Severe adenovirus community-acquired pneumonia in immunocompetent adults: chest radiographic and CT findings

Abstract

Background: Severe adenovirus pneumonia and its associated imaging features are well-described in immunocompromised patients but are rare and poorly understood in immunocompetent adults. We sought to describe the radiographic and CT findings of severe adenovirus community-acquired pneumonia (CAP) in eight immunocompetent adults. Methods: We reviewed systematically chest imaging manifestations of laboratory-confirmed severe adenovirus pneumonia in eight immunocompetent adults from April 2012 to April 2014. Results: All patients showed abnormal results on initial chest radiograph and CT, with the exception of one normal initial chest radiograph. The abnormalities of the initial chest radiographs were unilateral (n=4) or bilateral (n=3), including consolidation (n=4), dense patchy opacity (n=3), ground glass opacity (GGO) (n=1), and pleural effusion (n=1). The initial CT findings consisted of unilateral (n=5) and bilateral (n=3) abnormalities, including consolidation (n=8), GGO (n=2), pleural effusion (n=3) and small nodules (n=1).Focal consolidation was the predominant finding in six patients whose initial CT scans were examined within one week after illness onset. Follow-up radiologic findings showed rapid development of bilateral consolidation within ten days after illness onset, usually accompanied by adjacent ground-glass opacity and pleural effusion. The parenchymal abnormalities began to absorb around two weeks after illness onset, with no appearances of fibrosis.Conclusions: Severe adenovirus CAP in immunocompetent adults mainly appears as focal consolidation followed by rapid progression to bilateral consolidation, usually accompanied by adjacent GGO and pleural effusion, which may resemble bacterial pneumonia. Adenovirus should be considered in severe pneumonia cases with negative cultures and failure to respond to antibiotics.

Prevalence and clinical impact of VIral Respiratory tract infections in patients hospitalized for Community-Acquired Pneumonia: the VIRCAP study

“…Interestingly, in our study CAP radiological features were not affected by the presence of VRTI. This is consistent with observations that, in some instance, viral and bacterial pneumonia may have similar radiological features [34] It is worth noting that, in spite of higher PSI scores in presence of VRTIs, we found no association between VRTIs and need of antibiotic treatment escalation, ICU admission and risk of mortality. Other studies investigating clinical outcomes in the same setting found opposite results.…”

Clinical and CT Findings of Adenovirus Pneumonia in Immunocompetent Adults, a Two-center Retrospectively Observation

“…In the current study, focal or subsegmental consolidation was more frequent in patients without mechanical ventilation, while patients with mechanical ventilation commonly indicated initial predominant lung consolidation or progress rapidly from initial focal consolidation to lobar consolidation, suggesting that patients required mechanical ventilation may be more prone to indicate intra-pulmonary abnormalities in CT scans. Consistent with previous studies [13,21] , 60% of this group of cases demonstrated pleural effusion and 20% of patients indicated pericardial effusion, which may be related to more serious abnormalities.…”

“…Yao et al [12] reported Human adenovirus among hospitalized children was detected in every month throughout the study period from April 2017 to March 2018, peaking in August 2017. In current study, summer and winter were peak season of immunocompetent adult adenovirus pneumonia, which was partially similar with another study that reported seasonal peak for adenovirus infections in winter and spring in immunocompetent patients [13] .…”

The Repertoire of Adenovirus in Human Disease: The Innocuous to the Deadly

“…Adenoviral pneumonia in immunocompetent individuals presents with chest Computerized Tomographic (CT) scan findings of subpleural and peribronchovascular consolidation with or without surrounding ground glass opacities [ 36 , 37 ]. A single center study done in a tertiary care hospital in Korea in 2016 suggested that large parenchymal involvement and presence of pleural effusion on CT are factors suggestive of progression to ARDS [ 38 ].…”