Pediatric adenovirus pneumonia: clinical practice and current treatment

Zhang, Jie; Zhu, Yiting; Zhou, Yiyang; Gao, Fei; Qiu, Xiu; Li, J.; Yuan, Hao; Jin, Wenwen; Lin, Wei

doi:10.3389/fmed.2023.1207568

Cited by 16 publications

(8 citation statements)

References 160 publications

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“…There were no speci c ndings in EEG or MRI examination of the children in this group, which was consistent with other research reports [11] At present, there is no speci c treatment for HAdV pneumonia. Symptomatic support, respiratory support and immunomodulatory therapy such as glucocorticosteroid and gamma globulin are the main treatments [12]. Antibiotics should be given when bacterial co-infection is considered, and BAL therapy should also be selected at the right time.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and half-year outcomes of 53 children with severe adenovirus pneumonia complicated with encephalitis or encephalopathy

Zeng,

Wei,

Liu

et al. 2023

Preprint

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The clinical characteristics and prognosis of children with human adenovirus pneumonia complicated with encephalitis or encephalopathy remain unclear. We analyzed clinical datas of 53 children who were admitted to the Respiratory Department of Children's Hospital of Chongqing Medical University in 2019 with severe adenovirus pneumonia and complicated with viral encephalitis or encephalopathy retrospectively, and 78 cases diagnosed with severe adenovirus pneumonia but without encephalitis or encephalopathy were selected as controls. Among the 53 children, 32 (60.4%) were males with a median age of 18.0(7.5-37.0) months. All of them had fever and cough, and the median fever duration was 12.0(9.5-15.0) days, 90.6%(48/53) had listlessness, 62.3%(33/53) had dysphoria, 47.2%(25/53) had hypersomnia, 13.2%(7/53) had seizure, and 30.2%(16/53) had positive signs in nervous system physical examination. The median leukocyte count of children with encephalitis or encephalopathy was 7.39 (3.53-10.73) *10^9/L, the median procalcitonin was 1.885(0.390-4.555)ng/ml, and the median lactate dehydrogenase was 980.50 (516.40-1938.00) U/L, these were significant differences compared with the control group (P values were 0.011, 0.001, 0.000), but there was no difference in nasopharyngeal adenovirus load. Children with encephalitis or encephalopathy are more likely to be complicated with leukopenia, hypoproteinemia, liver function impairment, coagulopathy, anemia, pleural effusion, abdominal effusion, hemophagocytic lymphohistiocytosis. 75.47% (40/53) of the children needed mechanical ventilation, and the rate of tracheal intubation and mechanical ventilation time were significantly increased compared with the control group (P values were 0.039, 0.000). The rates of gamma globulin, albumin and blood transfusion were 92.45% (49/53), 52.83% (28/53) and 26.42% (14/53), which were significantly higher than those in the control group (P values were 0.004, 0.000, 0.028). At the follow-up of half a year later, 35.85% (19/53) showed obliterative bronchiolitis, which was significantly higher than 11.54% (9/78) in the control group ( c2=11.098, P=0.001), and there was no obvious sequelae in the nervous system. Conclusion It is necessary to be aware of the possibility of encephalitis/encephalopathy in children with severe adenovirus pneumonia when the consciousness state changes such as listlessness. The clinical manifestations of these children are severe and the prognosis of the nervous system is not bad, but the incidence of bronchiolitis obliterans is high in the later stage.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and half-year outcomes of 53 children with severe adenovirus pneumonia complicated with encephalitis or encephalopathy

Zeng,

Wei,

Liu

et al. 2023

Preprint

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“…Treatment of HAdV respiratory disease is primarily supportive [14,48]. Most infections in otherwise healthy children are self-limited and do not require treatment.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…Intravenous immunoglobulin has been used to treat acute myocarditis, pneumonia (in immunocompromised patients), and disseminated disease due to adenovirus [27,39]. Glucocorticoids have also been used in patients with adenovirus-associated pneumonia; early administration may improve treatment success and reduce inpatient mortality [27,48].…”

Section: Treatment Optionsmentioning

confidence: 99%

“…Cidofovir-related nephrotoxicity and myelotoxicity is a concern, and has been described in high-risk hematopoietic stem cell transplant patients [15,39], However, only a minority of immunocompetent children treated with cidofovir seem to develop nephrotoxicity. Recently, brincidofovir, an oral formulation lipid conjugate of cidofovir, has been reported to have good oral bioavailability, and reduced nephrotoxicity and bone marrow toxicity compared with cidofovir [48]. Other orally bioavailable cidofovir analogues with reduced nephrotoxicity and increased activity are under development [49].…”

