Abstract
BackgroundMost pediatric adenovirus respiratory infections are mild and indistinguishable from other viral causes. However, in a few children, the disease can be severe and result in substantial morbidity. We describe the epidemiologic, clinical, radiologic features and outcome of adenovirus lower respiratory tract infections (LRTI) in Aboriginal and Non-Aboriginal children in Manitoba, Canada during the years 1991 and 2005.MethodsThis was a retrospective study of 193 children who presented to the department of pediatrics at Winnipeg Children's Hospital, Manitoba, Canada with LRTI and had a positive respiratory culture for adenovirus. Patients' demographics, clinical and radiologic features and outcomes were collected. Adenovirus serotype distributions and temporal associations were described. Approximate incidence comparisons (detection rates) of adenovirus LRTI among Aboriginal and Non-Aboriginal children were estimated with 95% confidence intervals.ResultsAdenovirus infections occurred throughout the year with clusters in the fall and winter. Serotypes 1 to 3 were the predominant isolates (two thirds of the cases). The infection was more frequent among Canadian Aboriginals, as illustrated in 2004, where its incidence in children 0-4 years old was 5.6 fold higher in Aboriginals (13.51 vs. 2.39 per 10,000, p < 0.000). There were no significant differences in length of hospitalization and use of ventilator assistance between the two groups (p > 0.185 and p > 0.624, respectively) nor across serotypes (p > 0.10 and p > 0.05, respectively). The disease primarily affected infants (median age, 9.5 months). Most children presented with bronchiolitis or pneumonia, with multi-lobar consolidations on the chest x-ray. Chronic (residual) changes were documented in 16 patients, with eight patients showing bronchiectasis on the chest computerized tomography scan.ConclusionsAdenovirus infection is associated with significant respiratory morbidities, especially in young infants. The infection appears to be more frequent in Aboriginal children. These results justify a careful follow-up for children with adenovirus LRTI.
Highlights
Most pediatric adenovirus respiratory infections are mild and indistinguishable from other viral causes
Adenoviruses play a significant role in pediatric infections, accounting for 2-5% of the overall respiratory illnesses and 4-10% of the pneumonias [1]
Epidemiology One hundred ninety three children were identified with lower respiratory tract infections (LRTI) and positive respiratory culture for adenovirus (Table 1)
Summary
Most pediatric adenovirus respiratory infections are mild and indistinguishable from other viral causes. The species C includes serotypes 1, 2, 5 and 6, and the species E includes serotype 4 These serotypes are common causes of pediatric upper and lower respiratory infections [8,9,10,11,12,13,14]. Most adenovirus respiratory infections are mild and indistinguishable from other viral causes. Specific serotypes, such as serotypes 3, 7 and 14, have been implicated with fatal outcomes [15,16,17]. Severe disease has been reported among newborns and patients with underlying medical conditions [18,19]
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