{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T01:46:06Z","timestamp":1788918366889,"version":"build-2803163510"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>HMPV is a leading cause of pediatric lower respiratory tract infections, second only to respiratory syncytial virus in causing severe pneumonia in children. Its clinical presentation closely mimics other common respiratory viruses, making diagnosis challenging. This study aimed to characterize the clinical profile and identify independent risk factors for severe community-acquired pneumonia (CAP) in hospitalized children with human metapneumovirus (HMPV) infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective cohort study of 878 children hospitalized with HMPV-positive CAP at Shanghai Children\u2019s Hospital from 2021 to 2024. Patients were classified into mild (\n                      <jats:italic>n<\/jats:italic>\n                      = 632) and severe (\n                      <jats:italic>n<\/jats:italic>\n                      = 246) groups based on established CAP criteria. Data on demographics, clinical features, laboratory findings, and concomitant pathogen detection were collected. Multivariate logistic regression was used to identify independent risk factors for severe disease.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The severe group comprised 28.0% of the cohort. Key clinical manifestations included fever (98.0%), cough (97.6%), wheezing (56.5%), and pulmonary crackles (84.6%). Compared to the mild group, the severe group had significantly higher rates of premature birth, wheezing, elevated inflammatory markers (NLR &amp;gt; 1, PCT &amp;gt; 1 ng\/mL, CRP \u2265 50 mg\/L), and co-infection with\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      (MP) (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). Multivariate analysis identified premature birth (odds ratio [OR] = 2.43, 95% CI: 1.45\u20134.07), wheezing (OR = 3.47, 95% CI: 2.51\u20134.80), NLR &amp;gt; 1 (OR = 1.75, 95% CI: 1.26\u20132.43), PCT &amp;gt; 1 ng\/mL (OR = 2.38, 95% CI: 1.42\u20133.99), CRP \u2265 50 mg\/L (OR = 2.20, 95% CI: 1.19\u20134.06), and co-infection with MP (OR = 2.17, 95% CI: 1.53\u20133.08) as independent risk factors for severe CAP in children with HMPV infection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Approximately 28% of hospitalized children with HMPV-positive CAP progress to severe disease. Premature birth, wheezing, elevated inflammatory markers, and co-infection with MP are independent risk factors, which can facilitate early risk stratification and targeted clinical management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1813199","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:32:27Z","timestamp":1777527147000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical characteristics and risk factors for severe community-acquired pneumonia in hospitalized children with human metapneumovirus infection in Shanghai: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Lijiao","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Emergency, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Emergency, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiqin","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Emergency, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzhe","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Emergency, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Emergency, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujuan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Emergency, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"104364","DOI":"10.1016\/j.drudis.2025.104364","article-title":"An overview of progress in human Metapneumovirus (Hmpv) research: structure, function, and therapeutic opportunities.","volume":"30","author":"Kr\u00fcger","year":"2025","journal-title":"Drug Discov Today."},{"key":"B2","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1038\/89098","article-title":"A newly discovered human pneumovirus isolated from young children with respiratory tract disease.","volume":"7","author":"van den Hoogen","year":"2001","journal-title":"Nat Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1016\/j.cmi.2024.10.023","article-title":"Epidemiology of Human Metapneumovirus among children with severe or very severe pneumonia in high pneumonia burden settings: the pneumonia etiology research for child health (perch) study experience.","volume":"31","author":"Miyakawa","year":"2025","journal-title":"Clin Microbiol Infect."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e33","DOI":"10.1016\/s2214-109x(20)30393-4","article-title":"Global burden of acute lower respiratory infection associated with human Metapneumovirus in children under 5 years in 2018: a systematic review and modelling study.","volume":"9","author":"Wang","year":"2021","journal-title":"Lancet Glob Health."},{"key":"B5","doi-asserted-by":"publisher","first-page":"182","DOI":"10.15585\/mmwr.mm7411a1","article-title":"Human Metapneumovirus seasonality and co-circulation with respiratory syncytial virus - 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