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Wang N, Fang Y, Dong H, Wang L, Hou M, Wang W, Ning J. Clinical features and prediction of risk factors for severe adenovirus pneumonia in children. Transl Pediatr 2024; 13:63-71. [PMID: 38323185 PMCID: PMC10839281 DOI: 10.21037/tp-23-312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/16/2023] [Indexed: 02/08/2024] Open
Abstract
Background Adenoviral infections are most likely to invade the respiratory tract, and the clinical manifestations of the infections are varied; in severe cases, they may cause systemic multi-system damages and so on. At present, early clinical differential diagnosis is difficult under the existing testing methods, so it is important to analyze its clinical characteristics and risk factors for early identification of critical status and early and rational treatment. Methods The clinical data of 202 children with adenovirus pneumonia admitted to Tianjin Children's Hospital from January 2019 to December 2021 were retrospectively analyzed. According to the evaluation criteria for severe pneumonia, they were divided into a severe group (77 cases) and a non-severe group (125 cases). The clinical characteristics, complications, and laboratory data of the 2 groups were collected for statistical analysis, and then significant factors were analyzed by receiver operating characteristic curve (ROC) and binary logistic regression. Results Among the 202 children with adenovirus pneumonia, there were 108 males and 94 females. The children ranged in age from 2 months to 13 years. The duration of fever, incidence of wheezing, neutrophil ratio (NEUT%), and serum ferritin (SF) levels were significantly higher in the severe group than in the non-severe group (χ2/Z/P=-9.173/<0.001, 5.469/0.019, 5.831/<0.001, -3.845/<0.001). The incidences of liver injury, electrolyte disturbance, and coagulation dysfunction in the severe group were significantly higher than those in the non-severe group (χ2/Z/P=0.001/0.001, 28.208/0.001, 32.079/0.001). Logistic regression combined with ROC curve analysis suggested that fever duration >4.50 days, with wheezing, NEUT% ≥47.60, and SF ≥139.60 ng/mL were risk factors for developing severe adenovirus pneumonia in children [odds ratio (OR) (95% CI): 1.394 (1.230-1.581), 3.673 (1.246-10.828), 1.034 (1.001-1.067), 1.004 (1.001-1.008)]. Conclusions Studies have shown that the fever associated with severe adenovirus pneumonia has a long duration, and that severe clinical manifestations and multiple complications, fever duration >4.50 days, wheezing, NEUT% ≥47.60, and SF ≥139.60 ng/mL are risk factors for severe adenovirus pneumonia.
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Affiliation(s)
- Ning Wang
- Department of Pediatric Research Institute, Tianjin Children’s Hospital/Children’s Hospital of Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Yulian Fang
- Department of Pediatric Research Institute, Tianjin Children’s Hospital/Children’s Hospital of Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Hanquan Dong
- Department of Respiratory, Tianjin Children’s Hospital/Children’s Hospital of Tianjin University, Tianjin, China
| | - Lu Wang
- Department of Pediatric Research Institute, Tianjin Children’s Hospital/Children’s Hospital of Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Mengzhu Hou
- Department of Pediatric Research Institute, Tianjin Children’s Hospital/Children’s Hospital of Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Wei Wang
- Department of Pediatric Research Institute, Tianjin Children’s Hospital/Children’s Hospital of Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Jing Ning
- Department of Respiratory, Tianjin Children’s Hospital/Children’s Hospital of Tianjin University, Tianjin, China
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Hong Y, Wang Q, Song Y, Liu G, Shen J. Factors Associated with Severe Adenovirus Pneumonia in Children: A Retrospective Study from Guangzhou, China (2017-2019). Med Sci Monit 2023; 29:e939578. [PMID: 37496263 PMCID: PMC10392226 DOI: 10.12659/msm.939578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/07/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Adenovirus infections are prevalent in children, typically presenting with mild or asymptomatic symptoms. However, some children develop severe pneumonia necessitating hospitalization. This retrospective study aimed to identify risk factors associated with severe adenovirus pneumonia in children. MATERIAL AND METHODS We screened consecutive children admitted for community-acquired pneumonia at the Emergency Department of Guangzhou Women's and Children's Medical Center between 2017 and 2019. Adenovirus infection was confirmed through rapid respiratory virus assay, RT-PCR assay from respiratory secretions, or serum IgM antibodies. According to Chinese guidelines, patients with pneumonia were classified into severe and mild groups. We assessed risk factors for severe adenovirus pneumonia by comparing clinical features and laboratory indicators, then included differing factors between the 2 groups in a logistic regression analysis. Data analysis was performed using SPSS 26.0 software. RESULTS Our study included 173 children diagnosed with adenovirus pneumonia (117 severe, 56 mild). The median age was 40 months, with 64 male patients. Univariate analysis and binary logistic regression analysis revealed that pleural effusion (13.449 [1.226-147.510], p=0.033), electrolyte disturbances (15.149 [2.724-84.246], p=0.002), oxygen therapy (258.219 [20.684-3223.548], p<0.001), bronchoscopy (26.781 [6.088-117.805], p<0.001), and steroid administration (6.584 [1.497-28.953], p=0.013) were associated with the severity of adenovirus pneumonia. CONCLUSIONS This single-center retrospective study identified pleural effusion, the need for bronchoscopy, oxygen therapy, and steroid treatment, along with impaired serum electrolytes, as factors associated with severe adenovirus pneumonia in children.
