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Objective:To investigate the clinical characteristics and risk factors of postinfectious bronchiolitis obliterans(PIBO)after severe adenovirus pneumonia(SAP).Methods:We retrospectivly analyzed 78 children who were hospitalized for SAP at Shenzhen Children′s Hospital from April 2015 to April 2020.The cases were divided into PIBO group( n=26) and non-PIBO group( n=52) based on the diagnosis results.The general conditions, clinical characteristics, and laboratory data from two groups were analyzed, and the risk factors for PIBO were explored. Results:A total of 78 children were included in this study.There were 18 (69.2%) males and eight (30.8%) females in PIBO group; the average age of onset in PIBO group was younger than that in non-PIBO group[(11.77±3.24)months vs.(15.08±6.48)months, P=0.027]. The cough duration[(11.35±7.35)days vs.(7.15±5.67)days, P=0.010], and heat duration[(13.12±6.78)days vs.(8.62±4.76)days, P=0.007] were longer in PIBO group than those in non-PIBO group.The white blood cell count[(12.46±7.23)×10 9/L vs.(9.17±3.66)×10 9/L), P<0.05], platelet count[(390.12±209.03)×10 9/L vs.(284.69±83.33)10 9/L, P<0.05], C-reactive protein[(37.04±32.16)mg/L vs.(18.14±18.33)mg/L, P<0.05], procalcitonin[(3.51±3.33)μg/L vs.(1.09±1.37)μg/L, P<0.05], lactate dehydrogenase(LDH)[(1 155.88±842.94)IU/L vs.(414.00±218.94)IU/L, P<0.01] were all higher in PIBO group than those in non-PIBO group; The roportion of patients with mycoplasma pneumoniae infection[5(19.2%) cases vs.4(7.7%) cases, P<0.05], admitted to PICU[18(69.2%) cases vs.8(15.4%) cases, P<0.01] , using invasive mechanical ventilation[10(38.5%) cases vs.5(9.6%) cases, P<0.01], using hormones[23(88.5%) cases vs.21(40.4%) cases, P<0.01], and using human immunoglobulin[20 (76.9%) cases vs.10(19.2%) cases, P<0.01] were higher in PIBO group than those in non-PIBO group.The multivariate Logistic regression using stepwise method showed that older age ( OR=0.942, 95% CI 0.890-0.997) was a protective factor for PIBO, while higher LDH levels ( OR=1.005, 95% CI 1.002-1.008), using intravenous corticosteroids ( OR=6.622, 95% CI 0.924-47.436), and using human immunoglobulin ( OR=9.681, 95% CI 1.742-53.802) were the risk factors for PIBO in SAP ( P<0.05). The receiver operating characteristic curve was constructed through the combination of age of onset, LDH level, using intravenous hormone, and using human immunoglobulin.The area under the curve reached 0.954.The overall best cut-off value of the prediction model was 0.272, the sensitivity was 92.3%, and the specificity was 86.5%.When LDH=462 IU/L, the area under the curve reached the maximum value of 0.882, the sensitivity was 100.0%, and the specificity was 61.5%. Conclusion:SAP children with characteristics such as younger age, long cough and fever duration, high inflammatory index, LDH level higher than 462 IU/L, admitted to PICU, mechanical ventilation and need hormones and human immunoglobulin, should be alert to the risk of PIBO.
