Adenovirus respiratory tract infections in infants: a retrospective chart-review study

Abstract

BackgroundHuman adenoviruses have an important role in paediatric respiratory tract infections. They are estimated to cause 2–5% of the overall respiratory tract infections and 4–10% of all pneumonias. The aim of this study was to evaluate the clinical presentation and effect of adenoviral infection on the management of infected infants. MethodsData were collected from the medical records of patients infected with adenovirus and admitted to Caritas Baby Hospital. Adenoviral respiratory tract infections were diagnosed from nasopharyngeal aspirates using direct fluorescent antibody staining. We analysed patient clinical presentation, medical workup, laboratory workup, and antibiotic administration. This study was approved by Caritas Baby Hospital Medical Research Committee. FindingsWe reviewed records for 491 patients admitted to Caritas Baby Hospital with adenoviral infection between Jan 1, 2006, and June 30, 2016. Adenoviral activity was noted throughout the months of the study period, with major activity during late winter, spring, and early summer. Boys were most affected (male to female ratio 2:1). Upon admission, 187 (38%) patients were afebrile. According to the clinical presentation, 327 (67%) patients presented with upper respiratory tract infection symptoms, 165 (34%) with gastrointestinal tract symptoms, 59 (12%) with difficulty of breathing, and 46 (9%) with conjunctivitis. 279 (57%) patients had leucocytosis, whereas the C-reactive protein titre was more than 50 μg/mL in 228 (46%) patients. 92 (19%) patients needed a lumbar puncture. Overall, 354 (72%) patients received antibiotic treatment. Length of hospital stay was 1–10 days, and most patients were discharged from hospital on day 3. The average cost of hospitalisation was US$1180·5 per patient. InterpretationAdenoviral infections in infants can present with a sepsis-like picture, mandating unnecessary interventions. Clinical laboratories in hospitals must therefore have rapid and sensitive adenovirus detection techniques to assist the doctors in making appropriate treatment decisions. FundingMedical Research Committee of Caritas Baby Hospital.