1
|
Eom J, Kim Y, Kim D, Lee E, Kwon SH, Jo MW, Jung J, Park H, Park B. Cost-benefit analysis of human adenovirus vaccine development in a Korean military setting. Vaccine 2024:S0264-410X(24)00622-4. [PMID: 38806354 DOI: 10.1016/j.vaccine.2024.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Human adenovirus (HAdV) is a prevalent causative agent of acute respiratory disease (ARD) and is frequently responsible for outbreaks, particularly in military environments. Current vaccines do not effectively cover HAdV subtypes commonly found among Korean military personnel, highlighting the need for a new targeted vaccine. This study presents a cost-benefit analysis to evaluate the economic viability of developing and implementing such a vaccine within a military context. METHODS We adopted a societal perspective for this cost-benefit analysis, which included estimating costs associated with vaccine development, production, and distribution over a projected timeline. We assumed a development period of five years, after which vaccine production and administration were initiated in the sixth year. The cost associated with vaccine development, production, and dispensation was considered. The benefits were calculated based on both direct and indirect cost savings from preventing HAdV infections through vaccination. All financial figures were expressed in 2023 US dollars. A sensitivity analysis was conducted to explore the impact of varying factors such as vaccination rate, incidence of infection, vaccine efficacy, and discount rate. RESULTS For the base case scenario, we assumed a vaccination rate of 100 %, an incidence rate of 0.02, and a vaccine efficacy of 95 %, applying a 3 % discount rate. Initially, in the sixth year, the benefit-cost ratio stood at 0.71, suggesting a cost disadvantage at the onset of vaccination. However, this ratio improved to 1.32 in the following years, indicating a cost benefit from the seventh year onward. The cumulative benefit-cost ratio over a decade reached 2.72. The outcomes from the sensitivity analysis were consistent with these findings. CONCLUSION Our cost-benefit analysis demonstrates that the introduction of an HAdV vaccine for the Korean military is economically advantageous, with substantial cost benefits accruing from the seventh year after the commencement of vaccination.
Collapse
Affiliation(s)
- Jungmin Eom
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea.
| | - Yeonjae Kim
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea.
| | - Donghoon Kim
- Department of Critical Care Medicine, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, South Korea.
| | - Eunyoung Lee
- Department of Laboratory Medicine, Armed Forces Capital Hospital, Seongnam, South Korea.
| | - Soon-Hwan Kwon
- Department of Infectious Diseases Research, Armed Forces Medical Research Institute, Daejeon, South Korea.
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, South Korea; Artificial Intelligence and Big-Data Convergence Centre, Gil Medical Centre, Gachon University College of Medicine, Incheon, South Korea.
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Graduate Program for System Health Science and Engineering, Ewha Womans University, Seoul, South Korea.
| | - Bomi Park
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea.
| |
Collapse
|
2
|
Kim D, Lee E, Eom J, Kim Y, Kwon SH, Oh HS, Huh K, Park H, Jung J, Park B. Prevalence and Burden of Human Adenovirus-Associated Acute Respiratory Illness in the Republic of Korea Military, 2013 to 2022. J Korean Med Sci 2024; 39:e38. [PMID: 38288539 PMCID: PMC10825453 DOI: 10.3346/jkms.2024.39.e38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/12/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Human adenovirus (HAdV) is a common cause of acute respiratory disease (ARD) and has raised significant concerns within the Korean military. Here, we conducted a comprehensive epidemiological analysis of HAdV-associated ARD by evaluating its prevalence, clinical outcomes, and prognosis. METHODS We reviewed data from multiple sources, including the New Defense Medical Information System, Defense Medical Statistical Information System, Ministry of National Defense, Army Headquarters, Navy Headquarters, Air Force Headquarters, and Armed Forces Medical Command. We analyzed data of patients who underwent polymerase chain reaction (PCR) testing for respiratory viruses between January 2013 and July 2022 in all 14 Korean military hospitals. The analysis included the PCR test results, demographic characteristics, health care utilization, and prognosis including types of treatments received, incidence of pneumonia, and mortality. RESULTS Among the 23,830 individuals who underwent PCR testing at Korean military hospitals, 44.78% (10,670 cases) tested positive for respiratory viruses. Across all military types and ranks, HAdV was the most prevalent virus, with a total of 8,580 patients diagnosed, among HAdV, influenza virus, human metapneumovirus, human parainfluenza virus, and human respiratory syncytial virus. HAdV-infected patients exhibited higher rates of healthcare use compared to non-HAdV-infected patients, including a greater number of emergency visits (1.04 vs. 1.02) and outpatient visits (1.31 vs. 1.27), longer hospitalizations (8.14 days vs. 6.84 days), and extended stays in the intensive care unit (5.21 days vs. 3.38 days). Furthermore, HAdV-infected patients had a higher proportion of pneumonia cases (65.79% vs. 48.33%) and greater likelihood of receiving advanced treatments such as high flow nasal cannula or continuous renal replacement therapy. CONCLUSION Our findings indicate that HAdV posed a significant public health concern within the Korean military prior to the coronavirus disease 2019 (COVID-19) pandemic. Given the potential for a resurgence of outbreaks in the post-COVID-19 era, proactive measures, such as education, environmental improvements, and the development of HAdV vaccines, are crucial for effectively preventing future outbreaks.