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Zhang J, Zhu Y, Zhou Y, Gao F, Qiu X, Li J, Yuan H, Jin W, Lin W. Pediatric adenovirus pneumonia: clinical practice and current treatment. Front Med (Lausanne) 2023; 10:1207568. [PMID: 37476615 PMCID: PMC10354292 DOI: 10.3389/fmed.2023.1207568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Adenovirus pneumonia is common in pediatric upper respiratory tract infection, which is comparatively easy to develop into severe cases and has a high mortality rate with many influential sequelae. As for pathogenesis, adenoviruses can directly damage target cells and activate the immune response to varying degrees. Early clinical recognition depends on patients' symptoms and laboratory tests, including those under 2 years old, dyspnea with systemic toxic symptoms, atelectasis or emphysema in CT image, decreased leukocytes, and significantly increased C-reaction protein (CRP) and procalcitonin (PCT), indicating the possibility of severe cases. Until now, there is no specific drug for adenovirus pneumonia, so in clinical practice, current treatment comprises antiviral drugs, respiratory support and bronchoscopy, immunomodulatory therapy, and blood purification. Additionally, post-infectious bronchiolitis obliterans (PIBO), hemophagocytic syndrome, and death should be carefully noted. Independent risk factors associated with the development of PIBO are invasive mechanical ventilation, intravenous steroid use, duration of fever, and male gender. Meanwhile, hypoxemia, hypercapnia, invasive mechanical ventilation, and low serum albumin levels are related to death. Among these, viral load and serological identification are not only "gold standard" for adenovirus pneumonia, but are also related to the severity and prognosis. Here, we discuss the progress of pathogenesis, early recognition, therapy, and risk factors for poor outcomes regarding severe pediatric adenovirus pneumonia.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Wei Lin
- Department of Pediatrics, The Second School of Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Yao G, Ma C, Liu J, Sun Z, Wei B. Interleukin-6 serum levels are independently associated with severe adenovirus pneumonia in children: a cross-sectional study. Transl Pediatr 2022; 11:1962-1971. [PMID: 36643667 PMCID: PMC9834950 DOI: 10.21037/tp-22-585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study aimed to explore the potential association between interleukin-6 (IL-6) serum levels and severe adenovirus pneumonia (SAP) in children. METHODS A retrospective hospital-based cross-sectional study was conducted on children with SAP who presented to the Tianjin Children's Hospital between January 2019 and December 2020. Serum IL-6 levels were categorized into quintiles (Q1-5). The primary outcome variable was the occurrence of SAP. The patients' clinical features, laboratory findings, and radiographic characteristics were also assessed, and a descriptive bivariate analysis was carried out. Multivariable logistic regression analysis was applied to evaluate the relationship of IL-6 with SAP after adjustment for confounders. The nonlinear relationship between IL-6 and SAP was also analyzed. P value <0.05 was considered statistically significant. RESULTS In total, 542 patients met our inclusion criteria (223 males and 319 females). The mean IL-6 serum level was 38.51 pg/mL (range, 1.50-659.2 pg/mL). After adjustment for confounders, the odds ratio (OR) per SD (standard deviation) increase in IL-6 was 1.66 [95% confidence interval (CI): 1.14, 2.41]. The multivariable-adjusted OR (95% CI) of SAP across the Q1-Q5 categories of IL-6 were as follows: 1.00 (reference), 1.17 (0.59, 2.35), 1.79 (0.88, 3.63), 2.31 (1.12, 4.76), and 2.85 (1.32, 6.14) (P for trend =0.002). The risk of SAP increased with the IL-6 serum level up to 40.78 pg/mL (adjusted OR 1.029, 95% CI: 1.008-1.051; P=0.007); however, when the IL-6 level exceeded 40.78 pg/mL, it had no association with the risk of SAP (OR 1.003, 95% CI: 0.996-1.010; P=0.384). CONCLUSIONS Our findings suggest that the serum level of IL-6 is associated with the risk of SAP in children. The levels of IL-6 in children should therefore be of concern to clinicians.
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Affiliation(s)
- Guohua Yao
- Department of Infectious Disease, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Cuian Ma
- Department of Infectious Disease, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Jie Liu
- Department of Infectious Disease, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Zexuan Sun
- Department of Children's Internal Medicine, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Botao Wei
- Department of Infectious Disease, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
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Liu S, Zhu A, Pan J, Ying L, Sun W, Wu H, Zhu H, Lou H, Wang L, Qin S, Yu Z, Cai J, Chen Y, Chen E. The clinical and virological features of two children's coinfections with human adenovirus type 7 and human coronavirus-229E virus. Front Public Health 2022; 10:1048108. [PMID: 36457331 PMCID: PMC9706225 DOI: 10.3389/fpubh.2022.1048108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Human adenovirus (HAdV) coinfection with other respiratory viruses is common, but adenovirus infection combined with human coronavirus-229E (HCoV-229E) is very rare. Study design and setting Clinical manifestations, laboratory examinations, and disease severity were compared between three groups: one coinfected with HAdV-Ad7 and HCoV-229E, one infected only with adenovirus (mono-adenovirus), and one infected only with HCoV-229E (mono-HCoV-229E). Results From July to August 2019, there were 24 hospitalized children: two were coinfected with HAdV-Ad7 and HCoV-229E, and 21 were infected with a single adenovirus infection. Finally, one 14-year-old boy presented with a high fever, but tested negative for HAdV-Ad7 and HCoV-229E. Additionally, three adult asymptotic cases with HCoV-229E were screened. No significant difference in age was found in the coinfection and mono-adenovirus groups (11 vs. 8 years, p = 0.332). Both groups had the same incubation period (2.5 vs. 3 days, p = 0.8302), fever duration (2.5 vs. 2.9 days, p = 0.5062), and length of hospital stay (7 vs. 6.76 days, p = 0.640). No obvious differences were found in viral loads between the coinfection and mono-adenovirus groups (25.4 vs. 23.7, p = 0.570), or in the coinfection and mono-HCoV-229E groups (32.9 vs. 30.06, p = 0.067). All cases recovered and were discharged from the hospital. Conclusion HAdV-Ad7 and HCoV-229E coinfection in healthy children may not increase the clinical severity or prolong the clinical course. The specific interaction mechanism between the viruses requires further study.