Section: Treatment Optionsmentioning

confidence: 99%

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Respiratory adenovirus infections in children: a focus on Africa

van der Zalm,

Sam-Agudu,

Verhagen

2024

Current Opinion in Pediatrics

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Purpose of review Lower respiratory tract infections (LRTIs) are an important cause of child morbidity and mortality globally, especially in children under the age of 5 years in Africa. Respiratory viruses, including human adenoviruses (HAdVs), are common causes of LRTIs in children. This review aims to shed light on the epidemiology, clinical manifestations, sequelae, and treatment options specific to adenovirus respiratory infections in African children. Recent findings Recent evidence has challenged the perception that adenovirus is a negligible cause of LRTIs. Studies show HAdV emerging as the third most common viral pathogen in fatal pneumonias among under-5 children in low-income and middle-income African countries, contributing to 5.5% of all pneumonia deaths and ranking second in hospital-associated viral pneumonia deaths. Predominant HAdV serotypes associated with disease differ by country and region, and have changed over time. Risk factors for increased disease severity and long-term respiratory sequelae in previously healthy African children with HAdV LRTIs are not well established. Summary Although respiratory viruses, including HAdV, are recognized contributors to LRTIs, the prevalence and impact of adenovirus infections have been under-recognized and understated. Available data suggests that African children, particularly those under 5 years old, are at risk of severe sequelae from respiratory HAdV infections. Long-term sequelae, including bronchiectasis and postinfectious bronchiolitis obliterans, further underscore the significant impact of HAdV infections. However, the scarcity of comprehensive data hampers our understanding of the extent on the impact of HAdV infections child lung health in Africa. We recommend scaled-up HAdV surveillance, ensuring its consistent inclusion in population-level LRTI assessments, and expanded and equitable access to diagnostics for early recognition of African children at risk of developing chronic sequelae and death. Enhanced understanding of adenovirus epidemiology and clinical outcomes and the availability of therapeutic options are essential for informed public health strategies and clinical care.

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“… 2 , 5 , 6 Bronchoscopy combined with bronchoalveolar lavage (BAL) is not only a diagnostic method of PB but also plays an important role in the treatment of adenovirus pneumonia, especially with PB, because it can clamp the blocked mucus plug out of the small bronchi and effectively ease the clinical symptoms of children with pulmonary consolidation and atelectasis. 7 Our study aimed to evaluate the clinical features and risk factors for PB in children with severe adenovirus pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Risk Factors for Plastic Bronchitis in Children with Severe Adenovirus Pneumonia: A Retrospective Study

Xu,

Cai,

Fan

et al. 2024

IDR

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Purpose Plastic bronchitis (PB), a rare complication of respiratory infection characterized by the formation of casts in the tracheobronchial tree, can lead to airway obstruction and severe condition. Adenovirus is one of the common pathogens of PB caused by infection. This study aimed to evaluate the clinical features and risk factors for PB in children with severe adenovirus pneumonia. Methods A retrospective study of children with severe adenovirus pneumonia with bronchoscopy results at Guangzhou Women and Children’s Hospital between January 2018 and January 2020 was performed. Based on bronchoscopy, we divided children with severe adenovirus pneumonia into two groups: PB and non-PB. Binary logistic regression analysis was used to identify independent risk factors for PB in patients with severe adenovirus pneumonia after univariate analysis. Results Our study examined 156 patients with severe adenovirus pneumonia with bronchoscopy results in hospital. Among them, 18 developed PB and 138 did not. On multivariate analysis, the independent risk factors of PB in children with severe adenovirus pneumonia were history of allergies (OR 10.147, 95% CI 1.727–59.612; P =0.010), diminished breath sounds (OR 12.856, 95% CI 3.259–50.713; P =0.001), and increased proportion of neutrophils (>70%; OR 8.074, 95% CI 1.991–32.735; P =0.003). Conclusion Children with severe adenovirus pneumonia with a history of allergies, diminished breath sounds, and increased the proportion of neutrophils >70% may show higher risk of PB.

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Pediatric adenovirus pneumonia: clinical practice and current treatment

Cited by 16 publications

References 160 publications

Clinical characteristics and half-year outcomes of 53 children with severe adenovirus pneumonia complicated with encephalitis or encephalopathy

Clinical characteristics and half-year outcomes of 53 children with severe adenovirus pneumonia complicated with encephalitis or encephalopathy

Respiratory adenovirus infections in children: a focus on Africa

Analysis of the Risk Factors for Plastic Bronchitis in Children with Severe Adenovirus Pneumonia: A Retrospective Study

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