Fatal Adenovirus Infection With Misleading Positive Serology for Infectious Mononucleosis

Smith, R.H.

doi:10.1016/s0140-6736(79)90708-6

Cited by 12 publications

(7 citation statements)

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“…All of these radiological patterns (including normal initial chest radiographs) have been described in patients with primary influenza pneumonia [29][30][31]. Although the overall mortality rate in this series [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] was 24%, only two patients who were reported on after 1979 have died, possibly representing improvement in supportive care over this time period. Our present case report of an immunocompetent adult civilian patient with sporadic adenoviral pneumonia is the first case to be reported in the literature in which molecular diagnostic methods were used.…”

Section: Discussionmentioning

confidence: 93%

“…The advantages of rapidly diagnosing respiratory viral infection in patients with community-acquired pneumonia include the institution of appropriate infection control measures, the rational use of antibiotics in the absence of bacterial co-pathogens and, in some instances, the use of specific antiviral therapy. Two patients in our series [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] received the antiviral agent cidofovir, and while there are no randomized, controlled trials demonstrating its efficacy in adenoviral infection, it has been used successfully in immunocompromised patients with severe adenoviral pneumonia [34].…”

Section: Discussionmentioning

confidence: 99%

“…We identified 19 articles published between 1975 and 2008 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] describing 21 patients that matched our search terms. The demographic, laboratory, radiological and clinical details of these cases and our own are shown in Table 1.…”

Section: Case Presentationmentioning

confidence: 99%

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Severe community-acquired adenovirus pneumonia in an immunocompetent 44-year-old woman: a case report and review of the literature

2011

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IntroductionThis case report describes a rare condition: community-acquired adenovirus pneumonia in an immunocompetent adult. The diagnosis was achieved by using a multiplex real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay and highlights the usefulness of these novel molecular diagnostic techniques in patients hospitalized with acute respiratory illness. We also performed a literature search for previously published cases and present a summary of the clinical, laboratory and radiological features of this condition.Case presentationA 44-year-old immunocompetent Caucasian woman was admitted to our hospital with an acute febrile respiratory illness associated with a rash. Her blood tests were non-specifically abnormal, and tests for bacterial pathogens were negative. Her condition rapidly deteriorated while she was in our hospital and required mechanical ventilation and inotropic support. A multiplex real-time RT-PCR assay performed on respiratory specimens to detect respiratory viruses was negative for influenza but positive for adenovirus DNA. The patient recovered on supportive treatment, and antibiotics were stopped after 5 days.ConclusionsCommunity-acquired adenovirus pneumonia in immunocompetent adult civilians presents as a non-specific acute febrile respiratory illness followed by the abrupt onset of respiratory failure, often requiring mechanical ventilation. Its laboratory and radiological features are typical of viral infections but also are non-specific. Novel multiplex real-time RT-PCR testing for respiratory viruses enabled us to rapidly make the diagnosis in this case. The new technology could be used more widely in patients with acute respiratory illness and has potential utility for rationalization of the use of antibiotics and improving infection control measures.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Severe community-acquired adenovirus pneumonia in an immunocompetent 44-year-old woman: a case report and review of the literature

2011

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“…7 Although bilateral interstitial infiltrates was the most common CXR finding, adenovirus caused lobar consolidation in 3 patients. 15,18,19 Three of 13 (23%) previously reported healthy civilian adults with AVP died, but all fatal cases occurred before 1980. We found no reports of fatal cases of AVP in this patient population in the more recent English literature.…”

Section: Case Reportmentioning

confidence: 99%

“…[8][9][10] In the third setting, life-threatening cases of pneumonia have been seen in healthy, noninstitutionalized civilian adults. [11][12][13][14][15][16][17][18][19][20][21][22] Thirteen cases of severe AVP in nonimmunocompromised, civilian, noninstitutionalized adults have been described in English medical literature. [11][12][13][14][15][16][17][18][19][20][21][22] The clinical features have been reviewed in 2 previous publications.…”

