Severe Community-Acquired Pneumonia Caused by Human Adenovirus in Immunocompetent Adults: A Multicenter Case Series

Abstract

BackgroundSevere community-acquired pneumonia (CAP) caused by human adenovirus (HAdV), especially HAdV type 55 (HAdV-55) in immunocompetent adults has raised increasing concerns. Clinical knowledge of severe CAP and acute respiratory distress syndrome induced by HAdV-55 is still limited, though the pathogen has been fully characterized by whole-genome sequencing.MethodsWe conducted a multicentre retrospective review of all consecutive patients with severe CAP caused by HAdV in immunocompetent adults admitted to the Emergency Department Intensive Care Unit of two hospitals in Northern China between February 2012 and April 2014. Clinical, laboratory, radiological characteristics, treatments and outcomes of these patients were collected and analyzed.ResultsA total of 15 consecutive severe CAP patients with laboratory-confirmed adenovirus infections were included. The median age was 30 years and all cases were identified during the winter and spring seasons. HAdV-55 was the most frequently (11/15) detected HAdV type. Persistent high fever, cough and rapid progression of dyspnea were typically reported in these patients. Significantly increased pneumonia severity index (PSI), respiratory rate, and lower PaO2/FiO2, hypersensitive CRP were reported in non-survivors compared to survivors (P = 0.013, 0.022, 0.019 and 0.026, respectively). The rapid development of bilateral consolidations within 10 days after illness onset were the most common radiographic finding, usually accompanied by adjacent ground glass opacities and pleural effusions. Total mortality was 26.7% in this study. Corticosteroids were prescribed to 14 patients in this report, but the utilization rate between survivors and non-survivors was not significant.ConclusionsHAdV and the HAdV-55 sub-type play an important role among viral pneumonia pathogens in hospitalized immunocompetent adults in Northern China. HAdV should be tested in severe CAP patients with negative bacterial cultures and a lack of response to antibiotic treatment, even if radiologic imaging and clinical presentation initially suggest bacterial pneumonia.

Seroprevalence of neutralizing antibodies against adenovirus type 14 and 55 in healthy adults in Southern China

“…2 Clarifying the circulation of Ad14 and Ad55 nAbs in general populations is essential for understanding the herd immunity. Here, we investigated the seroprevalence of Ad14 and Ad55 nAbs in a large cohort from Southern China, and we found that the seropositive rates of Ad14 and Ad55 were much lower than that of Ad5 according to our previous results.…”

Influenza and Viral Pneumonia

“…Different studies have reported that patients with community-acquired pneumonia and adenovirus infection have mean age that ranges from 30 to 38 years old. 52,53 Adenovirus also causes serious infection in immunocompromised patients. The adenovirus species found in immunocompromised patients are not typically found in the community, which indicates endogenous viral reactivation in these patients.…”

Viral Pneumonia and Acute Respiratory Distress Syndrome

“…169 In a retrospective review, the use of corticosteroids in immunocompetent patients with adenovirus pneumonia did not show any benefit. 172…”