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Objective:To analyze the clinical features of bronchiectasis in children after severe adenovirus pneumonia and to provide clinical clues for the early diagnosis of bronchiectasis in children after severe adenovirus pneumonia.Methods:A retrospective study was made to analyze the clinical data of 26 children with bronchiectasis after severe adenovirus pneumonia treated in Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from May 2016 to May 2021.Results:A total of 26 cases were reported, including 18 males and 8 females.The median onset age of severe adenovirus pneumonia was 23.0 (15.0, 48.0) months.A total of 23 cases suffered concurrent infections, and bacterial co-infection was the most common (16 cases). High resolution computed tomography (HRCT) showed multiple lobar solids in the lung with/without pleural effusion.During the acute phase, most of the cases were treated with intravenous immunoglobulin (21 cases), mechanical ventilation (20 cases), and systemic glucocorticoids (19 cases). The median age at diagnosis of bronchiectasis was 29.5 (21.0, 56.8) months, and the median time that the patients took to develop into acute adenovirus pneumonia was 6.0 (3.3, 13.0) months.Six cases suffered bronchiectasis alone, and 20 cases had bronchiectasis combined with post-infectious bronchiolitis obliterans (PIBO). Of these 20 cases, 3 cases developed bronchiectasis and PIBO simultaneously, and the remaining 17 cases developed bronchiectasis after PIBO.In the included 26 cases, diffuse bronchiectasis predominated (24 cases), most frequently involving the left lower lobes (21 cases) and right lower lobes (21 cases). Cylindrical bronchiectasis was the most common type (23 cases). All the patients had recurrent cough and wheezing during follow-up, and only 3 cases coughed up pus sputum without hemoptysis.All children had acute exacerbations, which were mostly caused by bacteria (21 cases). Nineteen cases combined with PIBO and 1 case with only bronchiectasis were rehospitalized.There was no cases of surgical resection or death.Conclusions:Bronchiectasis after severe adenovirus pneumonia mostly occurs in patients with or without PIBO.Multiple lobe involvement and co-infection may be a risk factor for PIBO patients to develop bronchiectasis.The clinical manifestations are mostly recurrent cough and wheezing, while sputum and hemoptysis are less common.Pediatricians should promptly perform chest HRCT for early diagnosis of the disease.
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Human adenovirus pneumonia(adenovirus pneumonia for short)is one of the important types of community-acquired pneumonia in children.Severe pneumonia can easily occur in infants or patients with impaired immune function, which can lead to acute lung injury and pulmonary sequelae.In severe infection, the significant imbalance between inflammatory cells and cytokines leads to tissue damage.In this paper, the classification, structure, infection receptor of human adenovirus and the immunological pathogenesis of adenovirus pneumonia are described.
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Early diagnosis and treatment of adenovirus pneumonia is critical to reduce the mortality and pulmonary sequelae.This review summarizes the research progress of risk factors affecting the severity and poor prognosis of adenovirus pneumonia in children.Adenovirus type 7 and high adenovirus DNA load suggest acute severe disease and sequelae.On imaging, children with pleural effusion and small airway lesions need to be vigilant.Abnormal cytokines are observed in laboratory indicators, and changes in biochemical indicators caused by damage of various organs in and outside the lung suggest the occurrence of severe adenovirus pneumonia.Children with young age, premature birth, underlying diseases, long fever, wheezing, low hemoglobin and albumin, mixed infection, and extrapulmonary complications are more likely to progress to severe adenovirus pneumonia.Children younger than 2 years old, with a family history of asthma, history of wheezing, long fever, dyspnea or even respiratory failure, hospitalized in ICU, ventilator-assisted ventilation, and systemic use of hormones should be more vigilant against pulmonary sequelae.
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Severe pneumonia related to human adenoviruses (HAdVs) has a high lethality rate in children and its early diagnosis and treatment remain a major challenge. Circular RNAs (circRNAs) are novel long noncoding RNAs that play important roles in gene regulation and disease pathogenesis. To investigate the roles of circRNAs in HAdV pneumonia, we analyzed the circRNA profiles of healthy children and children with HAdV pneumonia, including both mild and severe cases, and identified 139 significantly upregulated circRNAs in children with HAdV pneumonia vs healthy controls and 18 significantly upregulated circRNAs in children with severe HAdV pneumonia vs mild HAdV pneumonia. In particular, hsa_circ_0002171 was differentially expressed in both groups and might thus be useful as a diagnostic biomarker of HAdV pneumonia and severe HAdV pneumonia. To identify the underlying mechanisms of circRNAs in HAdV pneumonia, we analyzed the transcriptome of children with HAdV pneumonia and established a circRNA-mRNA regulatory network. Enrichment analysis of differentially expressed target mRNAs demonstrated that the differentially expressed genes between healthy controls and HAdV pneumonia patients were mainly involved in RNA splicing while the differentially expressed genes between children with mild and severe HAdV pneumonia were mainly involved in regulating lymphocyte activation. Receiver operating characteristic (ROC) curve analysis suggested that hsa_circ_0002171 had a significant value in the diagnosis of HAdV pneumonia and of severe HAdV pneumonia. Taken together, the circRNA expression profile was altered in children with HAdV pneumonia. These results demonstrated that hsa_circ_0002171 is a potential diagnostic biomarker of HAdV pneumonia.