Section: Case Reportmentioning

confidence: 99%

Life-Threatening Adenovirus Pneumonia in an Immunocompetent Civilian Adult

Ahmad

Weinstein

Boruchoff

2005

Infectious Diseases in Clinical Practice

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We describe a case of life-threatening adenovirus pneumonia in a previously healthy immunocompetent civilian adult who presented with a rash, leukocytosis, lobar infiltrate, and renal failure. The clinical course was complicated by shock, adult respiratory distress syndrome, and respiratory failure. Adenovirus type 4 was isolated from both sputum and a nasopharyngeal swab. (Infect Dis Clin Pract 2005;13:39-41) CASE REPORTA 49-year-old previously healthy white male began experiencing excessive sweating, generalized myalgias, and fatigue 5 days prior to admission. His physician prescribed azithromycin but there was no improvement in the patient's symptoms. Two days prior to admission, the patient noticed redness and itching of the left eye, mild shortness of breath, and low-grade fever. His physician prescribed levofloxacin, but the patient's condition worsened, and he developed fever as high as 1048F. On the morning of admission, the patient noticed a generalized rash and came to the Robert Wood Johnson University Hospital emergency room. Physical examination revealed a temperature of 100.48F, heart rate of 121 beats/ min, blood pressure of 106/71 mm Hg, and a respiratory rate of 18/min. Pulse oxygenation was 93% on room air. The conjunctiva of the left eye was red, with purulent drainage. Mild pharyngeal erythema was present. Chest auscultation revealed good air movement with a few scattered wheezes but no rales. A maculopapular rash was present on the trunk and upper extremities, and there were petechiae over the lower extremities. Chest x-ray (CXR) showed a left lower lobe infiltrate (Fig. 1). Abnormal laboratory results included white blood cell (WBC) count of 23,000 with 78% polymorphonuclear leukocytes and 15% bands, serum creatinine (Cr) level of 1.4 mg/dL, serum bilirubin level of 1.7 mg/dL, and serum aspartate aminotransferase (AST) level of 77 IU/L. The patient was treated empirically with ceftriaxone 1 g IV and clarithromycin 500 mg PO twice/d. Levofloxacin and azithromycin were withheld due to the possibility that the patient's rash represented a drug eruption. On the morning after admission, the patient developed acute respiratory distress and became hypotensive. He was intubated and started on vasopressors. CXR now revealed extensive bilateral pulmonary infiltrates, consistent with adult respiratory distress syndrome [ARDS] (Fig. 2). PO 2 was 47 mm Hg on 100% FiO 2 . Serum Cr from a specimen drawn prior to the development of hypotension was 3.0 mg/dL.

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Involvement of adenovirus in clinical mononucleosis-like syndromes in young children

Melón

Méndez

Iglesias

et al. 2005

Eur J Clin Microbiol Infect Dis

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Although Epstein-Barr virus (EBV) commonly causes infectious mononucleosis (IM) or IM-like syndromes, other agents can be implicated. In this study, viral and parasitic screening was performed to determine the etiological agent of pediatric IM-like syndromes in 38 children. Adenovirus was the agent most frequently detected (47.3%), followed by EBV (31.5%) and cytomegalovirus (2.6%). Although the statistically significant difference between viral detection rates observed in patients who fulfilled clinical and hematological criteria and detection rates in those who presented clinical symptoms only (91.6% vs. 64.3%) indicates that hematological abnormalities are common in viral IM-like syndromes, the existence of syndromes of viral etiology without hematological criteria cannot be discarded. A further analysis showed an absence of lymphocytosis in adenovirus infections as well as a low number (14.3%) of EBV infections associated with increased neutrophils. These data suggest the usefulness of appropriate virological techniques for the detection of adenovirus in pediatric IM-like syndromes.

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Fatal Adenovirus Infection With Misleading Positive Serology for Infectious Mononucleosis

Cited by 12 publications

References 2 publications

Severe community-acquired adenovirus pneumonia in an immunocompetent 44-year-old woman: a case report and review of the literature

Severe community-acquired adenovirus pneumonia in an immunocompetent 44-year-old woman: a case report and review of the literature

Life-Threatening Adenovirus Pneumonia in an Immunocompetent Civilian Adult

Involvement of adenovirus in clinical mononucleosis-like syndromes in young children

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