Collapse
Affiliation(s)
- Donghoon Kim
- Department of Critical Care Medicine, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Eunyoung Lee
- Department of Laboratory Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Jungmin Eom
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Yeonjae Kim
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Soon-Hwan Kwon
- Department of Infectious Diseases Research, Armed Forces Medical Research Institute, Daejeon, Korea
| | - Hong Sang Oh
- Division of Infectious Disease, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Graduate Program for System Health Science and Engineering, Ewha Womans University, Seoul, Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
- Artificial Intelligence and Big-Data Convergence Centre, Gil Medical Centre, Gachon University College of Medicine, Incheon, Korea
| | - Bomi Park
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.
| |
Collapse
|
3
|
Li Y, Lin F, Li W, Chen G, Li S, Liu B, Li H, Song C, Lu R, Pan P. Comparison of clinical, laboratory and radiological characteristics between Chlamydia psittaci and adenovirus pneumonias: a multicenter retrospective study. Int J Infect Dis 2023; 126:114-124. [PMID: 36455811 DOI: 10.1016/j.ijid.2022.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Pneumonia caused by Chlamydia psittaci is a significant global public health issue. Symptom onset and laboratory characteristics may be confused with those of other respiratory viral infections, including adenovirus pneumonia. We aimed to determine differences in clinical presentations and establish a simple nomogram to differentiate C. psittaci and adenovirus pneumonias. METHODS We conducted a multicenter retrospective study in 10 tertiary general hospitals to compare patients with either C. psittaci (n = 78) or adenovirus (n = 102) pneumonia. A multivariable logistic regression model was used to identify risk factors of C. psittaci pneumonia that were used to establish a nomogram. RESULTS C. psittaci and adenovirus pneumonia showed certain similar clinical symptoms, including fever, dyspnea, and fatigue, but differed in other characteristics. The multivariate logistic regression showed that age, sex, nervous system symptoms, lymphocyte count, C-reactive protein level, and bilateral lung lesions were risk factors for C. psittaci pneumonia. After incorporating these six factors, the established nomogram achieved a good concordance value (0.949 [95% CI 0.917-0.982]) in differentiating the types of pneumonia, with well-fitting calibration curves. CONCLUSION Despite having similar clinical features, the variables of age, sex, nervous system symptoms, lymphocytes, C-reactive protein levels, and bilateral lung lesions were combined into a clinically useful nomogram for the rapid and early differentiation of C. psittaci pneumonia from adenovirus pneumonia. This nomogram may help improve treatments and clinical outcomes.
Collapse
Affiliation(s)
- Yi Li
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Fengyu Lin
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Wen Li
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Gang Chen
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Sha Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Ben Liu
- Department of Emergency Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Haitao Li
- First Department of Thoracic Medicine, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Chao Song
- Nosocomial Infection Control Center, Xiangya Hospital, Central South University, Changsha, China
| | - Rongli Lu
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Pinhua Pan
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China.
| |
Collapse
|
4
|
HUANG C, WEI D, LIU Y, SHI G. Clinical and imaging findings of patients diagnosed with adenovirus-positive pneumonia during 2015-2019 in Shanghai, China. Turk J Med Sci 2022; 52:329-337. [PMID: 36161612 PMCID: PMC10381194 DOI: 10.55730/1300-0144.5319] [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: 10/13/2020] [Revised: 04/14/2022] [Accepted: 10/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study was to describe the clinical characteristics, chest CT image findings, and potential role of T cells immunity in adenovirus positive pneumonia. METHODS In this retrospective study, medical records of 53 adult Adv+ patients who were admitted to the Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from May 2015 to August 2019 were included. The presence of adenovirus and other respiratory viruses was detected using polymerase chain reaction of throat swabs samples. Clinical features and chest computed tomography (CT) findings were compared between patients with Adv+ pneumonia and Adv+ non-pneumonia. RESULTS The top 3 most commonly occurring symptoms in Adv+ pneumonia patients were fever (66.7%), cough (63.3%), and tachypnea (16.7%). Patients with Adv+ pneumonia showed significantly higher rates of cough and fever and longer duration of hospitalization than patients with Adv+ non-pneumonia. In the Adv+ pneumonia group, consolidation (73.3%) was the most common imaging finding on chest CT scan, and the likelihood of involvement of bilateral lobes (60%) was high. Classical conspicuous consolidation with surrounding ground-glass opacity was observed in 5 (16.6%) patients with Adv+ pneumonia. Patients with Adv+ pneumonia showed a higher inhibition of T-cell immunity than did patients with Adv+ non-pneumonia, and counts of CD3+, CD4+, and CD8+ T-cells may predict the presence of pneumonia in Adv+ patients. DISCUSSION With regard to Adv+ pneumonia, the most frequent symptoms were cough and fever, and the most common CT pattern was consolidation; classical CT findings such as consolidation with surrounding ground-glass opacity could also be observed. Furthermore, our data indicated the incidence of abrogated cellular immunity in patients with Adv+ pneumonia.
