The patient became comatose and was transferred to our department. At that time, the physical examination showed fever (40.2°C), neck stiffness, Brudzinski sign, thoracic dullness, and bilateral crackling rales. The level of C-reactive protein was 123 mg/L. Renal failure was noted with a creatinine blood level of 312 mmol/L and uncontrolled diabetes with fasting glucose of 24.75 mmol/L. Computed tomographic (CT) scan of the brain did not show brain abscesses or tumors. Examination of the cerebrospinal fluid (CSF) indicated a protein level of 2.67 g/L, decreased glucose concentration of 0.55 mmol/L, and a leukocyte count of 2.3 x 10 9 /L with 96% neutrophils; no microbial pathogens were demonstrable under direct examination of CSF. Chest xray identified bronchopneumonia and bilateral pleural effusion. The pleural fluid analysis revealed a purulent exudate-protein, 4.5 g/L-containing 55% neutrophils. A urine specimen and three blood samples were obtained for cultures over the first 4 hours after admission. A bacterial invasive infection was considered and the antibiotic therapy was started with ceftriaxone, 2 g/day, and rifampin, 1,200 mg/day. Concomitantly, the patient received colloids to reestablish blood volume, intravenous dexamethasone, 6 mg four times daily, to diminish the cerebral edema; and fast- Human Metapneumovirus and Severity of Respiratory Syncytial Virus Disease  I n the United States, 100,000 infants and young children are hospitalized each year with respiratory syncytial virus (RSV) bronchiolitis (1) . Although the risk factors for severe RSV disease, such as prematurity and bronchopulmonary dysplasia, are well defined, severe RSV disease may develop in otherwise healthy children. The pathogenesis of severe RSV disease is poorly defined.