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Objective:To observe the therapeutic timing and dosage of intravenous immunoglobulin (IVIG) in children with severe adenovirus pneumonia.Methods:Clinical data of children with severe adenovirus pneumonia treated with IVIG at the Department of Respiratory, Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from January 2019 to January 2020 were retrospectively analyzed.Participants were classified as early presenters (5-10 days of illness course) and later presenters (11-15 days of illness course) according to the timing of IVIG treatment.They were further subdivided into plan 1 group[1 g/(kg·d) IVIG for 2 days] and plan 2 group [0.4-0.5 g/(kg·d) IVIG for 3-5 days]. Continuous variables and categorical variables between groups were analyzed by the nonparametric Mann- Whitney U test and the Fisher′ s exact test, respectively. Results:A total of 202 patients with the median age of 12 (12, 36) months were recruited, involving 128 early presenters (63.37%) and 74 later presen-ters (36.63%). Later presenters had a longer duration of fever [18.00(14.00, 23.25) days vs.11.00(9.00, 14.00) days], more demands for mechanical ventilation (33.78% vs.20.31%), and higher incidence of bronchiectasis (9.46% vs.1.56%) than those of early presenters (all P<0.05). For early presenters, no significant differences were detected in the demand for advanced life support, outcomes and sequelae between plan 1 group and plan 2 group (all P>0.05). For later presenters, a shorter duration of fever [18.00(14.00, 21.00) days vs.21.00(15.50, 30.75) days] and lower usage of extracorporeal membrane oxygenation (ECMO, 2.13% vs.18.52%) were observed in the plan 1 group than that of plan 2 group (all P<0.05). The incidence of post-infectious bronchiolitis obliterans and bronchiectasis as pulmonary sequelae was comparable between plan 1 group and plan 2 group ( P>0.05). The incidence of adverse events was 5.77% during IVIG infusion, showing no significant difference between plan 1 group and plan 2 group ( P>0.05). Conclusions:Early treatment of IVIG are very important to improve the prognosis of children with severe adenovirus pneumonia.For later presenters, a high dosage of IVIG is effective in reducing the ECMO use and shortening the duration of fever, thus providing clinical benefits.
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Objective:To investigate the risk factors for wheezing in the children with HAdV pneumonia.Methods:Ninety-seven cases of children aged 2 to 5 years with HAdV pneumonia were selected from Pediatric Department of Shengjing Hospital of China Medical University from January 2019 to December 2019.Meanwhile, 100 children of the same age without adenovirus pneumonia were recruited as the control group.According to whether wheezing or not, the children with HAdV pneumonia were divided into wheezing group and non-wheezing group.The general characteristics, clinical characteristics and laboratory examination data of HAdV pneumonia group and non-HAdV pneumonia group were statistically analyzed, and the risk factors of wheezing after HAdV pneumonia were analyzed by multivariate logistic regression.Results:Compared with the non-HAdV group, fever duration, serious cases, cases of wheezing in HAdV group were significant different( P<0.05). In laboratory examination, the white blood cell(WBC)count in HAdV group was significantly higher than those in control group( P<0.05). Whereas, hospitalization time, C-reactive protein(CRP), alanine aminotransferase(ALT), creatinine(Cr), creatine kinase(CK), CKMB, and lactic dehydrogenase(LDH)levels in HAdV group were not statistically significant compared with those of the children in non-HAdV pneumonia group( P>0.05). Wheezing occurred in 52.6%(51/97)of children with HAdV pneumonia.Compared with the non-wheezing group, history of wheezing, cases with atopy, serious cases, eosinophils(EO)count, and cases with small airway changes in wheezing group were significantly different( P<0.05). Whereas, atopic family history, hospitalization time, fever duration, lymphocyte(LY)count, WBC count, CRP level, the cases with co-infection and consolidation in lung images in wheezing group were not statistically significant compared with those of the children in non-wheezing group( P>0.05). Multivariate logistic regression analysis showed that the risk of wheezing in children with severe HAdV pneumonia was 2.949 times as much as those without severe HAdV pneumonia.The risk of wheezing in children with HAdV pneumonia with atopic constitution was 3.930 times as much as those without atopiy. Conclusion:The incidence of wheezing in children with HAdV pneumonia is higher than those in children of non-HAdV pneumonia.Severe cases and atopy are the independent risk factors for wheezing in the children with HAdV pneumonia.