Collapse
Affiliation(s)
- Chunrong HUANG
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of
China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of
China
| | - Dong WEI
- Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of
China
| | - Yahui LIU
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of
China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of
China
| | - Guochao SHI
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of
China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of
China
| |
Collapse
|
5
|
Zhang P, Liu M, Zhang L, Guo X, Lu B, Wang Y, Zhan Q. Clinical and CT findings of adenovirus pneumonia in immunocompetent adults. CLINICAL RESPIRATORY JOURNAL 2021; 15:1343-1351. [PMID: 34505348 DOI: 10.1111/crj.13439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/10/2021] [Accepted: 08/10/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Adenovirus pneumonia is not uncommon in children and immunocompromised patients. However, the study of the clinical and computed tomography (CT) characteristics of Adenovirus pneumonia in immunocompetent adults is still limited. OBJECTIVE The objective of this study was to retrospectively observe the clinical and CT characteristics as well as their dynamic change of Adenovirus pneumonia in immunocompetent adults. METHODS Twenty patients (18 males, median age, 36 years old) with Adenovirus pneumonia were retrospectively included from January 2018 to December 2019. Clinical information and chest CT at admission of all patients were reviewed. Twelve patients underwent serial CT scans, and the temporal changes of CT findings were summarized. Pneumonia severity index (PSI) was calculated according to clinical information. RESULTS The median time interval from illness onset to admission was 6 days (interquartile range [IQR], 5-7.5 days). The clinical characteristics included the high fever (39.2 ± 0.8°C) with the normal white blood cell count, the decreased lymphocyte, and elevated C-reactive protein. Ten cases complicated with mycoplasma infection at admission. Thirteen patients were mechanically ventilated, and two patients died during hospitalization. Consolidation was a predominant pattern found during the first 2 weeks and then resolved to minimal consolidation after the fourth week. There was no significant correlation between CT score and PSI score (r = 0.15, p = 0.41). CONCLUSIONS Predominant radiological finding of Adenovirus pneumonia was consolidation. Multilobular involvement, higher CT scores, and pleural effusion were found in more severe patients. The abnormal opacity peaked in 2 weeks of illness onset and gradually resolved after the third week. The temporal changes of radiological score are consistent with clinical findings.
Collapse
Affiliation(s)
- Peiyao Zhang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Ling Zhang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Xiaojuan Guo
- Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Binghuai Lu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yimin Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qingyuan Zhan
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
6
|
Complete Genome Sequences of Two Human Adenovirus Type 55 Isolates from South Korea and the United States. Microbiol Resour Announc 2021; 10:10/5/e01347-20. [PMID: 33541877 PMCID: PMC7862955 DOI: 10.1128/mra.01347-20] [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] [Indexed: 11/30/2022] Open
Abstract
Here, we report two complete genome sequences of human adenovirus 55 (HAdV-55) isolates, from a patient in Pennsylvania in 2006 and a U.S. military member in South Korea in 2019. The findings demonstrate the continued global transmission of HAdV-55 viruses in both military and civilian populations. Here, we report two complete genome sequences of human adenovirus 55 (HAdV-55) isolates, from a patient in Pennsylvania in 2006 and a U.S. military member in South Korea in 2019. The findings demonstrate the continued global transmission of HAdV-55 viruses in both military and civilian populations.
Collapse
|
7
|
Immune status affects the clinical features and outcomes of adult patients with respiratory adenovirus infection. Epidemiol Infect 2021. [PMCID: PMC8637456 DOI: 10.1017/s0950268821002272] [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] [Indexed: 11/24/2022] Open
Abstract
The differences in the clinical features and outcomes of respiratory adenovirus infection (RAI) between immunocompetent and immunocompromised adult patients remain unclear. Thirty-nine adult RAI patients, including 28 (71.8%) immunocompetent patients and 11 (28.2%) immunocompromised patients were enrolled in this retrospective study. Demographic characteristics, symptoms, laboratory tests, radiographic findings, therapies and clinical outcomes were compared between the two groups. We found fever (94.9%), cough (66.7%) and sputum production (56.4%) were the most frequent symptoms. Compared with immunocompetent RAI patients, the immunocompromised RAI patients were more likely to experience anaemia (g/l; 90.8 ± 24.0 vs 134.3 ± 14.6, P < 0.001), thrombocytopaenia ( × 109/l; 116.9 ± 92.7 vs 178.4 ± 74.6, P = 0.037), hypoalbuminaemia (g/l; 29.6 ± 5.5 vs 36.9 ± 5.2, P < 0.001), hyponatraemia (mmol/l; 134.8 ± 5.6 vs 138.5 ± 3.9, P = 0.026) and low levels of cholinesterase (U/l; 2650.5 ± 1467.4 vs 5892.8 ± 1875.1, P < 0.001). Chest computed tomography (CT) scans indicated that lung infiltrate was the most common finding (64.1%). Immunocompromised patients had a higher likelihood of bilateral lung involvement (72.7%) and lower lobe involvement (81.8%) of both lungs. The hospitalized mortality rate was 27.3% in immunocompromised RAI patients, but no death occurred among immunocompetent RAI patients (P = 0.018). Our data suggested immunocompromised RAI patients had worse laboratory test results, more bilateral lung and lower lobe involvement and higher in-hospital mortality compared with immunocompetent RAI patients.
