Zoonotic Infection With Pigeon Paramyxovirus Type 1 Linked to Fatal Pneumonia

Abstract

The characteristics and risk factors of pigeon paramyxovirus type 1 (PPMV-1) infection in humans are poorly known. We performed virological, pathological, and epidemiological analyses of a Dutch case, and compared the results with those of a US case. Both infections occurred in transplant patients under immunosuppressive therapy and caused fatal respiratory failure. Both virus isolates clustered with PPMV-1, which has pigeons and doves as reservoir. Experimentally inoculated pigeons became infected and transmitted the virus to naive pigeons. Both patients were likely infected by contact with infected pigeons or doves. Given the large populations of feral pigeons with PPMV-1 infection in cities, increasing urbanization, and a higher proportion of immunocompromised individuals, the risk of severe human PPMV-1 infections may increase. We recommend testing for avian paramyxovirus type 1, including PPMV-1, in respiratory disease cases where common respiratory pathogens cannot be identified.

Figure 1.

Maximum likelihood phylogenetic tree depicting the relationship of the Dutch clinical isolate (hPPMV-1/NL/579/2003) with related avian paramyxovirus type 1 (APMV-1) strains based on analysis of full-length genomes. Assignment of APMV-1 genotypes (VIb/1 or VII) and sublineages (EUre1, EUre2, EUea1, or EUea2) was based on the studies of Ujvári et al [16] and Czegledi et al [35] and the sequence comparison shown in Table 1. GenBank accession numbers are given in parentheses: hPPMV-1/NL/579/2003 (KJ544861), Be/98–238/1998 (JX901109), Be/98–248/1998 (JX901110), WF CHK-guangzhou/2005 (HM063425), IE/806/2004 (JN986839), CH/waterhen/05 (HM063423), CH/SDLC/2011 (JQ979176), CH/LLN/110713 (JX486552), Be/07-04943/2007 (JX901121), Chi/SDS/2011 (JQ993431), Be/11-08304/2011 (JX901123), JS/07/03 (FJ766531), JS/07/22 (FJ766526), JS/07/16 (FJ766527), Be/11-07574/2011 (JX901122), JS/07/04 (FJ766530), CH/LGD/110947 (JX486556), CH/LGD/110945 (JX486555), IE/AV32419/1996 (GQ429292), CH/LJL/100605 (JX486551), CH/LHLJ/110813 (JX486553), CH/LGD/110208 (JX486550), CH/LHLJ/110822 (JX486554), CH/LJL/120404 (JX486557), IT/273620/2000 (GQ429293), USA/0607/2006 (KC013033), IT/227/1982 (AJ880277), USA/0704/2007 (KC013034), USA/0810/2008 (KC013038), USA/0719/2007 (KC013036), USA/0717/2007 (KC013035), USA/0805/2008 (KC013037), USA/NY/1984 (FJ410145), USA/ML/1984 (FJ410147), IT/2736/2000 (AY562989), APMV-1/NL/152608/1993 (JN986837).

Figure 2.

Pulmonary immunohistochemistry and histopathology of the patient with hPPMV-1/NL/579/2003 infection. A, Diffuse alveolar damage, characterized by thickening of alveolar septa, flooding of alveolar lumina, and presence of hyaline membranes (hematoxylin and eosin [H&E] staining; original magnification ×4.) B, Higher magnification of A, showing single pulmonary alveole, where epithelial lining is replaced by hyaline membranes (H&E; original magnification ×40.) C, Avian paramyxovirus type 1 antigen visible as granular staining in cytoplasm of degenerate cell, suggestive of alveolar epithelial cell (immunoperoxidase stain for pigeon paramyxovirus type 1 [PPMV-1]; original magnification ×100.).