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Affiliation(s)
- Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - An Zhu
- Department of Pediatrics, Second People's Hospital of Jinyun County, Lishui, China
| | - Jinren Pan
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Lihong Ying
- Department of Infectious Diseases, Jinyun District Center for Disease Control and Prevention, Lishui, China
| | - Wanwan Sun
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Hanting Wu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Haiying Zhu
- Department of Pediatrics, Second People's Hospital of Jinyun County, Lishui, China
| | - Haiyan Lou
- Department of Radiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lan Wang
- Department of Geriatrics, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuwen Qin
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhao Yu
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jian Cai
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China,*Correspondence: Jian Cai
| | - Yin Chen
- Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China,Yin Chen
| | - Enfu Chen
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China,Enfu Chen
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Hussein Lazim H, Hussain Ali S, Abdul-Amir AS, Salim AB. A STUDY OF THE NOVEL WU AND KI POLYOMAVIRUSES, BOCAVIRUS ADENOVIRUS IN CHILDREN WITH UPPER RESPIRATORY TRACT INFECTIONS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1678-1682. [PMID: 35962680 DOI: 10.36740/wlek202207112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim: To find out the frequency of WU and KI polyomaviruses, and Human Boca and Adenoviruses infections among children with different types of acute upper respiratory tract infections and to compare the frequency of these viruses among immune-competent and immune compromised patients. PATIENTS AND METHODS Materials and methods: A case-control study conducted in children aged 3-18 years with acute upper respiratory tract infections. The samples were taken from: Group 1: 100 immuno competent children with acute upper respiratory tract infections. Group 2: 100 immuno compromised children (Leukemic, cancer, Nephrotic syndrome, chronic renal failure and children with renal transplant) with acute upper respiratory tract infections. Group 3: 100 apparently healthy children without respiratory infections as control group. Nasal swap samples were collected from children and then viral DNA extracted from these samples. Then detection of WU, KI polyomaviruses HBoV and HAdv was done by using real time PCR. RESULTS Results: All of 300 samples were negative for WU and KI polyomaviruses. However, human Bocavirus was detected in the three groups (immunocompromised, immunocompetent and control group) and the positivity rates were 61.61%, 37.37% and 18.18%, respectively. While human adenovirus was found only in 2% of immunocompromised patients and 1.1% of immunocompetent patients also there were cases positive for both HBoV and HAdv in 5.5% of immunocompromised patients, and 8.8% of immunocompetent patients. CONCLUSION Conclusions: High frequency of HBoV especially in immunocompromised patients while low number of positive cases for HAdv by using nasal swab samples, WU and KI polyomaviruses could not be detected in samples.
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Obermeier PE, Heim A, Biere B, Hage E, Alchikh M, Conrad T, Schweiger B, Rath BA. Linking digital surveillance and in-depth virology to study clinical patterns of viral respiratory infections in vulnerable patient populations. iScience 2022; 25:104276. [PMID: 35573195 PMCID: PMC9092969 DOI: 10.1016/j.isci.2022.104276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/09/2022] [Accepted: 04/17/2022] [Indexed: 11/29/2022] Open
Abstract
To improve the identification and management of viral respiratory infections, we established a clinical and virologic surveillance program for pediatric patients fulfilling pre-defined case criteria of influenza-like illness and viral respiratory infections. The program resulted in a cohort comprising 6,073 patients (56% male, median age 1.6 years, range 0–18.8 years), where every patient was assessed with a validated disease severity score at the point-of-care using the ViVI ScoreApp. We used machine learning and agnostic feature selection to identify characteristic clinical patterns. We tested all patients for human adenoviruses, 571 (9%) were positive. Adenovirus infections were particularly common and mild in children ≥1 month of age but rare and potentially severe in neonates: with lower airway involvement, disseminated disease, and a 50% mortality rate (n = 2/4). In one fatal case, we discovered a novel virus: HAdV-80. Standardized surveillance leveraging digital technology helps to identify characteristic clinical patterns, risk factors, and emerging pathogens. We used mobile health technology to enable clinical pattern recognition The ViVI ScoreApp provided precision data for cross-cohort meta-analysis Neonates with adenovirus infection are at risk of severe or fatal disease outcomes In one neonate with disseminated disease, we found a new adenovirus: HAdV-D80
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Affiliation(s)
- Patrick E. Obermeier
- Vienna Vaccine Safety Initiative, Pediatric Infectious Diseases, Berlin, Germany
- Charité University Medical Center, Department of Pediatrics, Berlin, Germany
- UMR Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France
| | - Albert Heim
- National Reference Laboratory for Adenoviruses, Hannover Medical School, Hannover, Germany
| | - Barbara Biere
- National Reference Centre for Influenza, Robert Koch-Institute, Berlin, Germany
| | - Elias Hage
- National Reference Laboratory for Adenoviruses, Hannover Medical School, Hannover, Germany
| | - Maren Alchikh
- Vienna Vaccine Safety Initiative, Pediatric Infectious Diseases, Berlin, Germany
- Charité University Medical Center, Department of Pediatrics, Berlin, Germany
- UMR Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France
| | - Tim Conrad
- Department of Mathematics and Computer Science, Freie Universität Berlin, Berlin, Germany
| | - Brunhilde Schweiger
- National Reference Centre for Influenza, Robert Koch-Institute, Berlin, Germany
| | - Barbara A. Rath
- Vienna Vaccine Safety Initiative, Pediatric Infectious Diseases, Berlin, Germany
- Charité University Medical Center, Department of Pediatrics, Berlin, Germany
- UMR Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France
- Corresponding author
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Ahmed A, Alsenaidy AM, Mobaireek KF, AlSaadi MM. Viral etiology of acute respiratory infections during 2014–16 in Riyadh, Saudi Arabia. Future Virol 2022. [DOI: 10.2217/fvl-2020-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Viral etiology of respiratory infections is not well understood in Saudi Arabia. This study was conceptualized to understand viral etiology in children with acute respiratory tract infections (ARTI) from Riyadh. Patients and methods: Respiratory viruses were detected by real-time PCR in nasopharyngeal aspirates or swab from 580 children aged ≤5 years. Results: Respiratory viruses were detected in 64% of the samples with 6% mixed viral infections. Respiratory syncytial virus, adenovirus, influenza, parainfluenza and human metapneumovirus infections accounted for 42, 20, 16, 12 and 10%, respectively. Maximum prevalence (37%) was among the lowest age group followed by 30% among the 7- to 12-month age group. Conclusion: The prevalence and determinants of viral etiology are in line with the previous report from the region. No major shift in the viral etiologies was observed in the 2-year study period.