Collapse
|
8
|
Adenovirus pneumonia should not be overlooked in immunocompetent youths and adults. Epidemiol Infect 2021. [PMCID: PMC8414599 DOI: 10.1017/s0950268821001485] [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] [Indexed: 11/16/2022] Open
Abstract
Adenovirus pneumonia can occur in immunocompetent youths and adults. We conducted a retrospective analysis on five immunocompetent patients (aged ⩾14 years) with adenovirus pneumonia who visited our fever clinic between 1 February 2020 and 29 February 2020. The symptoms at clinical onset were fever, with cough and phlegm production either absent or appearing several days after disease onset. One patient with severe disease exhibited dyspnoea and a rapid development of respiratory failure. A subset of patients had concurrent gastrointestinal symptoms. The results of blood tests revealed normal leukocyte counts, decreased lymphocyte counts and increased C-reactive protein levels. The imaging findings resembled those of bacterial pneumonia, and pleural effusions were present in some cases. Most patients had a good prognosis with symptomatic treatment and supportive care. However, one patient with severe disease and a MuLBSTA score of >12 had a poor prognosis and ultimately died. Immunocompetent youths and adults may develop adenovirus pneumonia, and severe cases are at the risk of death. Since no effective treatments for adenovirus pneumonia are currently known, the early diagnosis and provision of symptomatic treatment and supportive care should be adopted to prevent the development and progression of severe disease.
Collapse
|
9
|
Jiang J, Wan R, Pan P, Hu C, Zhou R, Yin Y, Zhou T, Huang H, Li Y. Comparison of Clinical, Laboratory and Radiological Characteristics Between COVID-19 and Adenovirus Pneumonia: A Retrospective Study. Infect Drug Resist 2020; 13:3401-3408. [PMID: 33061487 PMCID: PMC7537838 DOI: 10.2147/idr.s264132] [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] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background The pandemic of coronavirus disease 2019 (COVID-19) has become a global public health problem. It is important for clinical physicians to differentiate COVID-19 from other respiratory infectious diseases caused by viruses, such as human adenovirus. Subjects and Methods This was a retrospective observational study. We analyzed and compared the clinical manifestations, laboratory findings and radiological features of two independent cohorts of patients diagnosed with either COVID-19 (n=36) or adenovirus pneumonia (n=18). Results COVID-19 did not show a preference in males or females, whereas 94.4% of patients with adenovirus pneumonia were males. Fever and cough were common in both COVID-19 and adenovirus pneumonia. But the median maximal body temperature of the adenovirus pneumonia cohort was significantly higher than in COVID-19 (P<0.001). Furthermore, 77.8% of patients with adenovirus pneumonia had a productive cough versus only 13.9% of COVID-19 patients (P<0.001). Compared with adenovirus pneumonia, constitutional symptoms were less common in COVID-19, including headache (16.7% vs 38.9%, P=0.072), sore throat (8.3% vs 27.8%, P=0.058), myalgia (8.3% vs 61.1%, P<0.001) and diarrhea (8.3% vs 44.4%, P=0.002). Furthermore, patients with COVID-19 were less likely to develop respiratory failure (8.3% vs 83.3%, P<0.001) and showed less prominent laboratory abnormalities, including lymphocytopenia (61.1% vs 88.9%, P=0.035), thrombocytopenia (2.8% vs 61.1%, P<0.001), elevated procalcitonin (2.8% vs 77.8%, P<0.001) and elevated C-reactive protein (36.1% vs 100%, P<0.001). Besides, a higher percentage of patients with adenovirus pneumonia showed elevated transaminase, myocardial enzymes, creatinine and D-dimer compared with COVID-19 patients. On chest CT, the COVID-19 cohort was characterized by peripherally distributed ground-glass opacity and patchy shadowing, while the adenovirus pneumonia cohort frequently presented with consolidation and pleural effusion. Conclusion There were many differences between patients diagnosed with COVID-19 and those with adenovirus pneumonia in their clinical, laboratory and radiological characteristics. Compared with adenovirus pneumonia, COVID-19 patients tended to show a lower severity of illness.
Collapse
Affiliation(s)
- Juan Jiang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Rongjun Wan
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Pinhua Pan
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Rihua Zhou
- Medical Center of Tuberculosis, The Second People's Hospital of Chenzhou, Chenzhou, Hunan Province, People's Republic of China
| | - Yiping Yin
- Medical Center of Tuberculosis, The Second People's Hospital of Chenzhou, Chenzhou, Hunan Province, People's Republic of China
| | - Ting Zhou
- Medical Center of Tuberculosis, The Second People's Hospital of Chenzhou, Chenzhou, Hunan Province, People's Republic of China
| | - Hua Huang
- Medical Center of Tuberculosis, The Second People's Hospital of Chenzhou, Chenzhou, Hunan Province, People's Republic of China
| | - Yuanyuan Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| |
Collapse
|
10
|
Moon SM, Choe J, Na SJ, Chung CR, Suh GY, Jeon K. Comparative Study on the Effect of Cidofovir Treatment for Severe Adenovirus Pneumonia. J Intensive Care Med 2020; 36:1436-1442. [PMID: 32954945 DOI: 10.1177/0885066620960687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adenovirus infection can cause severe pneumonia even in immunocompetent adults. However, there is limited data on the benefits of cidofovir treatment in severe adenovirus pneumonia. The objective of this study was to evaluate the association of cidofovir treatment with clinical improvement in immunocompetent adult patients with severe adenovirus pneumonia. METHODS We evaluated 22 male patients who admitted to intensive care unit (ICU) with severe adenovirus pneumonia between January 2014 and December 2019. The patients were divided into 2 groups, patients treated with cidofovir or not. Clinical outcomes including time to defervescence and stopping of oxygen supplement, length of stay in ICU and hospital, and the need for mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) were compared between the 2 groups. RESULTS Among 22 patients, 13 patients (59%) were treated with cidofovir and 9 (41%) were not. The difference in mean time (95% confidence interval [CI]) to defervescence and stopping of oxygen supplement between cidofovir group and no cidofovir group was 2.1 (-5.7 to 10.0) and 1.0 (-14.9 to 16.8) days, respectively. The difference in mean length of stay (95% CI) in ICU and hospital between the 2 groups was 0.2 (-7.1 to 7.5) and -0.4 (-18.3 to 17.5) days, respectively. The differences in proportion of patients requiring MV and ECMO between the 2 groups was 28.2 (-17.4 to 73.8) % and -10.3 (-52.2 to 31.7) %, respectively. CONCLUSIONS The treatment with cidofovir for severe adenovirus pneumonia in immunocompetent patients did not improve clinical outcomes. Further studies with larger samples with prospective design are warranted.
