Human Metapneumovirus (hMPV) and Lupus: Risks, Symptoms, and Management

By SWA

Image: credit Dr. McMillan

Dr. McMillan: "This is a global issue.  I would caution against that because you have to remember, you're not just concerned about COVID, you're concerned about all the other viruses and bacteria that are circulating."

 People with lupus (systemic lupus erythematosus, or SLE) face a heightened risk of severe complications from human metapneumovirus (hMPV) due to their compromised immune system. Lupus is an autoimmune disease where the immune system attacks healthy tissues. Additionally, lupus treatments, including immunosuppressive medications like corticosteroids, methotrexate, or biologics (e.g., rituximab), further weaken the body's defenses against infections.

Why People with Lupus Are at Greater Risk

  1. Weakened Immune System

    • Lupus and its treatments impair the body’s ability to fight infections, including respiratory viruses like hMPV.

  2. Higher Risk of Severe Respiratory Infections

    • hMPV can escalate from mild respiratory symptoms to severe pneumonia or bronchiolitis in lupus patients.

  3. Chronic Lung Involvement

    • Lupus patients often have existing lung conditions, such as interstitial lung disease (ILD) or pleuritis, which exacerbate respiratory complications.

  4. Cytokine Dysregulation

    • Lupus-associated immune dysregulation can lead to hyperinflammation during viral infections, increasing the risk of cytokine storms and severe lung damage.

Understanding Bronchiolitis and Pneumonia

Bronchiolitis

  • Definition: Inflammation of the bronchioles (small airways in the lungs).
  • Cause: Primarily viral, often caused by RSV, hMPV, influenza, or parainfluenza.
  • Who It Affects: Mostly infants and young children, though adults with weakened immune systems are also at risk.

Symptoms:

  • Initial cold-like signs: runny nose, mild fever, cough
  • Progression to:
    • Wheezing
    • Rapid, shallow breathing
    • Difficulty breathing
    • Cyanosis (blue lips/skin in severe cases)

Complications:

  • Hypoxia (low oxygen levels)
  • Respiratory distress
  • Rarely, respiratory failure requiring hospitalization

Pneumonia

  • Definition: Infection and inflammation of the alveoli (air sacs in the lungs), often filling them with fluid or debris.
  • Cause: Can be viral (e.g., hMPV, RSV, influenza, or SARS-CoV-2), bacterial, or fungal.

Symptoms:

  • Fever and chills
  • Persistent cough (with yellow, green, or bloody sputum)
  • Chest pain (worse with breathing or coughing)
  • Shortness of breath
  • Fatigue
  • Cyanosis in severe cases

Complications:

  • Pleural effusion (fluid buildup around the lungs)
  • Sepsis (systemic infection)
  • Respiratory failure requiring mechanical ventilation

Severity of hMPV in Lupus Patients

Lupus patients are more likely to experience severe outcomes from hMPV, including:

  1. More Severe Symptoms

    • Persistent high fever, severe cough, and difficulty breathing.
    • Fatigue that takes longer to resolve.

  2. Progression to Severe Conditions

    • Greater likelihood of bronchiolitis, pneumonia, or acute respiratory distress syndrome (ARDS).

  3. Higher Hospitalization Risk

    • Need for supplemental oxygen, IV fluids, or mechanical ventilation.

  4. Longer Recovery Times

    • Prolonged illness due to their compromised immune system.

  5. Risk of Lupus Flares

    • Viral infections like hMPV can trigger lupus flares, exacerbating joint pain, fatigue, and inflammation.

Testing and Diagnosis in Lupus Patients

  1. Early Testing is Critical

    • Lupus patients should undergo early PCR testing for hMPV if respiratory symptoms arise, as early diagnosis aids in monitoring and intervention.

  2. Comprehensive Respiratory Panel

    • Includes tests for hMPV, RSV, flu, and COVID-19 to determine the cause of symptoms.

  3. Imaging

    • Chest X-rays or CT scans may be performed to assess for pneumonia or lung complications.

Treatment for hMPV in Lupus Patients

  1. Supportive Care

    • Maintain hydration, manage fever with acetaminophen, and provide oxygen therapy if needed.

  2. Hospitalization for Severe Cases

    • Patients with significant symptoms (e.g., respiratory distress, hypoxia) may require hospitalization.

  3. Adjusting Lupus Medications

    • Immunosuppressive drugs may need temporary adjustment to help the immune system fight the infection, under medical supervision.

  4. Preventing Secondary Infections

    • Lupus patients are at risk for bacterial superinfections (e.g., bacterial pneumonia). Antibiotics may be prescribed as needed.

  5. Close Monitoring for Flares

    • Infections can worsen lupus symptoms, so regular follow-ups with a rheumatologist are necessary.

Prevention for Lupus Patients

  1. Avoid Exposure

    • Avoid contact with sick individuals, especially during hMPV’s peak season (winter/spring).
    • Wear masks in crowded places.

  2. Good Hygiene

    • Wash hands frequently, avoid touching the face, and disinfect high-touch surfaces.

