Genotype prevalence and risk factors for severe clinical adenovirus infection, united states 2004-2006
Genotype prevalence and risk factors for severe clinical adenovirus infection, united states 2004-2006
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DOI：
10.1086/522188
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发表时间：
2007-11-01
影响因子：
11.8
通讯作者：
Erdman, Dean D.
中科院分区：
文献类型：
--
作者：
Gray, Gregory C.;McCarthy, Troy;Erdman, Dean D.
背景最近，流行病学和临床数据已经揭示了重要的变化与临床腺病毒感染，包括抗原呈递，地理分布和病毒的毒力的改变。为了更好地了解美国临床腺病毒感染的流行病学，我们采用了一种新的分子腺病毒分型技术来研究2004 - 2006年期间25个月内从22家医疗机构收集的临床腺病毒分离株。六邻体基因序列分型方法用于表征2237个临床腺病毒阳性标本，将它们的序列与目前公认的51个原型人腺病毒株的序列进行比较。在盲法比较中，该方法表现良好，比经典的血清学分型方法快得多。在平民中，最流行的腺病毒类型是3型（流行率，34.6%）、2型（24.3%）、1型（17.7%）和5型（5.3%）。在军事训练人员中，最常见的类型是4型（患病率，92.8%），3型（2.6%）和21型（2.4%）。对于这两个群体，我们观察到随着时间的推移，21型腺病毒检测的统计学显著增加趋势。在从平民标本中回收的腺病毒分离株中，50%与住院有关，19.6%与慢性疾病有关，11%与骨髓或实体器官移植有关，7.4%与重症监护病房有关，4.2%与癌症诊断有关。多变量危险因素建模腺病毒病严重程度发现年龄！7年（比值比[ OR]，3.2; 95%置信区间[ CI]，1.4 - 7.4），慢性病（OR，3.6; 95% CI，2.6 - 5.1），近期移植（OR，2.7; 95%CI，1.3 - 5.2），5型腺病毒（OR，2.7; 95%CI，1.5 - 4.7）或21型感染（OR，7.6; 95%CI，2.6 - 22.3）增加了严重疾病的风险。
Background. Recently, epidemiological and clinical data have revealed important changes with regard to clinical adenovirus infection, including alterations in antigenic presentation, geographical distribution, and virulence of the virus.Methods. In an effort to better understand the epidemiology of clinical adenovirus infection in the United States, we adopted a new molecular adenovirus typing technique to study clinical adenovirus isolates collected from 22 medical facilities over a 25- month period during 2004 - 2006. A hexon gene sequence typing method was used to characterize 2237 clinical adenovirus- positive specimens, comparing their sequences with those of the 51 currently recognized prototype human adenovirus strains. In a blinded comparison, this method performed well and was much faster than the classic serologic typing method.Results. Among civilians, the most prevalent adenovirus types were types 3 ( prevalence, 34.6%), 2 ( 24.3%), 1 ( 17.7%), and 5 ( 5.3%). Among military trainees, the most prevalent types were types 4 ( prevalence, 92.8%), 3 ( 2.6%), and 21 ( 2.4%).Conclusions. For both populations, we observed a statistically significant increasing trend of adenovirus type 21 detection over time. Among adenovirus isolates recovered from specimens from civilians, 50% were associated with hospitalization, 19.6% with a chronic disease condition, 11% with a bone marrow or solid organ transplantation, 7.4% with intensive care unit stay, and 4.2% with a cancer diagnosis. Multivariable risk factor modeling for adenovirus disease severity found that age ! 7 years ( odds ratio [ OR], 3.2; 95% confidence interval [ CI], 1.4 - 7.4), chronic disease ( OR, 3.6; 95% CI, 2.6 - 5.1), recent transplantation ( OR, 2.7; 95% CI, 1.3 - 5.2), and adenovirus type 5 ( OR, 2.7; 95% CI, 1.5 - 4.7) or type 21 infection ( OR, 7.6; 95% CI, 2.6 - 22.3) increased the risk of severe disease.