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Objective:To discuss the role of continuous blood purification (CBP) therapy in children with severe adenovirus pneumonia.Methods:A total of 114 children with severe adenovirus pneumonia admitted to the Department of PICU at Children′s Hospital of Hunan Province from June 2018 to July 2019 were selected as the research objects.According to whether treated with CBP, they were divided into CBP group and control group.The following indicators during the process of treatment were compared between two groups, including respiratory mechanics indicators[respiratory index(PaO 2/FiO 2), dynamic lung compliance(Cdyn)]; hemodynamic indicators(heart rate and mean arterial pressure); changes in levels of inflammatory factors interleukin(IL)-6, IL-10, tumor necrosis factor(TNF)-α and the prognosis 28 days after admission. Results:The respiratory mechanics index, serum IL-6 and TNF-α levels of two groups after treatment were significantly lower than those before treatment, and the serum IL-10 level was significantly higher than that of this group before treatment.There were statistical differences in the CBP group before and after treatment, while there was no statistical difference in control group.In the CBP group, the serum IL-6 and TNF-α levels after treatment were significantly lower than those of the control group( P<0.05), and the serum IL-10 level was significantly higher than that of the control group( P<0.05). The 28-day mortality rate of patients in CBP group was 8.6%(3/35), which was significantly lower than 13.9%(11/79) of control group ( P<0.05). Conclusion:CBP could improve the main respiratory mechanical indexes of adenovirus pneumonia and decrease the level of inflammatory cytokines.
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Objective:To summary the mixed infection as well as clinical characteristics and analyze the risk factors for mixed infection of severe adenovirus pneumonia(SAP) in children.Methods:The clinical data of 114 children with SAP were retrospectively analyzed.Multivariate Logistic regression analysis was performed to assess the risk factors for mixed infection.Results:The incidence age was from 6 months to 2 years(62.5%). High fever(94.7%), cough(98.2%), dyspnea(86.8%) and lethargy(95.6%) were the main symptoms.Laboratory examination showed that children with SAP were prone to increased white blood cell count, C-reactive protein, procalcitonin, aspartate aminotransferase, alanine aminotransferase and CK-MB, as well as decreased proportion of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + and NK cells.The main complications intrapulmonary organ were respiratory failure(80.7%). The main complications extrapulmonary organ were circulatory complications (55.3%). SAP was easily combined with other pathogenic infections.Streptococcus pneumoniae(22.9%)was the most common bacterial pathogen.Respiratory syncytial virus(10.0%)were the most common virus, in addition, mycoplasma pneumoniae(17.1%) was also common.Multivariable Logistic regression analysis showed that the decreasing ratio of CD4 + /CD8 + and NK cells, congenital heart disease and congenital airway dysplasia were the independent risk factors for mixed infection of SAP in children( P<0.05). Conclusion:The SAP patients could easily suffer from mixed infection and high fatality rate.Immune dysregulation is the important risk factors for mixed infection of SAP in children.So immunoregulatory treatment is very important.
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Adenovirus is a common cause of respiratory infection in children and can cause severe pneumonia.Adenovirus can also cause damage to immune system.It can cause decrease in T and B cell number and function, imbalance of Th1/Th2 cell proportion, but also can cause imbalance of proinflammatory cytokines and anti-inflammatory cytokines, further leading to dysfunction of immune system, with severe complications such as severe sepsis and multiple organ and system dysfunction.In this paper we will discuss immune pathogenesis of adenovirus infection and provide suggestion for treatment of adenovirus pneumonia.
