Early Identification Of Severe Adenoviral Pneumonia In Children

Background:Human adenoviruses(HAd Vs)are recognized pathogens that cause a broad spectrum of viral diseases.In 2019,the number of children with adenovirus infection in southern China increased significantly.Likewise,the number of severe cases,complications and sequelae were high.This study mainly explores the clinical characteristics of severe HAd V pneumonia in children,so that early identification of severe adenoviral pneumonia can be provided to enhance the basis for early treatment.Clinical progress and long-term treatment have been associated with different adenoviral serotypes.Objective:To describe the clinical characteristics of severe HAd V pneumonia in children so that promptly early identification infection and provide evidence for the early treatment.Methodology:Retrospective review of the children admitted to hospital with HAd V pneumonia was conducted between January 2019 and July 2019 at a single Centre of children's hospital of Zhejiang university.We retrieved electronic medical records to obtain general patient conditions.Data of clinical symptoms,signs,changes in conditions,laboratory tests,treatment status,length of stay,and whether to stay in the ICU were obtained.Adenoviral antigen detection,rapid antigen detection of colloidal gold adenovirus in respiratory secretions was conducted using Kapily,Hangzhou Chuangxin Biological Prosecution Technology Co.,Ltd.,No.139,No.10 Avenue,Hangzhou Economic and Technological Development Zone).Adenovirus typing was undertaken on 2019.6.24-2019.6.31.30-40 samples of respiratory tract specimens positive for HADV rapid antigen detection were randomly sampled daily for genotyping testing.Criteria for inclusion of severe HADV pneumonia was based on the 2019 adenoviral pneumonia diagnosis and treatment guidelines issued by the National Health and Medical Commission.Results:A total of 491 respiratory samples were positive for HAd V between 1sJanuary 2019 and31 stJuly 2019.Demographic characteristics of the patients with severe group(n=228,46.4%)and non-severe(n=263,53.6%)of HAd V infection More than half patients(57.9%)were children greater than 2 years of age.There were significant differences in demographic characteristics between those with severe and non-severe disease.Most patients(more than 90%)in two groups were healthy babies,and there were no significant differences.140(28.5%)patients in total were with underlying comorbidities,while there were no significant differences in demographic characteristics between those with severe and non-severe disease.Patients in the severe group had a significantly longer duration of hospitalization(p<0.001).Compared with patients in non-severe group,the severe group tend to have respiratory symptoms,like cough(p<0.001),tachypnea(p<0.001),wheezing(p=0.01)and rhonchi(p<0.001).Besides,there were 26 severe children who have accepted an ICU treatment,while none in non-severe group.There were no significant differences before admission on laboratory investigations of white blood cell(WBC),neutrophil ratio(N%),C-reactive protein(CRP)and PCT between those with severe and non-severe infection.After admission the laboratory results were significantly lower(all p < 0.05)for T cell,CD4+ T cell,CD4/CD8,B cells,except CD8+ T cells(p=0.66).Review of laboratory investigations showed that there are significant differences in IL2,IL6,IL10 and TNF(p=0.03,0.001,p<0.001 and p<0.001,respectively)between two groups after admission.With regard to biochemical test parameters,children with severe disease,ALT,AST,CKMB and LDH were significantly higher and prealbumin and albumin was significantly lower after admission(all p < 0.05).Radiological features between severe and non-severe groups of patients before and after hospitalization showed significant differences(p<0.001)on lung consolidation,pleural effusion and lobar atelectasis.However,pneumothorax and emphysema were not associated with severe adenoviral infection(p = 0.10 and 0.43 respectively.Multivariate analysis showed that duration of hospitalization(p< 0.001,OR1.66 [95% CI 1.47–1.88]),duration of fever(p = 0.003,OR 1.18,[95% CI 1.06–1.32]),gender(p=0.01,OR 2.36 [95% CI 1.27–4.39]),and tachypnea(P<0.001,OR13.39[5.75-31.17])were independent risk factors associated with the development of respiratory complications.In the last week of June 2019,163 cases of outpatients and 38 samples of throat swabs positive for adenovirus antigen detection in the inpatient department were collected and genotyped.The results showed that 103 cases of outpatients were successfully typed(63.2%).Type 3(51.5%)and type 7(33%)were the main types,and 22 patients(57.9%)were successfully classified in hospitalized patients,both of which were type 3(54.5)and type 7(45.5%).Conclusion:There are a large number of human adenovirus respiratory infections in children in winter and summer.This disease is common in children,with a high incidence of severe cases.Males,long hospital stays,long fevers,and shortness of breath are independent risk factors for HADV pneumonia in the severe group.T lymphocytes,CD4 cells,and CD4 / CD8 ratios of patients in the severe group decreased,DD increased,IL-6 and IL-10 increased,and IL-2 and TNF decreased.The radiographic findings of chest disease in the severe group were significantly higher than those in the non-severe group with extensive lung lesions,pulmonary consolidation,atelectasis,and pleural effusion.The adenovirus epidemic occurred in many regions of southern China this year.We analyzed the serotypes and found that the HADV serotypes of patients with HADV pneumonia in our hospital have changed from type 1,2 and 5 to type 3 and 7 Mainly.The serotype change may be the cause of the adenovirus epidemic in children in our province in 2019.Understanding the clinical characteristics of HAd V pneumonia in children is of great significance for early detection,diagnosis and timely treatment,and for preventing death complications.