Severe Community-Acquired Pneumonia Caused by Human Adenovirus in Immunocompetent Adults: A Multicenter Case Series.
Severe Community-Acquired Pneumonia Caused by Human Adenovirus in Immunocompetent Adults: A Multicenter Case Series.
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DOI：
10.1371/journal.pone.0151199
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Yu X
中科院分区：
文献类型：
--
作者：
Tan D;Zhu H;Fu Y;Tong F;Yao D;Walline J;Xu J;Yu X
由人腺病毒（HAdV），尤其是HAdV 55型（HAdV-55）在免疫功能正常的成年人中引起的严重社区获得性肺炎（CAP）引起了越来越多的关注。尽管HAdV-55已通过全基因组测序得到充分鉴定，但对HAdV-55诱导的严重CAP和急性呼吸窘迫综合征的临床知识仍然有限。我们对2012年2月至2014年4月期间在中国北方两家医院急诊科重症监护室收治的免疫功能正常成人中由HAdV引起的所有重度CAP患者进行了多中心回顾性分析。收集并分析这些患者的临床、实验室、放射学特征、治疗和结局。共纳入了15例实验室确诊腺病毒感染的连续严重CAP患者。中位年龄为30岁，所有病例均在冬季和春季发现。HAdV-55是最常见的HAdV类型（11/15）。这些患者通常报告持续高热、咳嗽和呼吸困难快速进展。与存活者相比，死亡者的肺炎严重程度指数（PSI）、呼吸频率显著增加，PaO 2/FiO 2、超敏CRP降低（P分别为0.013、0.022、0.019和0.026）。发病后10天内双侧实变的快速发展是最常见的影像学发现，通常伴有邻近的磨玻璃样阴影和胸腔积液。本研究的总死亡率为26.7%。在这份报告中，14名患者接受了皮质类固醇治疗，但幸存者和非幸存者之间的使用率并不显著。HAdV和HAdV-55亚型在中国北方免疫功能正常的住院成人的病毒性肺炎病原体中起重要作用。HAdV应在细菌培养阴性且对抗生素治疗缺乏反应的严重CAP患者中进行检测，即使放射学成像和临床表现最初提示细菌性肺炎。
Severe community-acquired pneumonia (CAP) caused by human adenovirus (HAdV), especially HAdV type 55 (HAdV-55) in immunocompetent adults has raised increasing concerns. Clinical knowledge of severe CAP and acute respiratory distress syndrome induced by HAdV-55 is still limited, though the pathogen has been fully characterized by whole-genome sequencing. We conducted a multicentre retrospective review of all consecutive patients with severe CAP caused by HAdV in immunocompetent adults admitted to the Emergency Department Intensive Care Unit of two hospitals in Northern China between February 2012 and April 2014. Clinical, laboratory, radiological characteristics, treatments and outcomes of these patients were collected and analyzed. A total of 15 consecutive severe CAP patients with laboratory-confirmed adenovirus infections were included. The median age was 30 years and all cases were identified during the winter and spring seasons. HAdV-55 was the most frequently (11/15) detected HAdV type. Persistent high fever, cough and rapid progression of dyspnea were typically reported in these patients. Significantly increased pneumonia severity index (PSI), respiratory rate, and lower PaO2/FiO2, hypersensitive CRP were reported in non-survivors compared to survivors (P = 0.013, 0.022, 0.019 and 0.026, respectively). The rapid development of bilateral consolidations within 10 days after illness onset were the most common radiographic finding, usually accompanied by adjacent ground glass opacities and pleural effusions. Total mortality was 26.7% in this study. Corticosteroids were prescribed to 14 patients in this report, but the utilization rate between survivors and non-survivors was not significant. HAdV and the HAdV-55 sub-type play an important role among viral pneumonia pathogens in hospitalized immunocompetent adults in Northern China. HAdV should be tested in severe CAP patients with negative bacterial cultures and a lack of response to antibiotic treatment, even if radiologic imaging and clinical presentation initially suggest bacterial pneumonia.