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Adenovirus is one of the common pathogens causing respiratory tract infection in children, which can cause severe pneumonia.Severe adenovirus pneumonia has an acute onset, rapid progress, and many complications, but there is no specific treatment and the mortality rate is high.Mechanical ventilation is an important means of respiratory support for the treatment of severe adenoviral pneumonia, and ventilator-associated lung injury is an inevitable drawback of mechanical ventilation.ECMO can replace and support cardiopulmonary function for a long time, reduce the occurrence of such damage, and improve oxygenation.When patients with severe adenovirus pneumonia develop respiratory failure or ARDS, and conventional treatment fails to improve hypoxemia, or accompanied by air leakage and other complications, ECMO treatment should be considered.However, there are few relevant studies in China, and further experience needs to be accumulated in the selection of respiratory support modes, intervention opportunities and management points of ECMO respiratory support for severe adenovirus pneumonia.
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Adenovirus is a common cause of respiratory infection in children and can cause severe pneumonia. Adenovirus can also cause damage to immune system. It can cause decrease in T and B cell num﹣ber and function,imbalance of Th1/Th2 cell proportion,but also can cause imbalance of proinflammatory cytokines and anti﹣inflammatory cytokines, further leading to dysfunction of immune system, with severe complications such as severe sepsis and multiple organ and system dysfunction. In this paper we will discuss immune pathogenesis of adenovirus infection and provide suggestion for treatment of adenovirus pneumonia.
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Adenovirus is one of the common pathogens causing respiratory tract infection in chil﹣dren,which can cause severe pneumonia. Severe adenovirus pneumonia has an acute onset,rapid progress,and many complications,but there is no specific treatment and the mortality rate is high. Mechanical ventilation is an important means of respiratory support for the treatment of severe adenoviral pneumonia,and ventilator﹣associated lung injury is an inevitable drawback of mechanical ventilation. ECMO can replace and support cardiopulmonary function for a long time,reduce the occurrence of such damage,and improve oxygenation. When patients with severe adenovirus pneumonia develop respiratory failure or ARDS,and conventional treat﹣ment fails to improve hypoxemia,or accompanied by air leakage and other complications,ECMO treatment should be considered. However,there are few relevant studies in China,and further experience needs to be ac﹣cumulated in the selection of respiratory support modes,intervention opportunities and management points of ECMO respiratory support for severe adenovirus pneumonia.
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Adenovirus is a common cause of respiratory infection in children.Severe adenovirus pneumonia often occurs in infants or immunocompetent persons.The high incidence age is from 6 months to 2 years old.The clinical symptoms are hyperpyrexia,pale face,poor mental state,respiratory distress or wheezing,and fever may last 4-7days or longer.Severe extra-pulmonary complications are common especially in cardiovascular and hepatic dysfunction.Symptoms are similar to severe bacterial infections,but antibiotics is not effective,and mortality is high.X-ray imaging in acute phase is characterized by asymmetric exudation of lung,partial exudation fusion and interstitial emphysema.Rapid identification of adenovirus infection remains a difficult problem.Multiple nested polymerase chain reaction is helpful.Appropriate oxygen therapy and organ support are the main therapeutic strategies.Extracorporeal membrane oxygenation needs to be further explored as salvage therapy.
