Human Adenovirus Type 7 Infection Associated with Severe and Fatal Acute Lower Respiratory Illness and Nosocomial Transmission

Abstract

A 23-year-old male died of severe pneumonia and respiratory failure in a tertiary hospital in Beijing, and 4 out of 55 close contacts developed fever. Molecular analysis confirmed human adenovirus type 7 (HAdV7) as the causative agent. We highlight the importance of early diagnosis and treatment and proper transmission control of HAdV7. CASE REPORT Human adenovirus type 7 (HAdV7) infection is associated with acute respiratory disease syndrome, pharyngoconjunctival fever, pneumonia, and central nervous system disease (1-4). According to the last global survey, approximately one-fifth of all HAdV infections reported to the World Health Organization (WHO) were attributed to HAdV7 (5). HAdV7 outbreaks generally occur in settings with close living conditions, such as military barracks, hospital wards, and chronic care facilities (1,(6)(7)(8). In hospitals, HAdV has emerged as a nosocomial pathogen, and nosocomial outbreaks caused by HAdV7 with fatal cases have been reported worldwide (8-10). Although some prevention measurements have been carried out to control nosocomial transmission, questions regarding the efficacy of these programs persist, and the contribution of HAdV7 (and adenoviruses in general) to nosocomial infection is likely to be underestimated. Here, we report a case of HAdV7 infection associated with severe pneumonia and fatal acute lower respiratory disease and nosocomial transmission.The index case, a 23-year-old male in Wuhan City, Hubei Province, China, presented with a fever of approximately 39°C on 18 January 2014, but discontinuous treatment did not alleviate his symptoms. On 26 January, he was admitted to the emergency department of a tertiary hospital in Beijing. A routine blood test showed high neutrophil levels (71.4%) and elevated plasma C reactive protein (19 mg/ml), and chest radiographs revealed an increase of right lung markings. However, the use of cefoxitin sodium by injection did not prevent his condition from worsening, with symptoms including severe fever, cough, and phlegm. He was diagnosed with pneumonia and transferred to the respiratory department on 28 January. Six days later, he was transferred to an intensive care unit (ICU) because of lung consolidation, and he passed away on 5 February 2014.During his hospitalization, 4 of 55 close contacts developed fevers higher than 38.0°C, including a family member, a bedside clinician, and two patients in the same ward (Table 1 and Fig. 1). The initial secondary case (patient 1) was his cousin, a 19-year-old girl who visited the index case on 26 January for 30 min in the emergency department and on 2 February for 5 min in the respiration department. The distance between them was more than 2 meters, but neither wore a mask. She experienced a fever of 38.5°C on 3 February. Patient 2, a 29-year-old male with acute pancreatitis and a fatty liver, was admitted to the same ward of the emergency department on 27 January. He developed a fever on 3 February, and a chest X-ray showed pulmonary shadows. Patient 3, a bedside clinician of the inde...

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