Abstract
ObjectiveIncreased incidence of adenovirus infection in children was noticed since September 2010 in Taiwan and severe cases requiring intensive care were noted later. We did this study to find the clinical characteristics and risk factors associated with severe adenovirus infection.Patients and MethodsWe collected cases of severe adenovirus infection between November 2010 and June 2011 to analyze their clinical characteristics in two medical centers in northern Taiwan. Severe adenovirus infection was defined as laboratory-confirmed adenovirus cases with required intensive care. Hexon gene sequencing was performed for molecular genotyping.Results45 patients were included, 22 cases (49%) were infected with serotype 7, 19 (42%) with serotype 3, and 4 with serotype 2. The median age (range) was 2.75 years (0.08–15.43 years); 87% were below 5 years. Male to female ratio was 1.65 (28 to 17). Of these patients, 56% had underlying neurological diseases, 50% experienced fever higher than 40°C and 69% suffered fever longer than one week. The clinical diagnosis included pneumonia in 40 (89%) patients, bronchopneumonia in 5 (11%), and encephalitis in 7 (16%). At least 22 patients had pleural effusion. They had complications of respiratory failure (53%), acute respiratory distress syndrome (24%), hypotension (40%), and 6 (13%) patients needed extracorporeal membranous oxygenation. Ten (22%) patients died, all with underlying major systemic diseases and 7 (70%) infected with serotype 7.ConclusionsAdenovirus serotype 7 and 3 can cause severe disease–even death–in children, especially those with underlying neurological diseases. Patients infected with adenovirus serotype 7 tended to have a higher case-fatality rate.
Highlights
Adenovirus infection is common in early childhood [1], [2]
An increased number of adenovirus isolated from laboratories of two referral medical centers in northern Taiwan was noticed since September 2010
The rising number of children admitted to the intensive care unit (ICU) for adenovirus infection in these two medical centers was noticed since November 2010
Summary
Adenovirus infection is common in early childhood [1], [2]. The median incubation period is 5.6 days (95% confidence interval 4.8–6.3) [3]. An increased number of adenovirus isolated from laboratories of two referral medical centers in northern Taiwan was noticed since September 2010. The rising number of children admitted to the intensive care unit (ICU) for adenovirus infection in these two medical centers was noticed since November 2010. The nationwide surveillance system of Taiwan detected a similar trend [9] In this nationwide surveillance system, an average of 276 respiratory tract specimens from influenza-like illness outpatients, mainly (97%) ,18 years of age, were collected each week from 2008 to 2011 and the baseline adenovirus-positive rate in 2008–2010 was 5.75% [9]. For better understanding of this outbreak, we investigated the cases of severe adenovirus infection in these two medical centers between November 2010 and June 2011
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