| Part one Epidemiological of respiratory adenovirus in hospitalized children in Suzhou area from 2016 to 2019Objective:The clinician's understanding of respiratory tract adenovirus(ADV)infection is improved,and to provide basis for its diagnosis and treatment by analyzing the epidemiology of respiratory adenovirus in hospitalized children in Suzhou area.Methods:Respiratory secretion samples and clinical information were collected from 44484 children with acute respiratory tract infection who hospitalized in the Children's Hospital Affiliated to Suzhou University from 2016 to 2019.Results:Among 44484 children,ADV was detected in 1.54%(687/44484)children.The positive rate of ADV in male children was 1.61%(417/25881),and was 1.45%(270/18603)in female children,there was no statistically significant difference in the positive rate between gender(?2=1.819,P=0.177).The positive rate of ADV at the age of less than 1 year old,1-3 years old,3-6 years old and older than 6 years old were 0.43%(80/18534),2.35%(226/9597),2.83%(301/10642)and 1.40%(80/5711)respectively.Children in 1-3 years old and 3-6 years old were susceptible to ADV,the positive rate of ADV was higher than that of the other two groups,the difference was statistically significant(P<0.001).The positive rate of ADV in spring,summer,autumn and winter was 2.09%(220/10510),2.08%(202/9706),0.77%(90/11671),1.39%(175/12597)respectively.The positive rate of ADV in spring and summer were significantly higher than that in autumn and winter,and the difference of positive rate during the seasons was statistically significant(P<0.001).The positive rate of ADV in 2016,2017,2018 and 2019 was 1.24%(89/7161),1.65%(137/8312),1.11%(131/11800),1.92%(330/17211)respectively.The positive rate of ADV in 2019 was the highest among those years,the difference was statistically significant(P<0.001).The overall positive rate of ADV in hospitalized children in Suzhou area was fluctuated in the past 4 years.The highest positive rate of ADV was 1.92%in 2019,and the lowest was 1.11%in 2017.Of the 687 children infected with ADV,28.24%(194/687)children were simple infections,and 71.76%(493/687)children were mixed infections.Most of children were mixed infections with bacterial,accounting for 46.29%(318/687),HI accounted for 22.27%(153/687)and SP accounted for 19.21%(132/687)in them.Infection with MP was also common,accounting for 35.66%(245/687).Infection with other virus was about 17.18%(118/687),and the HRV was commonest,accounting for 6.73%(41/609),followed by HBoV,accounting for 5.68%(39/687).There were also 23.80%(163/687)of multiple mixed infections(ADV infected with two or more types of other pathogens).In terms of gender,the mixed infection rate of male children was higher than that of female children.There was no significant difference in the positive rate between gender(?2=0.828,P=0.363).In terms of age,mixed infection was common in all age groups.In infancy and early childhood,the most mixed with bacterial infections.In preschool,multiple mixed infection was the most common.In school-age,the most mixed with MP.In terms of seasons,ADV mixed with MP was commonest in summer and autumn and mixed with other virus was commonest in winter.There were 65 cases of upper respiratory tract infection,46 cases of bronchitis,438 cases of bronchopneumonia and 138 cases of lobar pneumonia in 687 children with adenovirus infection.Pneumonia was diagnosed most frequently.Conclusions:1.Adenovirus is one of the important pathogens that cause respiratory tract infection in children in Suzhou area,children in 1-6 years old were susceptible.2.In 2019,ADV infection was minor epidemic of in Suzhou area.The epidemic seasons were spring and summer.3.About 3/4 of the children had mixed infection in Suzhou area,and co-infecting with bacteria were the most common.Part two Clinical characteristics analysis of adenovirus pneumonia in hospitalized children in Suzhou area from 2016 to 2019.Objective:To explore the clinical characteristics of adenovirus pneumonia in children,and improve clinician's recognition about adenovirus pneumonia.To provide theoretic basis for its diagnosis and treatment,to minimize its complications,and improve its short-term prognosis by comparing the characteristics of clinical and laboratory examination results of mild and severe adenovirus pneumonia.Methods:Clinical information were collected from 576 children with adenovirus pneumonia hospitalized in the Children's Hospital Affiliated to Suzhou University from January 2016 to December 2019.The children were divided into mild group(n=423)and severe group(n=153).The general situation,symptoms,physical signs,laboratory examination results,imaging data,diagnosis and treatment were analyzed.Results:Of the 576 adenovirus pneumonia children,the proportion of male and female was 1.58:1.There was no statistically significant difference between gender(?2=0.513,P=0.474).Adenovirus pneumonia could occur in children of all ages in Suzhou area,the morbidity was highest in 1-6 years old,and the children under 2 years old were more likely to develop severe pneumonia.Adenovirus pneumonia could occur throughout the year,the morbidity was high in spring,summer and winter.The average hospital stay was(8.94±5.39)days,and the hospital stay in severe group was longer than that in mild group(P<0.001).On the first day of hospitalization,97.05%(559/576)children had fever,22.22%(128/576)children had wheeze,79.69%(459/576)children had positive pulmonary signs and all children had cough.There were 51 children with underling diseases,and the cardiopulmonary diseases were the commonest,accounting for 82.35%(42/51).Of the 576 adenovirus pneumonia children,67.19%(387/576)children had complications.The circulatory system and digestive system were the commonest.The number of white blood cell of peripheral blood was(1.88-39.34)×109/L,it was increased in 55.73%(321/576)children.The platelet count was(86-1116)×109/L,it was increased in 34.38%(198/576)children.The hemoglobin was(76-146)g/L,it was decreased in 24.83%(143/576)children.CRP was increased in 71.01%(409/576)children,the highest one was 199.98 mg/1.Hypoalbuminemia was decreased in 6.98%(35/576)children,the lowest one was 23.4 g/l.ALT or AST was increased in 13.89%(80/576)children,the highest ALT was 443.1 ?/L,the highest AST was 869.3?/L.LDH was increased in 42.36%(244/576)children,the highest one was 2593.7?/L.It was increased in 17.36%(80/576)children in myocardial enzymes(including MB,CKMB,cTnT).In addition,the PCT was tested in 241 children,it was increased in 26.56%(64/241)children,the highest one was 32.55 ng/ml,and the ESR was tested in 148 children,it was increased in 59.46%(88/148)children,the highest one was 120mm/h.In the 576 adenovirus pneumonia children,74.13%children were mixed infections.Most of children were mixed infections with bacterial,accounting for 47.74%,and the HI and SP were common.Infection with MP was also common,accounting for 36.11%.Infection with other virus was about 17.88%,and the HRV and HBoV were common.There were also 24.13%of multiple mixed infections(ADV infected with two or more types of other pathogens).All of them showed pneumonia,exudation and consolidation were common in both lungs.In addition,the other imaging manifestations included 35.59%(205/576)emphysema,10.94%(63/576)pulmonary atelectasis,5.38%(31/576)hydrothorax,1.91%(11/576)pleural changes,0.17%(1/576)multiple cavities,1.04%(6/576)unevenness of the inflation,and 0.35%(2/576)mosaic sign.The 108 children were examined by electronic fiberoptic bronchoscopy,the lesion site was consistent with the imaging changes,all of which were endobronchial inflammation.The severity of adenovirus pneumonia was associate with age less than 2 years,duration of fever,underling diseases,complications,and increase of PLT,PCT,LDH,ALT,AST,myocardial enzymes,and decrease of Hb,albumin(P<0.001).Conclusions:The risk factors for severe adenovirus pneumonia were age less than 2 years,duration of fever,underling diseases,multiple system damage,anemia,hypoalbuminemia,and high level of procalcitonin. |
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