Collapse
Affiliation(s)
- Seong Mi Moon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Junsu Choe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
11
|
Lim JU, Choi JY, Jeong HJ, Ko JH, Lee JE, Rhee CK. Comparison of clinical characteristics and inflammatory cytokines between hypoxemic and non-hypoxemic human adenovirus 55 pneumonia. J Thorac Dis 2020; 12:4044-4056. [PMID: 32944316 PMCID: PMC7475563 DOI: 10.21037/jtd-19-4067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background Human adenovirus (HAdV) can cause severe community-acquired pneumonia, but there are few studies on the associated cytokine patterns. The purpose of this study was to analyze the relationship between inflammatory cytokine and severity of adenovirus pneumonia. Methods This was a prospective observational study. We evaluated pneumonia patients admitted to the Armed Forces Capital Hospital in Korea. On admission, blood samples were acquired from patients who showed signs of pneumonia. HAdV infection was diagnosed using Real-Q RV detection Kit, and types of HAdV were confirmed by nucleotide blast analysis. We used enzyme-linked immunosorbent assays (ELISAs) to quantify the serum levels of cytokines [interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, γ-interferon (IFN-γ), and IL-10]. We evaluated clinical characteristics and cytokine patterns. Results Of 74 pneumonia patients, respiratory specimens from 43 tested positive for HAdV-55, and the other 31 tested negatives. The length of hospital stay was significantly longer in the HAdV group. The serum concentrations of IL-6, IL-8, IL-10, and IFN-γ were all significantly higher in the HAdV group. Of the 43 HAdV pneumonia patients, 6 evidenced PaO2/FiO2 (PF) ratio <300, and 37 did not. Compared to the non-hypoxemic group, the hypoxemic group showed significantly lower lymphocyte and monocyte counts, and increased IL-6 and IFN-γ concentrations. Logistic regression analysis showed that the IL-6, IL-10, and IFN-γ were significantly associated with hypoxemia in the HAdV group. The IL-6, and IFN-γ levels correlated significantly with the PF ratio. Conclusions We found that the levels IL-6, IL-10, and IFN-γ were significantly associated with hypoxemia in patients with HAdV-55 pneumonia.
Collapse
Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital, Seongnam, Korea.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital, Seongnam, Korea.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Ho Jung Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Eun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
12
|
Comparison of the computed tomography findings in COVID-19 and other viral pneumonia in immunocompetent adults: a systematic review and meta-analysis. Eur Radiol 2020; 30:6485-6496. [PMID: 32594211 PMCID: PMC7320914 DOI: 10.1007/s00330-020-07018-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/25/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To compare the chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) to other non-COVID viral pneumonia. METHODS MEDLINE, EMBASE, and Cochrane databases were searched through April 04, 2020, for published English language studies. Studies were eligible if they included immunocompetent patients with up to 14 days of viral pneumonia. Subjects had a respiratory tract sample test positive for COVID-19, adenovirus, influenza A, rhinovirus, parainfluenza, or respiratory syncytial virus. We only included observational studies and case series with more than ten patients. The pooled prevalence of each chest CT pattern or finding was calculated with 95% confidence intervals (95% CI). RESULTS From 2263 studies identified, 33 were eligible for inclusion, with a total of 1911 patients (COVID-19, n = 934; non-COVID, n = 977). Frequent CT features for both COVID-19 and non-COVID viral pneumonia were a mixed pattern of ground-glass opacity (GGO) and consolidation (COVID-19, 0.37; 0.17-0.56; non-COVID, 0.46; 0.35-0.58) or predominantly GGO pattern (COVID-19, 0.42; 0.28-0.55; non-COVID 0.25; 0.17-0.32), bilateral distribution (COVID-19, 0.81; 0.77-0.85; non-COVID, 0.69; 0.54-0.84), and involvement of lower lobes (COVID-19, 0.88; 0.80-0.95; non-COVID, 0.61; 0.50-0.82). COVID-19 pneumonia presented a higher prevalence of peripheral distribution (COVID-19 0.77; 0.67-0.87; non-COVID 0.34; 0.18-0.49), and involvement of upper (COVID-19, 0.77; 0.65-0.88; non-COVID 0.18; 0.10-0.27) and middle lobes (COVID-19, 0.61; 0.47-0.76; non-COVID 0.24; 0.11-0.38). CONCLUSION Except for a higher prevalence of peripheral distribution, involvement of upper and middle lobes, COVID-19, and non-COVID viral pneumonia had overlapping chest CT findings. KEY POINTS • Most common CT findings of coronavirus disease 2019 (COVID-19) were a predominant pattern of ground-glass opacity (GGO), followed by a mixed pattern of GGO and consolidation, bilateral disease, peripheral distribution, and lower lobe involvement. • Most frequent CT findings of non-COVID viral pneumonia were a predominantly mixed pattern of GGO and consolidation, followed by a predominant pattern of GGO, bilateral disease, random or diffuse distribution, and lower lobe involvement. • COVID-19 pneumonia presented a higher prevalence of peripheral distribution, and involvement of upper and middle lobes compared with non-COVID viral pneumonia.
