Severe Adenovirus Pneumonia Requiring Extracorporeal Membrane Oxygenation Support in Immunocompetent Children.

Xuefei Chen,Chaochun Zou,Lanfang Tang,Lu Qin,Jianhai Lv

doi:10.3389/fped.2020.00162

Abstract

Objective: To highlight severe adenovirus pneumonia in immunocompetent patients by analysis of severe adenovirus pneumonia associated with acute respiratory distress syndrome in whom extracorporeal membrane oxygenation (ECMO) support is required.Methods:Pediatric patients with adenovirus pneumonia and ECMO supports in our hospital from February 2018 to May 2019 were retrospectively analyzed, and having 100 common adenovirus pneumonia children as a control.Results:A total of 8 patients, including 4 boys (50.0%), were enrolled. They were previously immunocompetent with a median age of 31 months. They were admitted as persistent fever and cough for more than one week. Median time prior to development of respiratory failure requiring intubation and invasive mechanical ventilation was 5 days. Venoarterial ECMO support as rescue ventilation was instituted after a median time of 24.5 h of conventional mechanical ventilator support. The median duration on ECMO support was 9 days and mechanical ventilation was 14 days, respectively. Six patients (75%) were recovered and 2 (25%) died. Median length of stay in ICU and hospital were 27.5 days and 47.5 days, respectively.Conclusion:The promising outcomes of our cases suggested that ECMO support for rescue ventilation may be considered when symptoms deteriorated in adenovirus pneumonia patients, and may improve outcome. However, sequelae of adenovirus pneumonia and ECMO-related complications should also be taken into account.

Highlights

Human adenoviruses (HAdVs) are non-enveloped DNA viruses associated with a wide range of clinical manifestations [1]
We report 8 cases of severe adenovirus pneumonia associated with acute respiratory distress syndrome (ARDS) in whom conventional mechanical ventilation failed and required Extracorporeal membrane oxygenation (ECMO) support to highlight this rare condition, and set a comparison group to reveal the risk factors of severe adenovirus pneumonia requiring ECMO support
Adenovirus pneumonia was diagnosed based on the presence of adenovirus detected in bronchoalveolar lavage fluid (BALF), pleural fluid or nasopharyngeal swab samples by immunofluorescence microscopy, measurement of antibodies in paired serum samples or molecular methods, and chest radiographic changes combined with the presence of attributable symptoms and signs

Summary

Introduction

Human adenoviruses (HAdVs) are non-enveloped DNA viruses associated with a wide range of clinical manifestations [1]. HAdVs infections occur primarily in children younger than 5 years of age and account for 2–5% of all pediatric respiratory illnesses and 4–10% of childhood pneumonias [2, 3]. In China, HAdVs have caused respiratory tract infections outbreaks and several cases. At least 67 immunologically distinct serotypes of HAdVs have been recognized and classified into 7 subgroups (A-G) based on hemagglutinin properties, DNA homology and biochemical characteristics [12]. HAdVs serotypes 3, 7, 21 and 55 appear to be most commonly associated with severe lower respiratory tract infections in children [13,14,15]

Methods

Results

Discussion

Conclusion