| Objective: To analyze the clinical characteristics,diagnosis and treatment of community-acquired adenovirus pneumonia in immunocompetent adult,so as to improve the clinicians’ diagnosis and treatment of the disease.Methods:Clinical data of seven immunocompetent adults with communityacquired adenovirus pneumonia who were admitted in the First Affiliated Hospital of Guangxi Medical University from March 2019 to January 2020 were retrospectively analyzed.Using “adult”,“severe”,“fatal”,“immunocompetent”,“adenovirus”and“pneumonia” as search terms to search for literature on CNKI,Vip,Wanfang and Pub Med databases for retrieval.Results:(1)In this study,the 7 patients are all male,including 5 young adults,1 middle-aged patient and 1 elderly patient.The elderly patient had a history of hypertension and one of young patients had a history of brain tumor surgery and radiotherapy 10 years ago,without recurrence and metastasis of the tumor.The remaining 5 patients had no underlying disease.The illnesses of 5 patients occurred in winter and spring,and the average length of hospitalization time was20.7±15.3 days.The common symptoms of the patients:there were 7 patients with high fever,6 patients with coughing,5 patients with headache,4 patients with expectoration and shivering,3 patients with dyspnea,2 patients with dry cough,muscle ache and chest pain.There were 5 patients with wet rales in the lungs and hypoxemia,and 6 patients with oxygenation index<300 mm Hg,5patients with normal white blood cells counts,6 patients with a high percentage of neutrophils,1 patient with a decreased platelets counts,and 6 patients with decreased lymphocytes and CD4+T cell.C-reactive protein and procalcitonin were increased in 7 patients.4 patients showed increased d-dimer and pro-brain natriuretic peptide.3 patients showed increased cardiac troponin I.Creatine kinase and lactate dehydrogenase were increased in 5 patients,while increased creatine kinase isoenzyme was observed in 4 patients.Blood urea nitrogen was elevated in2 patients,aspartate aminotransferase was elevated in 5 patients,alanine aminotransferase was elevated in 1 patient,and serum albumin was decreased in3 patients.All 7 patients were examined by metanomicnomic extgeneration sequencing(m NGS).6 of them(85.7%)belonged to species B.The most common serotype was HADV-55(a total of 4 patients).All 7 patients had negative HADVIg M tests.Imaging manifestations:The lesions in 6 patients were confined to single lungs and all were in inferior lobes.In 1 patient,both lungs were lesioned in multiple lobes,but the right lower lobe was most seriously affected and almost completely consolidated.Chest CT showed consolidation and ground glass shadow in 7 patients,air bronchogram cough be seen in 6 patients,and 5 patients had pleural effusion.Treatment and prognosis:7 patients were treated with empirical antibiotics,3 patients were treated with ribavirin antivirus,5 patients were treated with glucocorticoids.4 patients were treated with intravenous immune globulin(IVIG)and thymus fascin.2 patients were treated with invasive mechanical ventilation and extracorporeal membrane oxygenation(ECMO).In terms of prognosis,6 patients were improved and discharged from hospital but 1patient was discharged automatically.(2)Results of searching articles and review of them:The search time was limited from January 1,2009 to May 1,2020.3Chinese articles and 9 English articles which contained 58 eligible patients were retrieved,88%of them are male and most of them are young and middle-age,with an average age of 32.7 years old and an age range from 18-62 years old.There were 5 patients with hypertension,1 patient with asthma and obesity,1 patient with gout,while the remaining patients had no underlying disease.The common clinical symptoms were:high fever(88%),cough(67%),dyspnea(66%),sputum(63%),chills(33%),hemoptysis(26%)and chest pain(24%),but diarrhea,sore throat,myalgia and headaches were relatively rare(16%,10%,9%,and 2%,respectively);most patients had hypoxemia or decreased of oxygenation index(54%);most patients had normal or reduced white blood cells counts(53%).The proportion of neutrophils were increased in most patients(50%),and reduction of platelets was rare(17%);T cell subsets were detected in 10 patients,and were decreased in 8 patients;it was common that C-reactive protein and procalcitonin were increased(respectively 50%,40%);65%of patients had elevated lactate dehydrogenase,61%of patients had elevated creatine kinase;The main anomaly indicator in the liver function was aspartate aminotransferase,which showed an increase in 77%patients,while alanine aminotransferase was increased in 49%patients and albumin was decreased in 39%patients;88%of patients used polymerase chain reaction(PCR)to detect HADV while 12%of them used m NGS,and the common serotypes were HADV-55(59%),HADV-7(19%),HADV-11(10%),HADV-4(3%),HADV-3(2%)and HADV-14(2%),5%of patients were not classified.Imaging suggests bilateral lung involvement was more common(76%),common imaging signs included consolidation and ground glass shadow(54%),air bronchogram(26%),55%of patients have pleural effusion.All patients underwent empirical antibiotic treatment.The proportions of anti-viral(except oseltamivir),glucocorticoid and intravenous immune globulin therapy were 69%,57%and 33%;37 patients(64%)were treated with invasive mechanical ventilation.9 patients were treated with ECMO,including 7 deaths;The most common serotype causing death from severe pneumonia was HADV-55(total 10patients),and the total deaths were 19 patients(accounted for 33%).The most common cause of death was acute respiratory distress syndrome(6 patients in total).Conclusions:(1)Immunocompetent adults severe community-acquired adenovirus pneumonia patients had a high mortality rate.(2)Immunocompetent adults severe community-acquired adenovirus pneumonia mainly occured in young and middle-aged men.The main clinical manifestations were high fever,chills,cough,sputum and dyspnea,with normal white blood cell counts,and increased neutrophils and inflammation indicators,lower T lymphocytes,and the patients were prone to respiratory failure,myocardial and liver damage.(3)Imagings mainly manifested as the involvement of both lungs,exhibited consolidation,ground glass shadow,air bronchogram,and were prone to pleural effusion when progressed.(4)Severe patients were mostly caused by HADV-55 and HADV-7.The fatality rates of severe pneumonia caused by HADV-55 were the highest.One common cause of death was ARDS.(5)When patients with severe pneumonia had difficulty obtaining pathogenic pathogens from clinical routine etiological examinations,m NGS might be a good method of assisting diagnosis.(6)Glucocorticoids might bring benefits in the treatment of immunocompetent adults severe community-acquired adenovirus pneumonia,but more clinical studies are needed to confirm it. |
PDF Full Text Request