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Severe adenovirus infection in children
Y u-Y u Chuang1, Cheng-Hsun Chiu, Kin-Sun Wong
1Department of Pediatrics, St. Mary's Hospital, Taiwan, ROC.
Insights
Severe adenovirus infection in children often presents with pneumonia and effusion, mimicking bacterial illness. Early diagnosis is crucial due to potential complications like hepatitis and long-term lung damage.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- Severe adenovirus infections pose a significant threat to pediatric patients.
- Distinguishing adenovirus from bacterial pneumonia is clinically challenging.
Purpose of the Study:
- To describe the clinical features, complications, and outcomes of severe adenovirus infection in children.
- To highlight diagnostic clues for severe adenoviral infections.
Main Methods:
- Retrospective case series of 9 children with severe adenovirus infection treated between July 1999 and September 2000.
- Analysis of clinical presentation, laboratory findings, radiographic data, and patient outcomes.
Main Results:
- All patients presented with lower respiratory tract infections (pneumonia, pleural effusion), requiring intensive care (88.9%) and mechanical ventilation (44.4%).
- Common extrapulmonary complications included hepatitis (66.7%), encephalitis (33.3%), and coagulopathy (22.2%).
- A significant mortality rate (12.5%) and high incidence of long-term sequelae (bronchiolitis obliterans/organizing pneumonia in 62.5% of survivors) were observed. Serotype 3 was the predominant strain.
Conclusions:
- Severe adenovirus infection can present with symptoms mimicking bacterial infections, necessitating careful clinical evaluation.
- Rapid clinical deterioration despite antibiotics and unusual extrapulmonary manifestations are key indicators for suspecting adenovirus.
- Adenovirus infection can lead to severe morbidity, including long-term pulmonary complications.
Abstract:
During the period from July 1, 1999 to September 30, 2000, 9 children with severe adenovirus infection were treated at Chang Gung Children's Hospital. The mean age was 22 months (range, 5-50 months). All of them had lower respiratory tract infections, which manifested as lobar or segmental pneumonia and pleural effusion. Eight (88.9%) of the 9 patients required intensive care and 4 of them required mechanical ventilation. Abnormal laboratory findings included leukocytosis, elevated C-reactive protein, anemia, and prolonged prothrombin time and partial thromboplastin time. Extrapulmonary complications included hepatitis (6 cases), encephalitis (3), conjunctivitis (3), periorbital ecchymosis (1), and coagulopathy (2). One patient died, resulting in a mortality rate of 12.5%. Follow-up at 3 months postdischarge, 5 patients (62.5% of survivors) had bronchiolitis obliterans and/or organizing pneumonia. Seven patients were infected by serotype 3 adenovirus, 1 patient by serotype 2, and another by serotype 11. In conclusion, the clinical, laboratory, and radiographic features of severe adenovirus infection may mimic bacterial infection. Rapid progression of the clinical course despite antibiotic therapy and the presence of unusual extrapulmonary symptoms are important clinical clues in the diagnosis of severe adenoviral infection.