  3. Vaccinations

    • Stay up to date on vaccines for influenza, COVID-19, and pneumococcal disease to reduce coinfection risks.

  4. Manage Lupus Flare Risks

    • Work with a rheumatologist to keep lupus under control with the lowest effective dose of immunosuppressants.

  5. Early Symptom Monitoring

    • Watch for early signs of infection and seek medical attention immediately.

When to Seek Emergency Care

Lupus patients with hMPV should seek emergency care if they experience:

  • Difficulty breathing or wheezing
  • High fever that doesn’t respond to medications
  • Cyanosis (blue lips, nails, or skin)
  • Severe fatigue or confusion
  • Signs of a lupus flare, such as increased joint pain or rashes

Summary

  • Increased Risk: Lupus patients are more vulnerable to severe hMPV infections due to immune suppression and underlying health conditions.
  • Management: Early diagnosis, supportive care, and close monitoring are essential. Adjusting lupus treatments during infections may also be necessary.
  • Prevention: Adopting strict hygiene practices and staying vaccinated can reduce the risk of infection.

Proactive measures and prompt medical intervention can help lupus patients minimize the impact of hMPV and other respiratory infections.

Human Metapneumovirus was first discovered in 2001 by researchers in the Netherlands, not in 2018. The Dutch scientists, led by Bernadette van den Hoogen, identified the virus while studying respiratory tract infections in children. The findings were published in the journal Nature Medicine in 2001.

Reference:
2018 Human metapneumovirus - what we know now
Excerpt: Human metapneumovirus (HMPV) is a leading cause of acute respiratory infection, particularly in children, immunocompromised patients, and the elderly. HMPV, which is closely related to avian metapneumovirus subtype C, has circulated for at least 65 years, and nearly every child will be infected with HMPV by the age of 5. However, immunity is incomplete, and re-infections occur throughout adult life. Symptoms are similar to those of other respiratory viral infections, ranging from mild (cough, rhinorrhea, and fever) to more severe (bronchiolitis and pneumonia).

 © 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9

Comments

Post a Comment

Popular posts from this blog

Toxic Skin Condition Post-mRNA COVID-19 Vaccination

By SWA
Image
Identifying Severe Skin Conditions Post-Vaccination Following administration of the BioNTech mRNA vaccine, a small subset of individuals may develop severe and complex reactions. These reactions are often misdiagnosed or misunderstood due to their rarity and diverse presentation. This essay examines a case characterized by severe skin conditions, systemic symptoms, and complications such as hypercalcemia and crystal formation. It highlights the need for accurate diagnosis, holistic management, and increased awareness of these rare but significant vaccine-related adverse events. Initial Symptoms and Misdiagnoses Severe symptoms began shortly after the first dose of the BioNTech vaccine, initially presenting as petechiae, diagnosed by a rheumatologist. However, following the second dose, symptoms rapidly escalated, resulting in intense burning pain and thinning of the skin. The skin on the legs and thighs became paper-thin and could tear with the slightest touch, with the affected area e...
Read more

Is ME CFS connected to Spinal Muscular Atrophy (SMA) or Post Polio?

By SWA
Image
Today, I understand why Spinal Muscular Atrophy (SMA) received little attention, particularly in the mid-50s. This complex and debilitating genetic illness was poorly understood, and patients' symptoms were often minimized or even dismissed. For more information, please visit the Spinal Muscular Atrophy (SMA) page on MalaCards . Even now, many neurologists lack detailed knowledge of SMA, and comprehensive examinations mentioned in research are rarely pursued. In 2008, while investigating permanent adrenal insufficiency, an MRI ordered by my endocrinologist unexpectedly revealed Chiari Malformation II. However, surgery in 2009 brought no improvement. In 2010, a DNA test showed a genetic marker in the ACTN3 gene: https://www.malacards.org/search/results?q=ACTN3%20gene%20and%20Spinal%20Muscular%20Atrophy%20(SMA) A 2015 MRI revealed ankylosing spondylitis, multiple Tarlov cysts, stenosis at L4 and L5, spinal canal narrowing, and widespread degenerative changes. Surgery on L4 and L5 ...
Read more

Cytokine Storm, Mast Cell Activation Syndrome (MCAS), Endothelial Dysfunction and microclots/thrombosis?

By SWA
Could a virus be the stimulus for cytokine production?   It is well established, but rarely  tested, that a cytokine storm is an overactive immune response characterized by the excessive release of pro-inflammatory cytokines. ( ANA, CRP, and CBC tests are necessary) It can occur in various conditions, such as severe infections (e.g., COVID-19), (and other viruses), autoimmune diseases, and after certain treatments.  Serositis and lymphopenia are common features of systemic lupus erythematosus following SARS-CoV-2 infection: A case report and literature review These cells are called NKG2D+CD8+ T cells and researchers say their aggressive response is responsible for neurological damage suffered from infections beyond just Zika, like COVID-19 and even septic shock. The aggressive response is the result of the body producing large amounts of inflammatory proteins called cytokines, which in moderation help to coordinate the body’s response in battling an infection...
Read more