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Affiliation(s)
- Anwar Ahmed
- Centre of Excellence in Biotechnology Research, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Abdulrahman M Alsenaidy
- Department of Biochemistry, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Khalid Fahad Mobaireek
- Pediatric Emergency Department, Children’s Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Muslim Mohammed AlSaadi
- Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, 11533, Saudi Arabia
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Lao Q, Han N, Pan H, Zhan M, Wu Y, Zhao S, Jia Y. Identified risk factors for co-infection in hospitalized children infected with adenovirus in Hangzhou. Epidemiol Infect 2022; 150:1-19. [PMID: 35351219 PMCID: PMC9044526 DOI: 10.1017/s0950268822000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/06/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to describe the clinical manifestations of adenovirus infections and identify potential risk factors for co-infection with chlamydia, viruses and bacteria in hospitalised children from Hangzhou, China. From January to December 2019, the characteristics of hospitalised children infected with adenovirus at Hangzhou Children's Hospital and Zhejiang Xiaoshan Hospital were collected. The clinical factors related to co-infection with chlamydia, viruses and bacteria were assessed using multivariate logistic regression analyses. A total of 5989 children were infected with adenovirus, of which 573 were hospitalised for adenovirus infection. The severity of adenovirus respiratory infection was categorised as follows: mild (bronchiolitis, 73.6%), moderate (bronchopneumonia, 17.6%) or severe (pneumonia, 8.8%). Of the 573 children who were hospitalised, 280 presented with co-infection of chlamydia, viruses or bacteria, while the remaining 293 had only adenovirus infection. Multivariate stepwise logistic regression analyses indicated that elevated ferritin was associated with an increased risk of chlamydia co-infection (odds ratio (OR) 6.50; 95% confidence interval (CI) 1.56–27.11; P = 0.010). However, increased white blood cell (WBC) count was associated with a reduced risk of viral co-infection (OR 0.84; 95% CI 0.75–0.95; P = 0.006). The study indicated that co-infection with chlamydia could be affected by elevated ferritin levels. WBC levels could affect viral co-infection in hospitalised children infected with adenovirus.
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Affiliation(s)
- Qun Lao
- Department of Radiology, Hangzhou Children's Hospital, Hangzhou 310014, PR China
| | - Ning Han
- Department of Radiology, Hangzhou Children's Hospital, Hangzhou 310014, PR China
| | - Haipeng Pan
- Department of Radiology, Hangzhou Children's Hospital, Hangzhou 310014, PR China
| | - Ming Zhan
- Department of Radiology, Zhejiang Xiaoshan Hospital, Hangzhou 310014, PR China
| | - Yidong Wu
- Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou 310014, PR China
| | - Shiyong Zhao
- Department of Infection, Hangzhou Children's Hospital, Hangzhou 310014, PR China
| | - Yuzhu Jia
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310014, PR China
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Wang X, Tan X, Li Q. Difference in clinical features and prognosis of severe adenoviral pneumonia in children with different ages. J Med Virol 2022; 94:3303-3311. [PMID: 35218046 DOI: 10.1002/jmv.27680] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/08/2022] [Accepted: 02/23/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aims to analyze the difference in clinical features and prognosis of severe adenovirus pneumonia (SAP) in children of different ages, and analyze the risk factors for poor prognosis in children with SAP. METHODS A retrospective observational study was performed to describe the clinical features and analyze the risk factors for death and post-infectious bronchiolitis obliterans (PIBO) in 303 children hospitalized with SAP from January 2015 through to January 2020. The participants were divided into 4 age groups: < 6 months (n = 25, 8.3%); 6-12 months (n = 98, 32.3%); 12-36 months (n = 118, 38.9%); and > 36 months (n = 62, 20.5%). RESULTS Fever rate, peak, and duration were the lowest in the < 6 months group, while no significant difference was found among other age groups. Serum levels of lactate dehydrogenase (LDH) and the load of adenovirus were the lowest in the < 6 months group, and the highest in the 6-12 months and 12-36 months groups, respectively. A total of 80.9% of patients recovered, 3.3% of patients died, and 15.8% of patients were diagnosed PIBO. The mortality rate showed no significance between age groups. The > 36 months group had the highest recovery rate and the lowest incidence of PIBO, while the 6-12 months group had the lowest recovery rate and the highest incidence of PIBO. Independent risk factors for PIBO among all participants from the 4 groups were invasive mechanical ventilation, administration of intravenous steroids, duration of fever, and male gender. Independent risk factors for death among all participants from the 4 groups were hypercapnia, low albumin levels, and invasive mechanical ventilation. Risk factor analysis of different ages was not possible due to the limited sample size. CONCLUSIONS The morbidity, clinical features, and prognosis of SAP are affected by children's ages. Pediatric patients with a longer duration of fever, hypercapnia, low serum albumin levels, invasive mechanical ventilation, and intravenous steroids use are more likely to develop a poor prognosis in SAP, especially if the patient is male. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xia Wang
- Department of Pediatrics, Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Xiangsheng Tan
- The First Hospital Affiliated to Army Medical University, Chongqing, 400038, China
| | - Qubei Li
- Department of the Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
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Liu Y, Shen Y, Wei B. The Clinical Risk Factors of Adenovirus Pneumonia in Children Based on the Logistic Regression Model: Correlation with Lactate Dehydrogenase. Int J Clin Pract 2022; 2022:3001013. [PMID: 35685584 PMCID: PMC9159200 DOI: 10.1155/2022/3001013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
METHODS Children with bacterial pneumonia (41 cases) and adenovirus pneumonia (179 cases) hospitalized in Tianjin Children's Hospital from January to October 2020 were selected. The differences in baseline and clinical characteristics between children with two pneumonias, respectively, were compared via the chi-square test and Wilcox test. The Least Absolute Shrinkage and Selection Operator (LASSO) model was applied to screen the pneumonia type-related characteristics. Patients were randomly divided into the training set (n = 154) and test set (n = 66). The logistic model was constructed using the screened characteristics in the training set to predict whether the cases are bacterial pneumonia or adenovirus pneumonia. Finally, the model was validated by receiver operating characteristic (ROC) curve and area under curve (AUC) in the test set. RESULTS The age (p < 0.001), hospital stay (p < 0.001), tonsil condition (p < 0.001), interleukin-6 (IL-6; p=0.033), and lactate dehydrogenase (LDH; p < 0.001) between children with bacterial pneumonia and adenovirus pneumonia were significantly different. Sex, tonsil condition, age, hospital stay, r-glutamyltransferase (r-GT), and LDH levels were the factors associated with the types of pneumonia. Compared with bacterial pneumonia, children with adenovirus pneumonia were younger (OR = 0.207, 95% CI: 0.041-0.475), with longer hospital stay (OR = 7.974, 95% CI: 2.626-74.354) and higher LDH expression level (OR = 1.025, 95% CI: 1.006-1.060). 92.4% types of pneumonia were correctly predicted, and the AUC value of the model was 0.981. CONCLUSION The LDH level was the associated factor to predict the types of pneumonia. Adenovirus pneumonia was associated with earlier age and longer hospital stay than bacterial pneumonia. The established model can well predict the types of pneumonia in children and provide clinical basis for guiding the individualized treatment of children.
