Clinical Manifestations Of Children’s Adenovirus Pneumonia And The Risk Factors For The Development Of Bronchiolitis Obliterans In Suzhou In 2013

Objective:Adenoviruses are the most common pathogen causing bronchial pneumonia in children. To understand the clinical manifestations and risk factors for development of bronchiolitis obliterans in children with adenovirus pneumonia, we conducted this study for applying some help to the diagnosis and treatment of adenovirus pneumonia for pediatricians.Methods:From January 2013 to January 2014, children suffered from adenovirus pneumonia and admitted to the Respiratory department of the Children’s hospital of Suzhou University were enrolled in this study. The clinical manifestations of children with adenovirus pneumonia [including general information, signs and symptoms, laboratory examinations (white blood cell count, liver function and c-reactive protein, blood immunoglobulin and cellular immunity), chest X radiography and chest computed tomography] were analyzed. The severity and hospitalized duration of patients with adenovirus pneumonia, who developed bronchiolitis obliterans, were collected and analyzed for risk factors for the development of bronchiolitis obliterans.Results:1. From the total of 93 patients with adenovirus pneumonia,61 cases were males (65.7%) and 32 cases were females (34.3%). The male to female ratio was 1.9:1. Age was ranged from 2 months to 108 months. At 0-6 months,6-24 months,24-60 months and for older than 60 months, there were 10 cases (10.75%),38 cases (40.86%),31 cases (33.34%) and 14 cases (15.05%) cases respectively. The duration of hospitalization was from 4-50 days, and the average was 10±7 days.2. Adenovirus infection in children occurring in spring (March to May), summer (June-August), autumn (September-November) and winter (December-February) were 41 cases (44.09%),17 cases (18.28%),13 cases (13.98%) and 22 cases (23.65%) respectively. Abstract Clinical manifestations of children’s Adenovirus pneumonia and the risk factors for the development of Bronchillitis Obliterans Obliterans in Suzhou in 20133.From the 93 patients with adenovirus pneumonia,86 cases had fever,75 cases had cough,25 cases had wheeze.4. For all patients with adenovirus pneumonia, adenovirus antigens were positive (+, ++ or +++).50 cases were mixed with other pathogenic infections.50 cases (53.8%) of sputum culture were positive for bacteria.5. For blood routine test, white blood cell count:59 cases (63.44%) were normal,34 cases (36.56%) were elevated,30 cases (32.26%) had a rise in the proportion of lymphocytes,10 cases (10.75%) had a rise in the proportion of neutrophils, and 53 cases (57%) had a normal proportion of neutrophils.6. The chest radiographs (X-rays) of 59 patients (86.8%) showed increased pulmonary markings. The chest X-rays revealed patchy shadows with 13 cases at the right upper lobe (19.12%),41 cases at the right middle lobe (60.29%),18 cases at the right lower lobe (26.47%),12 cases at the left upper lobe (17.64%) and 31 cases at the left lower lobe (45.59%). In 39 patients, the chest X-rays revealed large patches with 7 cases at the right upper lobe (10.29%),8 cases at the right middle lobe (11.76%),7 cases at the right lower lobe (10.29%),7 cases at the left upper lobe (10.29%) and 8 cases at the left lower lobe (11.76%). Only one patient had pleural effusion.22 of the 93 patients had chest computed tomography (CT) scans with 19 patients (86.4%) showing increased pulmonary markings. In 14 patients, the chest CT scans revealed patchy shadows in 8 cases (36.36%) at the right upper lobe,7 cases (31.82%) at the right middle lobe,8 cases (36.36%) at the right lower lobe,7 cases (31.82%) at the left upper lobe, and 12 cases (54.55%) at the left lower lobe. In 12 patients, the chest CT scans revealed large patches with 7 cases (31.81%) at the right upper lobe,2 cases (9.09%) at the right middle lobe,4 cases (18.18%) at the right lower lobe,3 cases (13.64%) at the left upper lobe and 7 cases (31.81%) at the left lower lobe. There was only 1 case of pleural effusion.7. Children eventually developed bronchiolitis obliterans (BO) in 11 cases aged from 4 months to 19 months. Their median age was 9 months with a quartile interval of 5 months. The median age of non-BO children was 35 months with a quartile interval of 35 months. The 2 groups were statistically different (P<0.05).Hospitalization duration of the patients, who eventually developed BO, varied from 10 to 50 days with a median of 15 days and a quartile interval of 10 days. However, the Clinical manifestations of children’s Adenovirus pneumonia and the risk factors for the development of Bronchiolitis Obliterans in Suzhou in 2013 Abstract median hospitalization duration of non-BO children was 7 days with a quartile interval of 4 days. In BO group,8 out of 11 cases had severe pneumonia. In non-BO group,4 out of 82 cases had severe pneumonia. There was a significant statistical difference between the BO group and non-BO group (p<0.05).Conclusions:1. Adenovirus infection was common in infants and young children, in 6 months to 2 years old, in males, and during the season of spring.2. Adenovirus infections could be complicated by other pathogenic infections of which bacterial infection was the most common.3. The major clinical manifestations of adenovirus infection in children were fever, cough and wheezing.4. Chest X-ray of adenovirus pneumonia infection in the lungs showed that lung involvement was more apparent in the right lung than the left lung.5. Patients with adenovirus infection who were hospitalized for longer than 15 days, had severe pneumonia, were younger than 9 months and males, were prone to develop bronchiolitis obliterans.