title: Emergent severe acute respiratory distress syndrome caused by adenovirus type 55 in immunocompetent adults in 2013: a prospective observational study.
abstract: BACKGROUND
  Since 2008, severe cases of emerging human adenovirus type 55 (HAdV-55) in immunocompetent adults have been reported sporadically in China. The clinical features and outcomes of the most critically ill patients with severe acute respiratory distress syndrome (ARDS) caused by HAdV-55 requiring invasive mechanical ventilation (IMV) and/or extracorporeal membrane oxygenation (ECMO) are lacking.
  
  
  METHODS
  We conducted a prospective, single-center observational study of pneumonia with ARDS in immunocompetent adults admitted to our respiratory ICU. We prospectively collected and analyzed clinical, laboratory, radiological characteristics, sequential tests of viral load in respiratory tract and blood, treatments and outcomes.
  
  
  RESULTS
  The results for a total of five consecutive patients with severe ARDS with confirmed HAdV-55 infection were included. All five patients were immunocompetent young men with a median age of 32 years. The mean time from onset to dyspnea was 5 days. Arterial blood gas analysis at ICU admission revealed profound hypoxia. Mean partial oxygen pressure/fraction of inspired oxygen was 58.1. Mean durations from onset to a single-lobe consolidation shown on chest X-rays (CXRs) and, from the first positive CXR to bilateral multilobar lung infiltrates, were 2 days and 4.8 days, respectively. The viral load was higher than 1 × 108 copies in three patients and was 1 × 104 in one patient. It was negative in the only patient who survived. The mean duration for noninvasive positive pressure ventilation (NPPV) failure and IMV failure were 30.8 hours and 6.2 days, respectively. Four patients received venovenous ECMO. Four (80%) of the five patients died despite receiving appropriate respiratory support.
  
  
  CONCLUSIONS
  HAdV-55 may cause severe ARDS in immunocompetent young men. Persistent high fever, dyspnea and rapid progression to respiratory failure within 2 weeks, together with bilateral consolidations and infiltrates, are the most frequent clinical manifestations of HAdV-55-induced severe ARDS. Viral load monitoring may help predict disease severity and outcome. The NPPV and IMV failure rates were very high, but ECMO may still be the respiratory support therapy of choice.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01585922. Registered 20 April 2012.
authors.forename: Bing
authors.initials: B
authors.lastname: Sun
authors.forename: Hangyong
authors.initials: H
authors.lastname: He
authors.forename: Zheng
authors.initials: Z
authors.lastname: Wang
authors.forename: Jiuxin
authors.initials: J
authors.lastname: Qu
authors.forename: Xuyan
authors.initials: X
authors.lastname: Li
authors.forename: Chengjun
authors.initials: C
authors.lastname: Ban
authors.forename: Jun
authors.initials: J
authors.lastname: Wan
authors.forename: Bin
authors.initials: B
authors.lastname: Cao
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Tong
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D000260:Adenoviruses, Human / Q000302:isolation & purification / Q000472:pathogenicity; D002681:China; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000821:virology; D015897:Comorbidity; D015199:Extracorporeal Membrane Oxygenation; D056724:Immunity, Humoral; D016867:Immunocompromised Host; D007362:Intensive Care Units; D008168:Lung / Q000000981:diagnostic imaging; D011024:Pneumonia, Viral / Q000150:complications / Q000628:therapy / Q000821:virology; D011446:Prospective Studies; D012121:Respiration, Artificial; D045169:Severe Acute Respiratory Syndrome / Q000276:immunology / Q000401:mortality / Q000628:therapy / Q000821:virology; D014057:Tomography, X-Ray Computed; D019562:Viral Load
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