Collapse
|
13
|
Hang J, Kajon AE, Graf PCF, Berry IM, Yang Y, Sanborn MA, Fung CK, Adhikari A, Balansay-Ames MS, Myers CA, Binn LN, Jarman RG, Kuschner RA, Collins ND. Human Adenovirus Type 55 Distribution, Regional Persistence, and Genetic Variability. Emerg Infect Dis 2020; 26:1497-1505. [PMID: 32568062 PMCID: PMC7323512 DOI: 10.3201/eid2607.191707] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Human adenovirus type 55 (HAdV-55) causes acute respiratory disease of variable severity and has become an emergent threat in both civilian and military populations. HAdV-55 infection is endemic to China and South Korea, but data from other regions and time periods are needed for comprehensive assessment of HAdV-55 prevalence from a global perspective. In this study, we subjected HAdV-55 isolates from various countries collected during 1969-2018 to whole-genome sequencing, genomic and proteomic comparison, and phylogenetic analyses. The results show worldwide distribution of HAdV-55; recent strains share a high degree of genomic homogeneity. Distinct strains circulated regionally for several years, suggesting persistent local transmission. Several cases of sporadic introduction of certain strains to other countries were documented. Among the identified amino acid mutations distinguishing HAdV-55 strains, some have potential impact on essential viral functions and may affect infectivity and transmission.
Collapse
|
14
|
Characteristics of fever and response to antipyretic therapy in military personnel with adenovirus-positive community-acquired pneumonia. Mil Med Res 2020; 7:6. [PMID: 32079545 PMCID: PMC7033854 DOI: 10.1186/s40779-020-00235-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/12/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In 2014, an outbreak of adenoviral pneumonia occurred in the Korean military training center. However, there are limited data on the characteristics of the fever and its response to antipyretic therapy in immunocompetent adults with adenovirus-positive community-acquired pneumonia (CAP). METHODS The medical records of the patients who were admitted to the Armed Forces Chuncheon Hospital for the treatment of CAP between January 2014 and December 2016 were retrospectively analyzed. The patients were divided into three groups, namely, the adenovirus-positive (Adv) group, the adenovirus-negative (Non-Adv) group and the unknown pathogen group, according to the results of a polymerase chain reaction (PCR) test and sputum culture used to measure adenovirus and other bacteria or viruses in respiratory specimens. We evaluated and compared the demographics, clinicolaboratory findings and radiological findings upon admission between the two groups. RESULTS Out of the 251 military personnel with CAP during the study periods, 67 were classified into the Adv group, while 134 were classified into the Non-Adv group and 50 were classified into the unknown pathogen group. The patients in the Adv group had a longer duration of fever after admission (3.2 ± 1.6 vs. 1.9 ± 1.2 vs. 2.2 ± 1.5 days, P = 0.018) and symptom onset (5.8 ± 2.2 vs. 3.9 ± 2.5 vs. 3.7 ± 2.0 days, P = 0.006) than patients in the Non-Adv and unknown pathogen groups, respectively. The patients in the Adv group had a higher mean temperature at admission (37.8 ± 0.3 vs. 37.3 ± 0.3 vs. 37.3 ± 0.3, P = 0.005), and more patients were observed over 40 and 39 to 40(14.9% vs. 2.2% vs. 4.0%, 35.8% vs. 3.7% vs. 6.0%, P < 0.001) than those in the Non-Adv and unknown pathogen groups, respectively. The Adv group more commonly had no response or exhibited adverse events after antipyretic treatment compared to the Non-Adv group (17.9% vs. 1.5%, 35.0% vs. 4.3%, P < 0.001, P = 0.05, respectively). In addition, the time from admission to overall clinical stabilization was significantly longer in the patients in the Adv group than in those in the Non-Adv group (4.3 ± 2.8 vs. 2.9 ± 1.8 days, P = 0.034, respectively). Furthermore, no significant difference in the length of hospital stay was observed between the two groups, and no patient died in either group. CONCLUSION In this study, Adv-positive CAP in immunocompetent military personnel patients had distinct fever characteristics and responses to antipyretic treatment.