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Affiliation(s)
- Yuqiao Liu
- Department of Infectious Diseases, Tianjin Children's Hospital, 238 Longyan Road, Beichen District, Tianjin, China
| | - Yang Shen
- Department of Infectious Diseases, Tianjin Children's Hospital, 238 Longyan Road, Beichen District, Tianjin, China
| | - Botao Wei
- Department of Infectious Diseases, Tianjin Children's Hospital, 238 Longyan Road, Beichen District, Tianjin, China
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Fan H, Cui Y, Xu X, Zhang D, Yang D, Huang L, Ding T, Lu G. Validation of a Classification Model Using Complete Blood Count to Predict Severe Human Adenovirus Lower Respiratory Tract Infections in Pediatric Cases. Front Pediatr 2022; 10:896606. [PMID: 35712623 PMCID: PMC9197341 DOI: 10.3389/fped.2022.896606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human adenovirus (HAdV) lower respiratory tract infections (LRTIs) are prone to severe cases and even cause death in children. Here, we aimed to develop a classification model to predict severity in pediatric patients with HAdV LRTIs using complete blood count (CBC). METHODS The CBC parameters from pediatric patients with a diagnosis of HAdV LRTIs from 2013 to 2019 were collected during the disease's course. The data were analyzed as potential predictors for severe cases and were selected using a random forest model. RESULTS We enrolled 1,652 CBC specimens from 1,069 pediatric patients with HAdV LRTIs in the present study. Four hundred and seventy-four patients from 2017 to 2019 were used as the discovery cohort, and 470 patients from 2013 to 2016 were used as the validation cohort. The monocyte ratio (MONO%) was the most obvious difference between the mild and severe groups at onset, and could be used as a marker for the early accurate prediction of the severity [area under the subject operating characteristic curve (AUROC): 0.843]. Four risk factors [MONO%, hematocrit (HCT), red blood cell count (RBC), and platelet count (PLT)] were derived to construct a classification model of severe and mild cases using a random forest model (AUROC: 0.931 vs. 0.903). CONCLUSION Monocyte ratio can be used as an individual predictor of severe cases in the early stages of HAdV LRTIs. The four risk factors model is a simple and accurate risk assessment tool that can predict severe cases in the early stages of HAdV LRTIs.
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Affiliation(s)
- Huifeng Fan
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ying Cui
- Department of Immunology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Xuehua Xu
- Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dongwei Zhang
- Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Diyuan Yang
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Huang
- Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tao Ding
- Department of Immunology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-sen University, Guangzhou, China.,Provincial Engineering Technology Research Center for Biological Vector Control, Guangzhou, China
| | - Gen Lu
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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13
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Wang C, Liu J, Mi Y, Chen J, Bi J, Chen Y. Clinical features and epidemiological analysis of respiratory human adenovirus infection in hospitalized children: a cross-sectional study in Zhejiang. Virol J 2021; 18:234. [PMID: 34844615 PMCID: PMC8628464 DOI: 10.1186/s12985-021-01705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022] Open
Abstract
Background HAdV is one of the common pathogens in hospitalized children with acute respiratory infections (ARIs). We aim to describe the clinical and laboratory features, epidemiological characteristics, and HAdV species and/or types of inpatients with HAdV respiratory infections. Methods Respiratory samples were gathered from inpatients diagnosed ARIs in Children’s Hospital, Zhejiang University School of Medicine, and were detected by using Direct Immunofluorescence Assay from 2018 to 2019. PCR amplification and sequencing of the hypervariable zone of hexon gene were used for genotyping. The clinical and laboratory features, and HAdV genotyping, and epidemiological characteristic analysis were retrospectively performed. Results Of 7072 samples collected, 488 were identified as HAdV-positive. The overall detection rate was 6.9%. The peaked detection rate was 14.1% in January 2019. HAdV-positive cases with ARIs mainly appeared in winter. The detection rate was highest among children between 6 months and 2 years (8.7%, 123/1408). Clinical diagnosis included pneumonia (70.3%, 343/488), bronchitis (7.0%, 34/488) and acute upper respiratory tract infection (22.7%, 111/488). The common clinical manifestations were fever (93.4%, 456/488), cough (94.7%, 462/488), wheezing (26.2%, 128/488), and shortness of breath (14.8%, 72/488). 213 (43.6%) cases had co-infection and 138 (28.3%) cases had extrapulmonary symptoms. 96(19.7%) cases had intrapulmonary and intrathoracic complications.78 (16.0%) had an underlying condition, most of which were congenital heart diseases (20.5%, 16/78). The proportions of hyperpyrexia, duration of fever > 10 days, severe pneumonia, and wheezing in the co-infection group were remarkably higher than those in HAdV single-infection group (all p < 0.05). The proportions of duration of hospitalization, duration of fever > 10 days, wheezing, shortness of breath, change in level of consciousness, serosal fluids, extrapulmonary symptoms, co-infections and underlying diseases were significantly higher in severe pneumonia group than those in the mild pneumonia group (all p < 0.05). Four HAdV species were successfully identified in 155 cases and presented by 8 genotypes. HAdV-B3 (56.1%, 87/155) and HAdV -B7 (31.0%, 48/155) were the most predominant detected types and occurred commonly in different severity groups (p = 0.000), while, HAdV-B55 was detected only in the severe group. HAdV-B7’s detection rate in the severe pneumonia group was significantly higher than the non-severe pneumonia group. Conclusion HAdV detection rate is related to age and season. Bronchopneumonia accounts for about 70% HAdV-positive inpatients. The common clinical manifestations include hyperpyrexia, cough, wheezing, and shortness of breath. HAdV-B3 and HAdV-B7 are the most common types in children diagnosed with respiration infections.
