old.
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.
Turnaround Time
Same day (within 12 to 18 hours of receiving specimen), Monday through Saturday
Shipping
Ship Monday through Friday. Friday shipments must be labeled for Saturday delivery. All specimens must be labeled with patient's name and collection date. Multiple tests can be run on one specimen.
Ship specimens FedEx Priority Overnight® to:
ViraCor Laboratories, 1001 NW Technology Dr, Lee's Summit, MO 64086
* NP swab has been cleared by the FDA for use in the RVP assay.
**In-house verification performed to establish as suitable specimen types.
CPT codes provided are based on ViraCor’s interpretation of the American Medical Association’s Current Procedural Terminology (CPT) codes and are provided for informational purposes only. CPT coding is the sole responsibility of the billing party. Questions regarding coding should be addressed to your local Medicare carrier. ViraCor assumes no responsibility for billing errors due to reliance on the CPT codes illustrated in this material. 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.
0109 V3
Pathogen Overview
ABOUT 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 in 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 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 2 subgroups, A and B, rather than 2 distinct serotypes. Data suggest 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 impede 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.
PAO-19-0907
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.
