Clinical features of children with severe adenovirus pneumonia and hemophagocytic syndrome: an analysis of 30 cases
ZHANG Hua-Yong, LI Chang-Jian, LONG Yuan, SUN Dong-Ming, WANG Rui-Geng, ZHANG Yong
Department of Cardiology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science&Technology, Wuhan 430016, China
Abstract Objective To study the clinical features of children with severe adenovirus pneumonia (SAP) and hemophagocytic syndrome (HPS). Methods A retrospective analysis was performed from the chart review data of 30 children with SAP and HPS who were admitted from January 2014 to June 2019. According to the prognosis, the children were divided into a good prognosis group (n=18) and a poor prognosis group (n=12). Results Among the 30 children with SAP and HPS, the ratio of male to female was 2:1. The median age of onset was 1 year and 3 months (range 3 months to 5 years), and the mean course of fever was 19±7 d. Of the 30 children, 28 (93%) experienced disease onset in January to June. High-throughput gene detection of serum pathogens showed that 16 (53%) children were positive for human adenovirus type 7 (HAdV-7), and the other 14 (47%) children were positive for HAdV antigen based on immunofluorescence assay for throat swab, with unknown type. Of all 30 children, 29 (97%) had respiratory complications, 24 (80%) had cardiovascular complications, 16 (53%) had gastrointestinal complications, and 9 (30%) had toxic encephalopathy. Eighteen children (60%) improved or recovered and 12 (40%) did not recover (3 died). Compared with the good prognosis group, the poor prognosis group had a significantly longer course from onset to diagnosis of HPS (P < 0.05), significantly higher levels of fibrinogen and tumor necrosis factor-α (P < 0.05), and a significantly lower level of interferon-γ (P < 0.05). The mean follow-up time was 6±2 months; 11 (41%) children recovered, 1 (4%) experienced recurrence of HPS, and 15 (56%) had the sequela of post-infectious bronchiolitis obliterans (PIBO). Conclusions HPS may be observed in children with SAP, and PIBO is the most common sequela of SAP.
ZHANG Hua-Yong,LI Chang-Jian,LONG Yuan et al. Clinical features of children with severe adenovirus pneumonia and hemophagocytic syndrome: an analysis of 30 cases[J]. CJCP, 2020, 22(7): 744-748.
ZHANG Hua-Yong,LI Chang-Jian,LONG Yuan et al. Clinical features of children with severe adenovirus pneumonia and hemophagocytic syndrome: an analysis of 30 cases[J]. CJCP, 2020, 22(7): 744-748.
Chen HL, Chiou SS, Hsiao HP, et al. Respiratory adenoviral infections in children:a study of hospitalized cases in Southern Taiwan in 2001-2002[J]. J Trop Pediatr, 2004, 50(5):279-284.
[2]
Yun BY, Kim MR, Park JY, et al. Viral etiology and epidemiology of acute lower respiratory tract infections in Korean children[J]. Pediatr Infect Dis J, 1995, 14(12):1054-1059.
[3]
Wo Y, Lu QB, Huang DD, et al. Epidemical features of HAdV-3 and HAdV-7 in pediatric pneumonia in Chongqing, China[J]. Arch Virol, 2015, 160(3):633-638.
[4]
Mellon G, Henry B, Aoun O, et al. Adenovirus related lymphohistiocytic hemophagocytosis:case report and literature review[J]. J Clin Virol, 2016, 78:53-56.
[5]
Censoplano N, Gorga S, Waldeck K, et al. Neonatal adenovirus infection complicated by hemophagocytic lymphohistiocytosis syndrome[J]. Pediatrics, 2018, 141(Suppl 5):S475-S480.
[6]
Hoşnut FÖ, Ozçay F, Malbora B, et al. Severe adenovirus infection associated with hemophagocytic lymphohistiocytosis[J]. Turk J Haematol, 2014, 31(1):103-105.
[7]
Odièvre MH, Danékova N, Picard C, et al. Pneumonia due to adenovirus type 7:a case report in a healthy infant[J]. Arch Pediatr, 2011, 18(7):772-777.
Li L, Woo YY, de Bruyne JA, et al. Epidemiology, clinical presentation and respiratory sequelae of adenovirus pneumonia in children in Kuala Lumpur, Malaysia[J]. PLoS One, 2018, 13(10):e0205795.
[14]
Ishii E, Ohga S, Imashuku S, et al. Nationwide survey of hemophagocytic lymphohistiocytosis in Japan[J]. Inter J hematol, 2007, 86(1):58-65.
[15]
Lev R, Haim A, Greenberg D, et al. Adenovirus infection as an imitator of hemophagocytic lymphocytosis[J]. Clin Pediatr (Phila), 2018, 57(5):600-602.
Daher EF, Lima LL, Vieira AP, et al. Hemophagocytic syndrome in children with visceral leishmaniasis[J]. Pediatr Infect Dis J, 2015, 34(12):1311-1314.
[18]
Wu PQ, Li X, Jiang WH, et al. Hypoxemia is an independent predictor of bronchiolitis obliterans following respiratory adenoviral infection in children[J]. Springerplus, 2016, 5(1):1622.
[19]
Castro-Rodriguez JA, Daszenies C, Garcia M, et al. Adenovirus pneumonia in infants and factors for developing bronchiolitis obliterans:a 5-year follow-up[J]. Pediatr Pulmonol, 2006, 41(10):947-953.