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Affiliation(s)
- Caiyun Wang
- Department of Infectious Disease, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, 3333 Binsheng Road, Hangzhou, 310052, China.
| | - Juanjuan Liu
- Department of Infectious Disease, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, 3333 Binsheng Road, Hangzhou, 310052, China
| | - Yumei Mi
- Department of Infectious Disease, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, 3333 Binsheng Road, Hangzhou, 310052, China
| | - Jing Chen
- Department of Infectious Disease, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, 3333 Binsheng Road, Hangzhou, 310052, China
| | - Jing Bi
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, 3333 Binsheng Road, Hangzhou, 310052, China
| | - Yinghu Chen
- Department of Infectious Disease, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, 3333 Binsheng Road, Hangzhou, 310052, China
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Xu XH, Fan HF, Shi TT, Yang DY, Huang L, Jiang WH, Lu G. Influence of the timing of bronchoscopic alveolar lavage on children with adenovirus pneumonia: a comparative study. BMC Pulm Med 2021; 21:363. [PMID: 34763680 PMCID: PMC8582151 DOI: 10.1186/s12890-021-01708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background Adenovirus pneumonia is prone to severe clinical and imaging manifestations in children. Bronchoscopic alveolar lavage (BAL) is an important adjunctive therapy for patients with severe imaging findings. The study aimed to evaluate the effect of the timing on the efficacy of bronchoalveolar lavage in children with adenovirus pneumonia. Methods This study included 134 patients with adenovirus pneumonia treated with BAL at Guangzhou Women and Children's Medical Center from January 2019 to January 2020.They were classified into the severe and mild groups. Based on the timing of BAL, each group was divided into the early BAL layer (received BAL within 1–9 days of the illness course) and the late BAL layer (received BAL within 10–14 days of the illness course). The clinical data of patients with different BAL timings were analyzed in two groups. Results Among the 134 patients, 70 were categorized into the mild group and 64 were categorized into the severe group. Of the 134 patients, 42 patients received BAL early (mild group: n = 21 and severe group: n = 21) and 92 patients received BAL later (mild group: n = 49 and severe group: n = 43). In the mild group, the fever and hospital duration were shorter in patients who received BAL early than in those who received BAL later (p < 0.05). However, in the severe group, there were no statistically significant differences in the fever and hospital duration between patients who received BAL early and those who received BAL later. However, the need for mechanical ventilation and the incidence of BAL complications, such as new need for oxygen, were higher in patients who received BAL early than in those who received BAL later in the severe group (p < 0.05). Conclusion For mild adenovirus pneumonia, early BAL may shorten the fever and hospital duration. However, early BAL in severe cases might not shorten the course of the disease or improve prognosis and may even increase the risks of mechanical ventilation and BAL complications.
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Affiliation(s)
- Xue-Hua Xu
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Hui-Feng Fan
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Ting-Ting Shi
- Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Di-Yuan Yang
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Li Huang
- Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wen-Hui Jiang
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Gen Lu
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
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15
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Du X, Wu G, Zhu Y, Zhang S. Exploring the epidemiological changes of common respiratory viruses since the COVID-19 pandemic: a hospital study in Hangzhou, China. Arch Virol 2021; 166:3085-3092. [PMID: 34480636 PMCID: PMC8417671 DOI: 10.1007/s00705-021-05214-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
Adenovirus, respiratory syncytial virus, and influenza virus are common causes of respiratory infections. The COVID-19 pandemic had a significant impact on their prevalence. The aim of this study was to analyze the epidemic changes of common respiratory viruses in the Affiliated Hospital of Hangzhou Normal University in Hangzhou, China, from October of 2017 to February of 2021. We collected statistics from 121,529 patients in the outpatient and inpatient departments of the hospital who had throat or nose swabs collected for testing for four virus antigens by the colloidal gold method. Of these, 13,200 (10.86%) were positive for influenza A virus, 8,402 (6.91%) were positive for influenza B virus, 6,056 (4.98%) were positive for adenovirus, and 4,739 (3.90%) were positive for respiratory syncytial virus. The positivity rates of the influenza A virus (0-14 years old, P = 0.376; over 14 years old, P = 0.197) and respiratory syncytial virus (0-14 years old, P = 0.763; over 14 years old, P = 0.465) did not differ significantly by gender. After January of 2020, influenza virus infection decreased significantly. The positivity rate of respiratory syncytial virus remained high, and its epidemic season was similar to before. Strict respiratory protection and regulation of crowd activities have a great impact on the epidemic characteristics of viruses. After major changes in the public health environment, virus epidemics and their mutations should be monitored closely, extensively, and continuously.
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Affiliation(s)
- Xinke Du
- Department of Pediatrics, The Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Gongchenqiao Street, Gongshu District, Hangzhou, China
| | - Guangsheng Wu
- Department of Pediatrics, The Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Gongchenqiao Street, Gongshu District, Hangzhou, China.
| | - Yafei Zhu
- Department of Pediatrics, The Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Gongchenqiao Street, Gongshu District, Hangzhou, China
| | - Siqi Zhang
- Clinical Medicine College of Hangzhou Normal University, Hangzhou, China
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16
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Clinical Characteristics of 204 Children With Human Adenovirus Type 7 Pneumonia Identified by Whole Genome Sequencing in Liuzhou, China. Pediatr Infect Dis J 2021; 40:91-95. [PMID: 33433157 DOI: 10.1097/inf.0000000000002925] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical knowledge of human adenovirus type 7 (HAdV-7) pneumonia in children remains limited. Moreover, predictors for disease severity are largely unknown. METHODS This is a retrospective study of children hospitalized at Liuzhou Maternal and Child Health Hospital, China, with HAdV-7 pneumonia in 2018-2019. Demographics, clinical characteristics, laboratory results, and imaging data were collected. HAdV-7 was identified in plasma using whole genome sequencing, which yielded quantitative HAdV-7 sequence numbers. RESULTS There were 204 children; 145 (71%) were <2 years of age. There were 68 children with severe pneumonia (SP) and 136 with nonsevere pneumonia (NSP). Up to 43% in SP group with respiratory failure (SP-RF) were <12 months of age. Median duration of fever before hospitalization was shorter in NSP group than SP groups (P < 0.01). Fourteen (6.9%) underwent mechanical ventilation. There was a significant difference in mean plasma HAdV-7 sequence numbers among SP-RF, SP without respiratory failure (SP-NRF), and NSP groups (2485 ± 165, 2034 ± 124, and 286 ± 35, respectively) (P < 0.01). In a logistic regression analysis, we found that elevated plasma HAdV-7 sequence numbers significantly increased the risk of severe HAdV-7 pneumonia (OR 1.80, 95% confidence interval: 1.59-2.60, P < 0.01) after adjusting for age, fever duration, platelet counts, and serum lactate dehydrogenase levels. CONCLUSIONS Over two-thirds of children hospitalized with HAdV-7 pneumonia were <2 years of age. Approximately 40% of those with SP associated with respiratory failure were <12 months of age. Those with SP exhibited higher plasma HAdV-7 sequence numbers. Thus, plasma HAdV-7 sequence numbers have a potential in predicting severity of HAdV-7 pneumonia in children.
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Correia W, Dorta-Guerra R, Sanches M, Almeida Semedo CDJB, Valladares B, de Pina-Araújo IIM, Carmelo E. Study of the Etiology of Acute Respiratory Infections in Children Under 5 Years at the Dr. Agostinho Neto Hospital, Praia, Santiago Island, Cabo Verde. Front Pediatr 2021; 9:716351. [PMID: 34650939 PMCID: PMC8505963 DOI: 10.3389/fped.2021.716351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/01/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Acute respiratory infections are one of the major causes of morbidity and mortality in children under 5 years in developing countries and are a challenge for the health system of these countries. In Cabo Verde, despite the lack of recent studies, data indicate that it affects thousands of children, being the fourth leading cause of infant mortality in 2013. The aim of this study was to identify and describe the etiological agents associated with acute respiratory tract infections in children under 5 years old, and their associated risk factors, such as clinical symptoms or socio-demographic characteristics. Methods: Naso-pharyngeal samples were collected from children under 5 years attending at Dr. Agostinho Neto Hospital (Praia, Santiago Island, Cabo Verde) with suspected ARI at different time-points during 2019. Samples were analyzed using FilmArray® Respiratory Panel v. 2.0 Plus to identify etiological agents of ARI. A questionnaire with socio-demographic information was also collected for each participant. Data analyses were carried out using the IBM SPSS version 25 (IBM Corporation, Armonk, NY) and R 3.5.1 statistical software. Results: A total of 129 naso-pharyngeal samples were included in the study. Seventeen different etiologic agents of respiratory infections were identified. HRV/EV was the most frequent agent detected, followed by FluA H3 and RSV. Coinfection with two or more pathogens was detected in up to 20% of positive samples. The results were analyzed in terms of age-group, sex, period of the year and other social and demographic factors. Conclusion: Viruses are the main causative agents of ARI in children <5 years attending at the pediatrics service at the Dr. Agostinho Neto Hospital in Praia city, Santiago Island, Cabo Verde. Some factors are described in this study as statistically associated with the presence of an infectious agent, such as having one or more children sharing the bedroom with an adult and the presence of some clinical symptoms. The data addresses the need for studies on respiratory tract infections in Cabo Verde.
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Affiliation(s)
- Wilson Correia
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Roberto Dorta-Guerra
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain.,Departamento de Matemáticas, Estadística e Investigación Operativa, Facultad de Ciencias, Universidad de La Laguna, La Laguna, Spain
| | - Mitza Sanches
- Hospital Dr. Agostinho Neto, Ministry of Health and Social Security of Cabo Verde, Praia, Cabo Verde
| | | | - Basilio Valladares
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain.,Departamento de Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna, La Laguna, Spain
| | | | - Emma Carmelo
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, La Laguna, Spain.,Departamento de Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna, La Laguna, Spain.,Red de Investigación Colaborativa en Enfermedades Tropicales (RICET), Madrid, Spain
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18
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Zheng L, Liao W, Liang F, Li K, Li L, Liang H. Clinical Characteristics and Outcomes of Severe Pneumonia in Children Under 5 Years Old With and Without Adenovirus Infection in Guangzhou. Front Pediatr 2021; 9:599500. [PMID: 34869087 PMCID: PMC8634581 DOI: 10.3389/fped.2021.599500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To identify the differences of clinical characteristics and outcomes of severe pneumonia in children under 5 years old with and without adenovirus infection. Methods: A retrospective cohort study was conducted in three pediatric hospitals in Guangzhou, China. In total, 1,595 children under the age of 5 with WHO-defined severe pneumonia had adenovirus testing performed between January 1, 2009 and December 31, 2019. Demographics, complications, the first routine laboratory findings, therapeutic records, and clinical outcome were collected from electronic medical records. We compared characteristics of children with and without adenovirus infection. Results: Adenovirus was detected in 75 (4.7%) out of 1,595 children with severe pneumonia. Cases with adenovirus infection were more likely to be boys (74.7 vs. 63.0%), older than 1 year old (78.7 vs. 25.1%), but less likely to have mixed virus infections (25.3 vs. 92.9%) and combined with cardiovascular disease (12.0 vs. 39.7%), and had more abnormal laboratory results than cases without adenovirus infection. Antiviral therapy (4.9%) was rarely used in children with severe pneumonia, but antibiotic therapy (65.3%) was commonly used, especially in cases with adenovirus infection (91.9%). Children infected with adenovirus (9.3 vs. 2.5%) were also hospitalized longer and had a higher mortality within 30 days of hospitalization. Conclusions: Children with severe pneumonia under 5 years old with adenovirus infection had more abnormal laboratory findings and more severe clinical outcomes than cases without adenovirus infection. More attention should be focused on the harm caused by adenovirus infection.
