Treatment of adenoviral pneumonitis with intravenous ribavirin and immunoglobulin.

Abstract

Forty eight hours later she was profoundly hypoxaemic with an oxygen saturation of 54% breathing air. The chest radiograph showed extensive alveolar shadowing in keeping with a severe pneumonitis (fig 1). She required ventilation with an Fio2 of 95%, 10 cm positive end expiratory pressure (PEEP), and cardiovascular support with adrenaline. Treatment with high dose erythromycin and imipenem was started. At this time the presence of a cytopathic effect suggestive of adenovirus was noted in the viral tissue cultures which had been inoculated with the bronchoalveolar fluid. The same cytopathic effect was also seen in tissue cultures inoculated with a throat swab taken on the same day that the bronchoscopy was performed. The presence of an adenovirus was confirmed by electron microscopy.She was commenced on continuous nebulised ribavirin (20 mg/ml ribavirin via small particle generating nebuliser) but remained critically ill. Twenty four hours later intravenous ribavirin (20 mg/kg loading dose fol- Figure 2 Chest radiograph after treatment with intravenous and nebulised ribavirin showing significant clearing of the pneumonitis.

Pulse Methylprednisolone Therapy in Type 3 Adenovirus Pneumonia with Hypercytokinemia

“…There have been some reports that adenovirus pneumonia was successfully treated with intravenous ribavirin (Gavin and Katz 2002). Other reports described successful treatment with a combination of intravenous immunoglobulin and clarithromycin, dexamethasone and cyclosporin A, or intravenous ribavirin and immunoglobulin (Sabroe et al 1995;Morimoto et al 2003;Seidel et al 2003). However, we chose intravenous pulse methylprednisolone therapy as a treatment, because we considered hypercytokinemia to be the predominant pathogenesis of respiratory distress and high fever in our case.…”

Early diagnosis of adenovirus infection and treatment with cidofovir after bone marrow transplantation in children

“…Neither polyclonal immunoglobulins nor ganciclovir have shown any clinical benefit in immunocompromised patients. 17,18 Ribavirin has been reported to be useful in cases of hemorrhagic cystitis, pneumonia and gastroenteritis 19,20 due to adenovirus in BMT patients but these findings are controversial. 21 There is some evidence to support the use of cidofovir in adenovirus infection.…”

The Lung in the Immunocompromised Patient

“…Adenoviruses are also known to cause serious syndromes in immunocompromised patients and adenovirus pneumonitis is associated with a high mortality [14]. Treatment with ribavirin and immunoglobulin has been proposed [15]. Paramyxovirus has been reported to cause respiratory infections in a considerable number of lung transplant recipients [16].…”