title: Severe Community-Acquired Pneumonia Caused by Human Adenovirus in Immunocompetent Adults: A Multicenter Case Series.
abstract: BACKGROUND
  Severe community-acquired pneumonia (CAP) caused by human adenovirus (HAdV), especially HAdV type 55 (HAdV-55) in immunocompetent adults has raised increasing concerns. Clinical knowledge of severe CAP and acute respiratory distress syndrome induced by HAdV-55 is still limited, though the pathogen has been fully characterized by whole-genome sequencing.
  
  
  METHODS
  We conducted a multicentre retrospective review of all consecutive patients with severe CAP caused by HAdV in immunocompetent adults admitted to the Emergency Department Intensive Care Unit of two hospitals in Northern China between February 2012 and April 2014. Clinical, laboratory, radiological characteristics, treatments and outcomes of these patients were collected and analyzed.
  
  
  RESULTS
  A total of 15 consecutive severe CAP patients with laboratory-confirmed adenovirus infections were included. The median age was 30 years and all cases were identified during the winter and spring seasons. HAdV-55 was the most frequently (11/15) detected HAdV type. Persistent high fever, cough and rapid progression of dyspnea were typically reported in these patients. Significantly increased pneumonia severity index (PSI), respiratory rate, and lower PaO2/FiO2, hypersensitive CRP were reported in non-survivors compared to survivors (P = 0.013, 0.022, 0.019 and 0.026, respectively). The rapid development of bilateral consolidations within 10 days after illness onset were the most common radiographic finding, usually accompanied by adjacent ground glass opacities and pleural effusions. Total mortality was 26.7% in this study. Corticosteroids were prescribed to 14 patients in this report, but the utilization rate between survivors and non-survivors was not significant.
  
  
  CONCLUSIONS
  HAdV and the HAdV-55 sub-type play an important role among viral pneumonia pathogens in hospitalized immunocompetent adults in Northern China. HAdV should be tested in severe CAP patients with negative bacterial cultures and a lack of response to antibiotic treatment, even if radiologic imaging and clinical presentation initially suggest bacterial pneumonia.
authors.affiliation: Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China.
authors.forename: Dingyu
authors.initials: D
authors.lastname: Tan
authors.affiliation: Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China.
authors.forename: Huadong
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China.
authors.forename: Yangyang
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Department of Emergency, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Tong
authors.affiliation: Department of Emergency, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China.
authors.forename: Dongqi
authors.initials: D
authors.lastname: Yao
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Saint Louis University Hospital, Saint Louis, Missouri, United States of America.
authors.forename: Joseph
authors.initials: J
authors.lastname: Walline
authors.affiliation: Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China.
authors.forename: Xuezhong
authors.initials: X
authors.lastname: Yu
mesh_terms: D000258:Adenovirus Infections, Human / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000821:virology*; D000260:Adenoviruses, Human / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002681:China; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000821:virology*; D004279:DNA, Viral / Q000378:metabolism; D005260:Female; D005838:Genotype; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000175:diagnosis / Q000473:pathology* / Q000821:virology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral