Tom Wingfield1,2,3, Luke Dearden4, Pete Calvert4, Orod Osanlou5, Brian Johnston4, Anu Chawla6, Ian Hart6, Catherine Thompson7, Lance Turtle8, Richard Wenstone4. 1. LIV-TB Collaboration and Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK. 2. Tropical and Infectious Diseases Unit, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UK. 3. Social Medicine, Infectious Diseases and Migration Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 4. Intensive Care Unit, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UK. 5. Department of Clinical Pharmacology, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UK. 6. Liverpool Specialist Virology Centre, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UK. 7. Respiratory Virus Unit, Virus Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK. 8. Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, UK.
Abstract
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.
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.
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