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Objective@#To study the clinical characteristics of children with adenovirus pneumonia and provide evidence for clinical diagnosis and treatment timely.@*Method@#This retrospective study included 89 children who were confirmed to have adenovirus pneumonia in hospital from January 2015 to December 2016. All the immunofluorescence test result of the 89 children showed that the exfoliated nasopharyngeal cells from the 89 children were all adenovirus antigen positive. All the severe type children reached the diagnostic criteria of severe pneumonia by the respiratory group in the society of pediatrics, Chinese Medical Association. The children were divided into 2 groups (severe type group and common type group). Different factors such as epidemiologic feature, clinical manifestation, laboratory examination and imaging data were analyzed.@*Results@#Among the 89 pediatric patients, the male to female ratio was 1.5∶1. The ages ranged from 1 month to 14 years. Children under 5 years of age accounted for 96.6%(86/89). The incidence was 37.1%(33/89)in winter and 30.3%(27/89)in spring. The lengths of hospital stay were 3-48 days and the median length of stay was 8.25±4.75 days. All of these 89 cases had fever and cough. The proportion of severe adenovirus pneumonia was high among male, under 2 years of age, those with dyspnea, hepatosplenomegaly, tachycardia, leukocytosis, elevated C-reactive protein (CRP), PCT, myocardial enzymes, electrocardiogram abnormality and cluster shadow in chest CT. Differences were statistically significant (P<0.05).@*Conclusions@#Special attention should be paid to the male children under the 2 years of age with abnormal related indicators to consider severe adenovirus pneumonia. Early detection and treatment are the key to improve treatment and reduce death.
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Objective To understand the risk factors for poor prognosis of severe adenovirus pneumonia (SAP)in children,and provide guidance for clinical diagnosis and prognosis.Methods Clinical data of 91 hospitalized children who diagnosed with SAP in Chongqing Children’s Hospital of Chongqing Medical University between January 2012 and January 2014 were analyzed retrospectively.Results Of 91 SAP children,23 (25.27%)had poor prognosis. Univariate analysis showed that risk factors for poor prognosis of SAP were age of onset,congenital heart disease and other serious underlying diseases,mechanical ventilation therapy,acute respiratory distress syndrome (ARDS), atelectasis and other serious radiological changes,and emergence of two and more extra-pulmonary complications (all P <0.05).Multivariate regression analysis showed that congenital heart disease and other serious underlying diseases,and emergence of two and more extra-pulmonary complications were independent risk factors for poor prognosis of SAP (all P <0.05).Conclusion Congenital heart disease and other serious underlying diseases,emer-gence of two and more extra-pulmonary complications are independent risk factors for poor prognosis of SAP,active intervention should be conducted during the process of clinical diagnosis and treatment,so as to improve the prognosis.
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Objective To explore the characteristics of chest multi-slice spiral CT and dynamic changes in adult patients with se-vere adenovirus pneumonia.Methods Clinical and CT data of 6 patients with severe pneumonia in an epidemic of the respiratory ade-novirus infection were retrospectively analyzed.The impact of hormone therapy was also studied.Results The first chest CT exami-nations in 6 patients were performed 2.22 ± 0.75 days after fever.CT showed segmental consolidation with ground-glass opacity (GGO)in one case,patchy consolidation with GGO in 3 cases,patchy interstitial changes in one case and small nodules in one case. The duration reaching the standards of severe pneumonia was 6.1 7 ± 0.37 days from the onset.During severe phase chest CT showed a range of lobar consolidation in one case,lobar in 2 cases,segmental in 2 cases or patchy in one case,consolidation with GGO in 5 cases.In all cases the lesions were commonly seen in the lower lobes of bilateral lungs.Multiple lobes were involved in 2 cases.After methylprednisolone treatment,no new lesion was showed but the early lesion was enlarged.During the first 2 to 4 days GGO absorbed completely in 6 cases,consolidation absorbed completely in one case and mostly in 5 cases.Conclusion Chest CT findings of severe adenovirus pneumonia in adult are single or multiple lobar or segmental consolidations with or without GGO which distribute mainly at lower lobes.
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Study on the scientific essence of traditional Chinese medicine (TCM) syndrome is the key in TCM modernization. This paper showed new research ideas for TCM syndrome, which was based on the pediatric adenovirus pneumonia and its TCM treatment, metabonomics and its application in TCM syndrome research, in order to discuss its application value in the diagnosis and treatment of pediatric viral pneumonia. This method was mainly implemented through the metabonomics technology, which reflected TCM holism concept. The syndrome of phlegm-heat obstructing the lung, which was the most frequent syndrome in the pediatric viral pneumonia, was studied. Through the comparison with metabolites of healthy children, the biomarkers of syndrome of phlegm-heat obstructing the lung in pediatric viral pneumonia were identified.