Clinical Characteristic Of Severe Adenovirus Pneumonia In Children And Risk Factors For Recurrent Wheezing

Objective:1.To analyse and summarize the clinical characteristics of severe adenovirus pneumonia 2.To analyse the risk factors for recurrent wheezing in severe adenovirus pneumonia Methods:48 patients diagnosed of severe adenovirus pneumonia was collected,and 47 children was followed-up by telephone or return visit at outpatient.The data including general condition history of atopic diseases,clinical manifestations,complications,laboratory findings,pathogens,radiology,antiviral drugs,immunoglobulin,and systematic glucocorticoids were recorded.The information followed up after discharge mainly containing data related to clinical symptoms,treatment methods,imaging examinations and others.Based on the respiratory sequelae,The data was devided into two groups and was analyzed.Multivariate logistic regression analysis was used to determine the risk factors for the sequelae of severe adenovirus pneumonia.Results:1.Clinical characteristics of severe adenovirus pneumonia:High fever(100%),cough(95.7%)and wheezing(46.8%)were the most common symptoms.85% patients had a longer fever duration over 7 days.C-reactive protein and white blood cell count were obviously high.60.4% patients have complications.23%patients had intrapulmonary complications,most of which were pleural effusion.Extrapulmonary complications was found in 48% of the patients,and digestive complications was in the first place.Most patients co-infected with other pathogens,with a percentage of 77.And Mycoplasma accounted for 52%。The main imaging changes were lung consolidation(82.9%)including lobar pulmonary consolidation(25,5%),flocculent shadow(53%),and cluster shadow(25.5%),.Interferon significantly reduced pulmonary complications(P=0.002).Patients treated with immunoglobulin had a shorter hospital stay(P=0.000),and The incidence of subsequent pulmonary symptoms was lower(P=0.036).2.Follow-up of severe adenovirus pneumonia:One patients died before discharge and 47 was followed up bwteen 12 months and one and a half years by telephone and outpatient.During the period,18(37.5%)children showed recurrent wheezing and cough.And 10 patients were diagnosed as bronchiolitis obliterans(BO),80% of which was confirmed in the first 3 months after discharge.Symptoms was controlled after appropriate treatment in most of patients,Only one child still had wheezing during the follow-up period of nearly one and a half years,.Symptoms of recurrent wheezing in others also controlled in one year,with a median time of 4.5 months 3.Risk factors for recurrent wheezing of severe adenovirus pneumonia:White blood cell count,co-infection with cytomegalovirus infection,length of hospital stay,and immunoglobulin were statistically significant risk factors for recurrent wheezing in severe adenovirus pneumonia(P < 0.05).Further analysis showed that combined cytomegalovirus infection was an independent risk factor for the development of recurrent wheezing in severe adenovirus pneumonia(P<0.05)。Conclusion:Severe adenovirus pneumonia is characterized by dangerous disease.In the early stage,most of the symptoms,such as fever and cough,are non-specific.And the inflammatory indicators such as white blood cell count and CRP are increased.It is easy to be confused with bacterial pneumonia in clinical practice,and causes the delay of antiviral treatment.Adenovirus pneumonia also needs to be differentiated from COVID-19 pneumonia,because of several similarities in early imaging.Therefore,early detection of etiology is important.mNGS has been used increasingly in clinical practice to make up for the deficiency of traditional pathogen detection in recent years.Treatment of severe adenovirus pneumonia(SAP)is mainly symptomatic supportive,and the antiviral treatment in China is mostly empirical treatment.SAP is prone to complicated with recurrent wheezing after discharge.Respirtory manifestations after discharge should be alterd for potential sequelae,such as bronchiolitis obiterans(BO).BO is diagnosed mostly in the first 3 months after discharge.Chest HRCT and lung function tests can help diagnose and assess disease status.In this study,combined cytomegalovirus infection is an independent risk factor for recurrent wheezing in SAP.However,this conclusion still needs to be verified in larger clinical studies.