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Adenovirus respiratory tract infections in infants: a retrospective chart-review study
Shaden Jobran1, Randa Kattan2, Jamal Shamaa1
1Department of Paediatrics, Caritas Baby Hospital, Bethlehem, West Bank, occupied Palestinian territory.
Insights
Human adenoviruses cause significant paediatric respiratory infections. This study found adenoviral infections in infants can mimic sepsis, leading to unnecessary antibiotic use.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health
Background:
- Human adenoviruses are a significant cause of pediatric respiratory tract infections, accounting for 2-5% of all cases and 4-10% of pneumonias.
- Adenoviral infections pose a considerable burden on healthcare systems, particularly in young children.
Purpose of the Study:
- To evaluate the clinical presentation of adenoviral infections in infants.
- To assess the impact of adenoviral infection on the management and treatment of affected infants.
Main Methods:
- Retrospective analysis of medical records from Caritas Baby Hospital (2006-2016).
- Diagnosis of adenoviral respiratory tract infections using direct fluorescent antibody staining on nasopharyngeal aspirates.
- Analysis of clinical presentation, medical workup, laboratory results, and antibiotic administration.
Main Results:
- 491 infants with adenoviral infection were reviewed; boys were more affected (2:1 ratio).
- Common presentations included upper respiratory tract symptoms (67%), gastrointestinal symptoms (34%), and difficulty breathing (12%).
- 72% of patients received antibiotic treatment, and 19% required lumbar puncture, indicating a sepsis-like presentation in many cases.
Conclusions:
- Adenoviral infections in infants can present with a sepsis-like picture, leading to potentially unnecessary interventions and antibiotic use.
- Rapid and sensitive adenovirus detection methods are crucial for accurate diagnosis and appropriate treatment decisions in clinical laboratories.
Background:
Human adenoviruses have an important role in paediatric respiratory tract infections. They are estimated to cause 2-5% of the overall respiratory tract infections and 4-10% of all pneumonias. The aim of this study was to evaluate the clinical presentation and effect of adenoviral infection on the management of infected infants.
Methods:
Data were collected from the medical records of patients infected with adenovirus and admitted to Caritas Baby Hospital. Adenoviral respiratory tract infections were diagnosed from nasopharyngeal aspirates using direct fluorescent antibody staining. We analysed patient clinical presentation, medical workup, laboratory workup, and antibiotic administration. This study was approved by Caritas Baby Hospital Medical Research Committee.
Findings:
We reviewed records for 491 patients admitted to Caritas Baby Hospital with adenoviral infection between Jan 1, 2006, and June 30, 2016. Adenoviral activity was noted throughout the months of the study period, with major activity during late winter, spring, and early summer. Boys were most affected (male to female ratio 2:1). Upon admission, 187 (38%) patients were afebrile. According to the clinical presentation, 327 (67%) patients presented with upper respiratory tract infection symptoms, 165 (34%) with gastrointestinal tract symptoms, 59 (12%) with difficulty of breathing, and 46 (9%) with conjunctivitis. 279 (57%) patients had leucocytosis, whereas the C-reactive protein titre was more than 50 μg/mL in 228 (46%) patients. 92 (19%) patients needed a lumbar puncture. Overall, 354 (72%) patients received antibiotic treatment. Length of hospital stay was 1-10 days, and most patients were discharged from hospital on day 3. The average cost of hospitalisation was US$1180·5 per patient.
Interpretation:
Adenoviral infections in infants can present with a sepsis-like picture, mandating unnecessary interventions. Clinical laboratories in hospitals must therefore have rapid and sensitive adenovirus detection techniques to assist the doctors in making appropriate treatment decisions.
Funding:
Medical Research Committee of Caritas Baby Hospital.
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