A Community-Based Outbreak of Severe Respiratory Illness Caused by Human Adenovirus Serotype 14
A Community-Based Outbreak of Severe Respiratory Illness Caused by Human Adenovirus Serotype 14
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DOI：
10.1086/598521
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发表时间：
2009-05-15
影响因子：
6.4
通讯作者：
Gilbert, David
中科院分区：
文献类型：
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作者：
Lewis, Paul F.;Schmidt, Mark A.;Gilbert, David
背景人类腺病毒（Ads）通常会在其他健康宿主中引起轻微疾病。我们调查了一个以社区为基础的爆发，有相当大的发病率主要是由Ad 14，一个不常见的administrationype. Methods。我们回顾性分析了俄勒冈州2006年11月1日至2007年7月31日期间所有确诊Ad感染病例的病历。通过测序对分离株进行分型。我们分析了临床和实验室变量，以确定严重的Ad 14疾病的危险因素。Ad 14于2005年首次出现在俄勒冈州。在研究期间检测到的67例Ad感染中，40例（60%）涉及Ad 14。在38例有病历可供审查的Ad 14感染患者中，大多数出现发热和咳嗽; 29例（76%）需要住院治疗，23例（61%）需要补充氧气，18例（47%）需要重症监护，9例（24%）需要血管加压药，7例（18%）死亡。在需要住院治疗的患者中，胸片上提示细菌性肺炎的肺叶浸润很常见。老年、慢性基础疾病、淋巴细胞绝对计数低和肌酐水平升高与严重疾病相关。除1例可能的医院传播外，我们没有发现患者之间的流行病学联系。Ad 14于2005年在俄勒冈州出现，到2007年成为主要的流行类型。这种不常见的病毒感染主要与社区获得性肺炎综合征有关，并导致大量的发病率和死亡率。
Background. Human adenoviruses (Ads) typically cause mild illnesses in otherwise healthy hosts. We investigated a community-based outbreak that had substantial morbidity caused primarily by Ad14, an uncommon serotype.Methods. We retrospectively reviewed the medical records of all patients with confirmed cases of Ad infection from 1 November 2006 through 31 July 2007 in Oregon. Isolates were typed by sequencing. We analyzed clinical and laboratory variables to identify risk factors for severe Ad14 disease.Results. Ad14 first emerged in Oregon in 2005. Of 67 cases of Ad infection detected during the study period, 40 (60%) involved Ad14. Most of the 38 Ad14-infected patients who had medical records available for review presented with fever and cough; 29 (76%) required hospitalization, 23 (61%) required supplemental oxygen, 18 (47%) required critical care, 9 (24%) required vasopressors, and 7 (18%) died. Lobar infiltrates on chest radiographs suggestive of bacterial pneumonia were common among those needing hospitalization. Older age, chronic underlying condition, low absolute lymphocyte counts, and elevated creatinine levels were associated with severe illness. Except for 1 case of possible hospital transmission, we identified no epidemiological links among patients.Conclusion. Ad14 emerged in Oregon in 2005 and became the predominant circulating type by 2007. Infection with this uncommon virus was primarily associated with a community-acquired pneumonia syndrome and caused substantial morbidity and mortality.