Human Metapneumovirus Diagnosis, Pathogenesis, and Therapeutics

Abstract

Human metapneumovirus (hMPV) is a globally prevalent respiratory pathogen that causes acute respiratory infections across all age groups, with the greatest disease burden in young children, older adults, and immunocompromised individuals. Clinical manifestations range from mild upper respiratory tract symptoms, including cough, wheezing, and sore throat, to severe lower respiratory tract disease such as bronchiolitis, pneumonia, acute respiratory distress syndrome (ARDS), and secondary bacterial infections that may require intensive care and mechanical ventilation. Despite its widespread circulation and substantial healthcare impact, important aspects of hMPV transmission, pathogenesis, and host immune responses remain incompletely understood, hindering the development of effective therapeutics and vaccines. This review summarizes the current knowledge of hMPV epidemiology, clinical presentation, diagnostics, pathogenesis, and prevention strategies, with emphasis on recent outbreaks that highlight its seasonal and geographic variability. We discuss the viral life cycle and the contributions of the major surface glycoproteins—fusion (F), attachment (G), and small hydrophobic (SH) proteins—to viral infectivity, immune evasion, and disease progression. Advances in molecular diagnostics, including reverse-transcription polymerase chain reaction (RT-PCR), next-generation sequencing, metagenomic approaches, and nanopore sequencing, are also examined. While supportive care remains the cornerstone of clinical management, existing antiviral therapies demonstrate limited and inconsistent efficacy. Emerging preventive and therapeutic strategies, including mRNA-based vaccines and neutralizing monoclonal antibodies, offer promising avenues for disease control. Improved understanding of hMPV biology and host-pathogen interactions will be critical for developing effective interventions to reduce the global burden of this increasingly recognized respiratory pathogen.