title: Clinical and molecular features of adenovirus type 2, 3, and 7 infections in children in an outbreak in Taiwan, 2011.
abstract: OBJECTIVE
  We studied paediatric patients with human adenovirus (HAdV) infection during the 2011 outbreak in northern Taiwan to define the clinical features of different HAdV genotypes in children.
  
  
  METHODS
  Between January and December 2011, 637 patients <19 years of age exhibited culture-confirmed adenoviral infection in Chang Gung Memorial Hospital, and provided specimens available for genotyping by multiplex real-time PCR. Clinical data were collected retrospectively.
  
  
  RESULTS
  Excluding five cases with multiple genotypes, 632 cases were included for analysis. Three genotypes were identified, including HAdV-3 (429/632; 67.6%), HAdV-7 (144/632; 22.6%) and HAdV-2 (59/632; 9.8%). Median age was 4.58 years (range 2 months to 18 years), with children infected with HAdV-3 significantly older (82.9% >3 years; p <0.001). Of the 621 inpatients, 98.2% had fevers and all exhibited respiratory symptoms, 75 patients (12.1%) had lower respiratory tract infections, 20 (3.2%) required intensive care (HAdV-2: 1; HAdV-3: 8; and HAdV-7: 11), and three died (all HAdV-7-infected). HAdV-3-infected patients were significantly more likely to have upper respiratory symptoms and a high serum C-reactive protein level >100 mg/L, whereas leucocytosis (white blood cell count >15 000/mm3) was more common in HAdV-2-infected patients (p 0.007). HAdV-7 infections were significantly associated with a longer duration of fever, leucopenia (white blood cell count <5000/mm3), thrombocytopenia (platelet count <150 000/mm3), lower respiratory tract infections, a longer length of hospital stay, and requiring intensive care (all p <0.001).
  
  
  CONCLUSIONS
  Childhood HAdV-2, HAdV-3 and HAdV-7 infections may exhibit different clinical manifestations. Although HAdV-3 was the most prevalent genotype observed during the 2011 Taiwan outbreak, HAdV-7 caused more severe disease characteristics and outcomes.
authors.affiliation: Department of Paediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Paediatrics, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: M-R
authors.initials: MR
authors.lastname: Lin
authors.affiliation: Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: S-L
authors.initials: SL
authors.lastname: Yang
authors.affiliation: Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Research Centre for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Y-N
authors.initials: YN
authors.lastname: Gong
authors.affiliation: Department of Paediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Paediatrics, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Kuo
authors.affiliation: Department of Paediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Paediatrics, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Chiu
authors.affiliation: Department of Paediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Paediatrics, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: C-J
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: Department of Paediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Paediatrics, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Hsieh
authors.affiliation: Department of Paediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Paediatrics, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Kuo
authors.affiliation: Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: C-W
authors.initials: CW
authors.lastname: Fang
authors.affiliation: Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Research Centre for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: kctsao@cgmh.org.tw.
authors.forename: K-C
authors.initials: KC
authors.lastname: Tsao
authors.affiliation: Department of Paediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Paediatrics, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: ychuang@cgmh.org.tw.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Huang
mesh_terms: D000258:Adenovirus Infections, Human / Q000175:diagnosis / Q000453:epidemiology* / Q000266:history / Q000821:virology*; D000260:Adenoviruses, Human / Q000145:classification* / Q000235:genetics*; D000293:Adolescent; D036022:Capsid Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D049674:History, 21st Century; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D010802:Phylogeny; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000266:history / Q000821:virology; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
chemical_list: D036022:Capsid Proteins; C018315:hexon capsid protein, Adenovirus
keywords: Adenovirus; Children; Genotype 7; Outbreak; Taiwan