Fatal Community-acquired Pneumonia in Children Caused by Re-emergent Human Adenovirus 7d Associated with Higher Severity of Illness and Fatality Rate.

Zhiwu Yu,Jing Zhang,Nan Yu,Yonghui Guo,Manjun Chen,James Chodosh,Zhiwei Zeng,Qiwei Zhang,Ning Fu,Yuxian Pan,Xiaoyan Che

doi:10.1038/srep37216

Abstract

Human adenoviruses (HAdVs) are highly contagious pathogens causing acute respiratory disease (ARD), such as community-acquired pneumonia. HAdV-7d, a re-emergent genomic variant, has been recently reported in Asia and the United States after a several-decade absence. However, whether HAdV-7d is associated with higher severity than other types is currently unclear. In this study, the clinical and epidemiological investigation showed that fever, cough, and sore throat were the three most common respiratory symptoms of HAdV infections. HAdV-7 caused longer duration of fever, higher morbidity of tachypnea/dyspnea, pleural effusion, diarrhea, hepatosplenomegaly, consciousness alteration, as well as higher rates of pneumonia, mechanical ventilation and higher fatality rate (28.6%) than other types, particularly HAdV-3 and HAdV-2. The genomes of seven HAdV-7d isolates from mild, severe, and fatal cases were sequenced and highly similar with each other. Surprisingly, two isolates (2011, 2012) had 100% identical genomes with an earlier strain from a fatal ARD outbreak in China (2009), which elucidates the virus origin and confirms the unexpected HAdV genomic conservation and stability. Phylogenetic analysis indicated that L1 52/55-kDa DNA packaging protein may be associated with the higher severity of illness and fatality rate of HAdV-7. Clinicians need to be aware of HAdVs in children with ARD.

Highlights

More and more acute respiratory disease (ARD) outbreaks with severe or even fatal cases caused by Human adenoviruses (HAdVs)-7 have been reported in Asia, especially in China, which has a large and high-density population[1,6,11,13,15,16,28,29,30,31]
More and more ARD outbreaks and fatal cases caused by HAdVs have aroused increasing public health concern about the emergence and re-emergence of human adenoviruses variants
In this study, we investigated the clinical features and molecular epidemiology of HAdVs circulating among pediatric inpatient and outpatient children with ARD during 2010-2012 in Guangzhou, Southern China

Summary

Introduction

More and more ARD outbreaks with severe or even fatal cases caused by HAdV-7 have been reported in Asia, especially in China, which has a large and high-density population[1,6,11,13,15,16,28,29,30,31]. Many hospitalizations and fatal CAP in adult civilians[27,32] These emergent or re-emergent HAdV-7d variants may have powerful potential to cause more outbreaks, in Asia with its dense population centers, and in Americas. More and more ARD outbreaks and fatal cases caused by HAdVs have aroused increasing public health concern about the emergence and re-emergence of human adenoviruses variants (http://english.caijing.com.cn/201203-13/111741354.html). In order to better understand the association between the disease severities and HAdV types, the comparison of clinical and epidemiological features as well as comparative genomic analysis of the seven HAdV-7d isolates was performed

Methods

Results

Conclusion