Collapse
|
15
|
Abstract
Adenovirus (AdV) can cause severe respiratory infections in children and immunocompromised patients, but less is known about severe AdV pneumonia in immunocompetent adults. In this retrospective study, we compared respiratory tract infections and pneumonia caused by AdV in immunocompromised and immunocompetent adult patients regarding clinical presentation and severity of infection. The results show that AdV can cause severe infections in both immunocompetent and immunocompromised patients, and the clinical presentation and need for hospitalisation, mechanical ventilation and antiviral treatment were equal in both groups. No underlying risk factors for severe AdV infection in healthy individuals were identified.
Collapse
|
16
|
Gentile G, Fréchard G, Dia A, Buzens A, Vives R, Jego M, Pommier de Santi V, Simon F. Incidence of acute respiratory tract infections (2006-2015) and influenza (2006-2013) among French armed forces. Med Mal Infect 2019; 50:689-695. [PMID: 31759689 DOI: 10.1016/j.medmal.2019.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/21/2018] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We aimed to assess the incidence of respiratory tract infections in military settings between 2006 and 2015. PATIENTS AND METHODS We performed a retrospective epidemiological study of the entire military population from 2006 to 2015. Comprehensive data was collected from all medical centers, operational medical units, naval services, and army training hospitals and provided by the epidemiological surveillance of the armies. RESULTS The annual average population of the study was 331,394 soldiers. For acute respiratory tract infections (2006-2015), 22,818 cases were reported in metropolitan France, 3,211 cases in French overseas territories, 1,595 cases in the French Navy, and 1,318 cases in external military operations for a total of 28,942 cases. For influenza (2006-2013), 934 cases were reported in metropolitan France, 101 cases in French overseas territories, and 23 cases in external operations, for a total of 1,058 cases. The mean incidence rate of acute respiratory tract infections expressed as case number per 1,000 person-years (PY) was 8.7 PY (95% CI [8.6-8.8]) with an exceptional increased incidence rate in 2009 (25.9 PY, 95% CI [25.4-26.4]). The mean incidence rate of influenza was 0.35 PY (95% CI [0.33-0.37]) with a peak incidence rate of 1.9 PY in 2009. CONCLUSION Acute respiratory tract infections are at the forefront of infectious episodes in the French armies. Although not necessarily severe, current prevention measures are not enough to reduce the incidence threshold of these infections and need to be improved.
Collapse
Affiliation(s)
- G Gentile
- Département universitaire de médecine générale, faculté de médecine, Aix Marseille université, 13885 Marseille, France; Inserm 1106, Institut des neurosciences des systèmes, Aix Marseille université, 13885 Marseille, France; Comité pédagogique, hôpital d'instruction des Armées Laveran, 13384 Marseille, France.
| | - G Fréchard
- Département universitaire de médecine générale, faculté de médecine, Aix Marseille université, 13885 Marseille, France
| | - A Dia
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - A Buzens
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - R Vives
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - M Jego
- Département universitaire de médecine générale, faculté de médecine, Aix Marseille université, 13885 Marseille, France; Centre d'études et de recherche sur les services de santé et qualité de vie (CERESS), Aix Marseille université, 13385 Marseille, France
| | - V Pommier de Santi
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - F Simon
- Comité pédagogique, hôpital d'instruction des Armées Laveran, 13384 Marseille, France; Department of infectious diseases and tropical medicine, Laveran military teaching hospital, 13384 Marseille, France
| |
Collapse
|
17
|
Yoon HY, Cho HH, Ryu YJ. Adenovirus pneumonia treated with Cidofovir in an immunocompetent high school senior. Respir Med Case Rep 2019; 26:215-218. [PMID: 30733919 PMCID: PMC6354651 DOI: 10.1016/j.rmcr.2019.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 11/26/2022] Open
Abstract
Most adenovirus infections are self-limiting in immunocompetent individuals. Here, we report a case of adenovirus pneumonia in a 17-year-old immunocompetent male. He was admitted to our emergency room complaining of a febrile sense, cough, and diarrhea for four days. Crackles in the left lung and a high fever (40.7 °C) were revealed. Initial chest X-ray and computed tomography images showed consolidation in the left lung. We immediately started empirical antibiotic treatment, but his clinical symptoms and pneumonic consolidation in radiography had not improved by hospital day three. Because adenovirus was detected in his sputum using RT-PCR, he was administered Cidofovir. After 24 h of Cidofovir treatment, the symptoms and fever subsided, and the consolidation in his X-ray was significantly reduced by hospital day nine. The early administration of Cidofovir could be beneficial for the treatment of adenovirus infection in immunocompetent patients.