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Affiliation(s)
- Lingling Zheng
- Clinical Data Center, The Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weiyao Liao
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Feng Liang
- Clinical Data Center, The Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Kuanrong Li
- Clinical Data Center, The Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ling Li
- Clinical Data Center, The Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiying Liang
- Clinical Data Center, The Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Guangdong Provincial Children's Medical Research Center, Guangzhou, China
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Shi J, Zhou Y, Wang F, Wang C, Miao H, Sun T, Shan Y, Cui Y, Zhang Y. A case series of children with adenovirus pneumonia: three-year experiences in a tertiary PICU. BMC Pediatr 2020; 20:375. [PMID: 32772917 PMCID: PMC7415409 DOI: 10.1186/s12887-020-02269-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/02/2020] [Indexed: 12/03/2022] Open
Abstract
Background Describe the outcome of adenovirus pneumonia in a pediatric intensive care unit (PICU) over a 3-year period, to identify the risk factors that may be associated with worse outcome. Methods A retrospective observational study was performed in the PICU of children’s hospital in Shanghai from July 2016 to June 2019. Sixty-seven children over 29 days to 14 years old with adenovirus pneumonia who were admitted to PICU with acute hypoxemic respiratory failure were included in this study. The primary outcome was hospital mortality, and secondary outcomes were hospital and PICU length of stay (LOS), and risk factors of worse outcome. Results Of 67 children with severe adenovirus pneumonia, the hospital mortality was 16.42% (11/67) and 28-day mortality was 14.93% (10/67). Median Pediatric Risk of Mortality III (PRISM III) score at admission was 13 (interquartile range [IQR], 10–15). Median PICU LOS stay was 11 days (8-18d) and hospital LOS was 22 days (16-31d). Among children with extracorporeal membrane oxygenation (n = 9), 6 cases survived and 3 cases died. The patients who need renal replacement therapy, neuromuscular blockade, parenteral nutrition, and packed red blood cell perfusion had higher hospital mortality (p < 0.001, p = 0.041, p = < 0.001, p = 0.012, respectively). Multivariate logistic analysis indicated that liver dysfunction and nosocomial infection were associated with high risk of mortality. Conclusions The hospital mortality of adenovirus pneumonia in our PICU was 16.42%. Patients complicated liver dysfunction and co-infection & nosocomial infection were associated with poor outcome.
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Affiliation(s)
- Jingyi Shi
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Yiping Zhou
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Fei Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Huijie Miao
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Ting Sun
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Yijun Shan
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Yun Cui
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China.
| | - Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China.
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20
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Deng X, Liu B, Li J, Zhang J, Zhao Y, Xu K. Blood biochemical characteristics of patients with coronavirus disease 2019 (COVID-19): a systemic review and meta-analysis. Clin Chem Lab Med 2020; 58:1172-1181. [PMID: 32554832 DOI: 10.1515/cclm-2020-0338] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/09/2020] [Indexed: 01/08/2023]
Abstract
Objective Recently, there have been several studies on the clinical characteristics of patients with coronavirus disease 2019 (COVID-19); however, these studies have mainly been concentrated in Wuhan, China; the sample sizes of each article were different; and the reported clinical characteristics, especially blood biochemical indices, were quite different. This study aimed to summarize the blood biochemistry characteristics of COVID-19 patients by performing a systemic review and meta-analysis of published studies. Methods Comprehensive studies were screened from PubMed, Embase, and Cochrane Library through March 11, 2020. The inclusion criteria included studies investigating the biochemical indexes of patients with COVID-19. The statistical software R3.6.3 was used for meta-analysis. Results Ten studies including 1745 COVID-19 patients met the inclusion criteria for our meta-analysis. Meta-analysis showed that 16% and 20% of patients with COVID-19 had alanine transaminase (ALT) and aspartate aminotransferase (AST) levels higher than the normal range, respectively. Thirty-four percent of patients showed albumin (ALB) levels lower than the normal range, and 6% of patients showed abnormal total bilirubin (TBil) levels. The levels of creatinine (CRE) were increased in 8% of patients. The creatine kinase (CK) level of 13% of patients exceeded the normal range, and 52% of patients had elevated lactate dehydrogenase (LDH) levels. In addition, six studies met the inclusion criteria for the systemic review evaluating the relevance between LDH levels and the severity of COVID-19, and all six studies showed a positive association between these two factors. Conclusions Some patients with COVID-19 had different degrees of blood biochemical abnormalities, which might indicate multiple organ dysfunction. Some biochemical indexes, such as abnormal ALB and LDH, could reflect the severity of the disease to a certain extent. These blood biochemical indicators should be considered in the clinical management of the disease.
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Affiliation(s)
- Xiaoling Deng
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Beibei Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Jiahuan Li
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Junli Zhang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Yajuan Zhao
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Keshu Xu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Road, Wuhan 430022, P.R. China
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