Clinical Feature of Severe Community-Acquired Pneumonia Infected With Respiratory Syncytial Virus, Influenza A Virus and Adenovirus in Children

Abstract

Objective To explore clinical characteristics severe community-acquired pneumonia(CAP)infected with respiratory syncytial virus(RSV), influenza A virus (FV) and adenovirus (ADV) infected in children. Methods Clinical data of 107 cases of severe CAP of Guangzhou children's Medical Center were selected from January 1, 2005 to January 1, 2008. According to infection by different virus they were divided into group RSV (n=69, RSV infection), group FV (n=12, FV infection) and group ADV (n=26, ADV infection). Pneumonia and severe CAP were diagnosed by reference toManagement Guide of Community-Acquired Pneumonia of Children (trial). No significant statistical difference in 3 groups among age, gender and hospitalization time (P>0.05). Clinical features, treatment and prognosis among 3 groups were retrospective compared and analyzed. Results ①The severe CAP incidence rates of RSV, FV and ADV were 7.64% (69/903), 4.96% (12/242) and 3.53% (26/737), respectively, and had significant difference among 3 groups(χ2=13.078, P=0.001). ②RSV, FV and ADV could cause severe CAP in healthy children without underlying disease, and some severe CAP cases had no fever syndrome in the whole course. Severe CAP cases in acute phase could have congestion, edema, inflammation in trachea, bronchus and branch of bronchial mucosa, in which ADV infected severe CAP cases was the most prominent and even could lead toplastic bronchitis. ③All of the 3 groups cases were treated with antibiotics and virazole, those with wheezing symptoms were treated with aminophylline, salbutamol sulfate; when necessary, treated with methylprednisolone, intravenous immunoglobulin. combined with mechanical ventilation for those with respiratory failure, airway nursing were strengthened for entire course. RSV group of acute heart failure children accounted for 4.35% (3/69), 1 cases (1.45%)of death due to acute respiratory distress syndrome(ARDS); FV group had 2 cases (16.67%)of shock, 1 case (8.33%) had multiple organ dysfunction syndrome, 2 cases(16.67%)died of ARDS; ADV group had no dead case. ④There were co-infections with bacteria, mycoplasma, chlamydia for some severe CAP cases. The chest X-ray examination of some of RSV, ADV infected severe CAP cases had more obvious right lung lesions than that left lung, however, all of FV group cases had double lung inflammation basically symmetrical. Conclusions Clinical characteristics of severe CAP children infected with RSV, FV and ADV had common and difference, and ADV infected cases had more serious inflammation in bronchus and bronchus ramous. Integrated treatment had good functions to the severe CAP children. Key words: virus; severe; pneumonia; child