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

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.