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Published on: December 10, 2013
Clinical Profile of Children with Adenovirus Infection - A Hospital-based Observational Study
Poovazhagi Varadarajan1, Ramesh Subramanian1, Gomathy Srividya1
1Department of Pediatric Intensive Care, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamil Nadu, India.
Insights
Adenovirus infection in children often presents with multisystem involvement, impacting over 74% of cases. Factors like acute kidney injury and left ventricular dysfunction are associated with increased mortality in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Viral Pathogen Research
- Clinical Epidemiology
Background:
- Adenovirus infections pose a significant health burden in pediatric populations worldwide.
- Understanding the clinical spectrum and mortality predictors is crucial for effective management.
Purpose of the Study:
- To delineate the clinical characteristics of hospitalized children with adenovirus infection.
- To identify factors associated with in-hospital mortality in this cohort.
Main Methods:
- An observational study involving polymerase chain reaction (PCR) testing of respiratory specimens from hospitalized children.
- Exclusion criteria included coinfections and incomplete treatment data.
- Logistic regression analysis was employed to determine mortality predictors.
Main Results:
- 130 children (median age 18 months) were diagnosed with adenovirus infection; 84.5% were under 5 years old.
- Multisystem involvement (74.62%) and abnormal chest radiographs (69.2%) were common.
- Mortality was 13%, with acute kidney injury, left ventricular dysfunction, and pancytopenia identified as significant risk factors.
Conclusions:
- Adenovirus infection frequently manifests as multisystem involvement in children.
- Non-respiratory presentations account for approximately 20% of pediatric adenovirus cases.
Objective:
To describe the clinical profile and determine the factors affecting mortality of children admitted with adenovirus infection in a tertiary care centre in South India.
Methods:
In this observational study, respiratory specimens (nasopharyngeal swab / endotracheal aspirate) were collected from all hospitalized pediatric patients presenting with fever, cough, breathlessness, gastrointestinal symptoms, unexplained encephalopathy or multisystem involvement, between February 2023 and August 2023. Infection with adenovirus was determined by viral pathogen panel based on polymerase chain reaction (PCR) technique. Those referred from elsewhere with positive adenovirus report but non-availability of treatment details and children with coinfections were excluded. The clinical and laboratory profile of children with adenovirus infection were collected and predictors for in-hospital mortality were determined by logistic regression analysis.
Results:
Out of 527 children who were screened, 130 children with a median (IQR) age of 18 (10, 48) months, had adenovirus infection. 84.5% were aged below 5 years. 62 (41.33%) children required intensive care admission. Abnormal chest radiograph, multisystem involvement and non-respiratory illness were present in 90 (69.2%), 97 (74.62%) and 26 (20%) children. Complications included acute respiratory distress syndrome (n = 8), hemophagocytic lymphohistiocytosis (n = 7), left ventricular dysfunction (n = 11), acute liver cell failure (n = 7), acute kidney injury (n = 13), and multiorgan dysfunction (n = 16). Overall mortality was 13%. Acute kidney injury, left ventricular dysfunction and pancytopenia were identified as factors that may be significantly associated with death.
Conclusion:
Multisystem involvement was observed in majority of children presenting with adenovirus infection. Non respiratory presentation is seen in a fifth of children with adenovirus infection.
