Adenovirus Type 7 causing severe lower respiratory tract infection in immunocompetent adults: a comparison of two contrasting cases from an intensive care unit in North West England
Objectives: Severe lower respiratory tract infection caused by adenovirus is well described in immunocompromised hosts and can cause significant morbidity and mortality. We compare and contrast the clinical presentation, radiological, and virological features of two rare cases in immunocompetent adu...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-10-01
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| Series: | Clinical Infection in Practice |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S259017021930007X |
| _version_ | 1828889630159667200 |
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| author | Tom Wingfield Luke Dearden Pete Calvert Orod Osanlou Brian Johnston Anu Chawla Ian Hart Catherine Thompson Lance Turtle Richard Wenstone |
| author_facet | Tom Wingfield Luke Dearden Pete Calvert Orod Osanlou Brian Johnston Anu Chawla Ian Hart Catherine Thompson Lance Turtle Richard Wenstone |
| author_sort | Tom Wingfield |
| collection | DOAJ |
| description | Objectives: Severe lower respiratory tract infection caused by adenovirus is well described in immunocompromised hosts and can cause significant morbidity and mortality. We compare and contrast the clinical presentation, radiological, and virological features of two rare cases in immunocompetent adults admitted to an intensive care unit in a large, teaching hospital in North West England. We then provide a concise, comprehensive literature review. Methods: The first case was a 35-year old female asthmatic who presented with respiratory distress and pneumonitis during peak influenza season, and recovered after a prolonged hospital stay. The second case was a 73-year old male who presented with diarrhoea, vomiting, and general malaise outside of influenza season, developed respiratory compromise, and died. Adenovirus type 7 was identified in bronchoalveolar lavages and plasma samples of both patients, each of whom received cidofovir. No other infectious aetiology was identified. Results: Clinical and radiological features of severe lower respiratory tract adenoviral infection are similar to other infectious causes of pneumonia and ARDS, including severe influenza. This can create diagnostic uncertainty, especially during influenza season. Positive adenovirus polymerase chain reaction results can support a diagnosis of severe lower respiratory tract adenovirus infection in patients with a clinically compatible syndrome and no other identified aetiology, with higher viral loads being associated with worse prognosis. Although treatment is predominantly supportive, early use of cidofovir may improve outcomes. Conclusions: These rare cases highlight that severe lower respiratory tract adenoviral infection should be considered in the differential diagnoses of immunocompetent patients presenting with pneumonia and ARDS. |
| first_indexed | 2024-12-13T12:44:44Z |
| format | Article |
| id | doaj.art-073b79567ace44bb8ddc3aa570be70fc |
| institution | Directory Open Access Journal |
| issn | 2590-1702 |
| language | English |
| last_indexed | 2024-12-13T12:44:44Z |
| publishDate | 2019-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Infection in Practice |
| spelling | doaj.art-073b79567ace44bb8ddc3aa570be70fc2022-12-21T23:45:31ZengElsevierClinical Infection in Practice2590-17022019-10-012Adenovirus Type 7 causing severe lower respiratory tract infection in immunocompetent adults: a comparison of two contrasting cases from an intensive care unit in North West EnglandTom Wingfield0Luke Dearden1Pete Calvert2Orod Osanlou3Brian Johnston4Anu Chawla5Ian Hart6Catherine Thompson7Lance Turtle8Richard Wenstone9LIV-TB Collaboration and Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK; Tropical and Infectious Diseases Unit, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UK; Social Medicine, Infectious Diseases and Migration Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Corresponding author at: Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.Intensive Care Unit, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UKIntensive Care Unit, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UKDepartment of Clinical Pharmacology, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UKIntensive Care Unit, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UKLiverpool Specialist Virology Centre, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UKLiverpool Specialist Virology Centre, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UKRespiratory Virus Unit, Virus Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UKDepartment of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, UKIntensive Care Unit, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UKObjectives: Severe lower respiratory tract infection caused by adenovirus is well described in immunocompromised hosts and can cause significant morbidity and mortality. We compare and contrast the clinical presentation, radiological, and virological features of two rare cases in immunocompetent adults admitted to an intensive care unit in a large, teaching hospital in North West England. We then provide a concise, comprehensive literature review. Methods: The first case was a 35-year old female asthmatic who presented with respiratory distress and pneumonitis during peak influenza season, and recovered after a prolonged hospital stay. The second case was a 73-year old male who presented with diarrhoea, vomiting, and general malaise outside of influenza season, developed respiratory compromise, and died. Adenovirus type 7 was identified in bronchoalveolar lavages and plasma samples of both patients, each of whom received cidofovir. No other infectious aetiology was identified. Results: Clinical and radiological features of severe lower respiratory tract adenoviral infection are similar to other infectious causes of pneumonia and ARDS, including severe influenza. This can create diagnostic uncertainty, especially during influenza season. Positive adenovirus polymerase chain reaction results can support a diagnosis of severe lower respiratory tract adenovirus infection in patients with a clinically compatible syndrome and no other identified aetiology, with higher viral loads being associated with worse prognosis. Although treatment is predominantly supportive, early use of cidofovir may improve outcomes. Conclusions: These rare cases highlight that severe lower respiratory tract adenoviral infection should be considered in the differential diagnoses of immunocompetent patients presenting with pneumonia and ARDS.http://www.sciencedirect.com/science/article/pii/S259017021930007XSevere lower respiratory tract infectionPneumoniaPneumonitisAcute respiratory distressAdenovirusCritical care |
| spellingShingle | Tom Wingfield Luke Dearden Pete Calvert Orod Osanlou Brian Johnston Anu Chawla Ian Hart Catherine Thompson Lance Turtle Richard Wenstone Adenovirus Type 7 causing severe lower respiratory tract infection in immunocompetent adults: a comparison of two contrasting cases from an intensive care unit in North West England Clinical Infection in Practice Severe lower respiratory tract infection Pneumonia Pneumonitis Acute respiratory distress Adenovirus Critical care |
| title | Adenovirus Type 7 causing severe lower respiratory tract infection in immunocompetent adults: a comparison of two contrasting cases from an intensive care unit in North West England |
| title_full | Adenovirus Type 7 causing severe lower respiratory tract infection in immunocompetent adults: a comparison of two contrasting cases from an intensive care unit in North West England |
| title_fullStr | Adenovirus Type 7 causing severe lower respiratory tract infection in immunocompetent adults: a comparison of two contrasting cases from an intensive care unit in North West England |
| title_full_unstemmed | Adenovirus Type 7 causing severe lower respiratory tract infection in immunocompetent adults: a comparison of two contrasting cases from an intensive care unit in North West England |
| title_short | Adenovirus Type 7 causing severe lower respiratory tract infection in immunocompetent adults: a comparison of two contrasting cases from an intensive care unit in North West England |
| title_sort | adenovirus type 7 causing severe lower respiratory tract infection in immunocompetent adults a comparison of two contrasting cases from an intensive care unit in north west england |
| topic | Severe lower respiratory tract infection Pneumonia Pneumonitis Acute respiratory distress Adenovirus Critical care |
| url | http://www.sciencedirect.com/science/article/pii/S259017021930007X |
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