Collapse
Affiliation(s)
- Hee-Young Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hyun-Hae Cho
- Department of Radiology, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| |
Collapse
|
18
|
Song J, Lee H, Cho E. Epidemiological Investigation of the Outbreak of Acute Respiratory Infection caused by Adenovirus Type B55 in a Physical Education School in 2017. Infect Chemother 2019; 51:119-129. [PMID: 31270991 PMCID: PMC6609751 DOI: 10.3947/ic.2019.51.2.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/21/2019] [Indexed: 12/23/2022] Open
Abstract
Background On May 19, 2017, the cluster of 6 acute respiratory infections due to adenovirus in the swimming department of a physical education school (School J) was reported to Korea Centers for Disease Control and Prevention. An epidemiological investigation was conducted to identify the transmission route of the infection and to control the outbreak. Materials and Methods A retrospective cohort study (Study 1) was conducted on students and teachers of the athletic departments using the swimming pool, and a prospective surveillance (Study 2) was conducted on all students and teachers of the School J. A case was defined as any student and school personnel who developed more than two of the following symptoms from April 10 to July 2, 2017: fever, sore throat, cough, rhinorrhea, or headache. Relative risks (RRs) were calculated to compare the attack rates according to potential risk factors. Multivariable logistic regression was performed to identify the risk factors for infection in the outbreak. Results 47 cases were identified: 33 (55.9%) cases occurred among 59 students and teachers in Study 1 and 14 (3.9%) among 362 students and school personnel in Study 2. There were 18 laboratory confirmed adenovirus infection cases. The common symptoms were headache (71.7%), fever (69.6%), rhinorrhea (63.0%), sputum (56.5%), and sore throat (54.3%). 23.9% of the cases were accompanied with diarrhea and 19.6% with eye congestion. None of the cases developed pneumonia. 32.6% of the cases were hospitalized. In Study 1, attack rate in the swimming department was higher than that in others (RR: 1.90; 95% confidence interval [CI]: 1.01-3.60). In Study 2, being a member of the shooting department (RR: 20.70; 95% CI: 4.90-87.47) and being a first year high school student (RR: 10.95; 95% CI: 2.90-41.33) were identified as risk factors for the infections. Genetic analyses of the adenoviruses showed 100% identical sequence in homology and confirmed the human adenovirus B55 (HAdV-B55). No adenovirus was detected at examining the water and environment of the swimming pool and dormitory. Conclusion The outbreak is inferred to be occurred via propagated transmission among the students in the same athletic department, while the students with symptoms of respiratory infection continued performing school activities without any restrictions. Infection control measures such as early detection of symptoms of respiratory infection and restriction of group activity are necessary to prevent respiratory infection outbreak in the communal living setting.
Collapse
Affiliation(s)
- Jeongsuk Song
- Division of Infectious Disease Control, Korea Centers for Disease control and Prevention, Cheongju, Korea
| | - Hyerim Lee
- Division of Infectious Disease Control, Korea Centers for Disease control and Prevention, Cheongju, Korea
| | - Enhi Cho
- Division of Control for Zoonotic and vector borne Disease, Korea Centers for Disease control and Prevention, Cheongju, Korea.
| |
Collapse
|
19
|
Romero-Espinoza JA, Moreno-Valencia Y, Coronel-Tellez RH, Castillejos-Lopez M, Hernandez A, Dominguez A, Miliar-Garcia A, Barbachano-Guerrero A, Perez-Padilla R, Alejandre-Garcia A, Vazquez-Perez JA. Virome and bacteriome characterization of children with pneumonia and asthma in Mexico City during winter seasons 2014 and 2015. PLoS One 2018; 13:e0192878. [PMID: 29447223 PMCID: PMC5813968 DOI: 10.1371/journal.pone.0192878] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/31/2018] [Indexed: 02/07/2023] Open
Abstract
Background Acute asthma exacerbations and pneumonia are important causes of morbidity and mortality in children and may coexist in the same children, although symptom overlap may lead to difficulties in diagnosis. Microbial and viral diversity and differential abundance of either may play an important role in infection susceptibility and the development of acute and chronic respiratory diseases. Objectives To describe the virome and bacteriome present in the upper respiratory tract of hospitalized children with a clinical diagnosis of asthma and pneumonia during an acute exacerbation and an acute respiratory illness ARI episode respectively. Methods During the winter seasons of 2013–2014 and 2014–2015, 134 nasopharyngeal swabs samples of children <15 years of age with ARI hospitalized at a referral hospital for respiratory diseases were selected based on clinical diagnosis of asthma or pneumonia. The virome and bacteriome were characterized using Whole Genome Sequencing (WGS) and in-house bioinformatics analysis pipeline. Results The Asthma group was represented mainly by RV-C, BoV-1 and RSV-B and the pneumonia group by Bacteriophage EJ-1 and TTMV. TTV was found in both groups with a similar amount of reads. About bacterial composition Moraxella catarrhalis, Propionibacterium acnes and Acinetobacter were present in asthma and Veillonella parvula and Mycoplasma pneumoniae in pneumonia. Streptococcus pneumoniae and Haemophilus influenzae were mostly found with both asthma and pneumonia. Conclusions Our results show a complex viral and bacterial composition in asthma and pneumonia groups with a strong association of RV-C presence in asthmatic children. We observed Streptococcus pneumoniae and Haemophilus influenzae concurrently in both groups.
Collapse
Affiliation(s)
- Jose A. Romero-Espinoza
- Departamento de Investigación en Virología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Yazmin Moreno-Valencia
- Departamento de Investigación en Virología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Rodrigo H. Coronel-Tellez
- Signalisation et Réseaux de Régulations Bactériens, Institut de Biologie Intégrative de la Cellule, Paris, France
| | - Manuel Castillejos-Lopez
- Vigilancia Epidemiológica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Andres Hernandez
- Vigilancia Epidemiológica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Aaron Dominguez
- Sección de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Angel Miliar-Garcia
- Sección de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Arturo Barbachano-Guerrero
- Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Rogelio Perez-Padilla
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Alejandro Alejandre-Garcia
- Unidad de Urgencias Pediátricas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Joel A. Vazquez-Perez
- Departamento de Investigación en Virología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
- * E-mail:
| |
Collapse
|