title: Fatal Community-acquired Pneumonia in Children Caused by Re-emergent Human Adenovirus 7d Associated with Higher Severity of Illness and Fatality Rate.
abstract: Human adenoviruses (HAdVs) are highly contagious pathogens causing acute respiratory disease (ARD), such as community-acquired pneumonia. HAdV-7d, a re-emergent genomic variant, has been recently reported in Asia and the United States after a several-decade absence. However, whether HAdV-7d is associated with higher severity than other types is currently unclear. In this study, the clinical and epidemiological investigation showed that fever, cough, and sore throat were the three most common respiratory symptoms of HAdV infections. HAdV-7 caused longer duration of fever, higher morbidity of tachypnea/dyspnea, pleural effusion, diarrhea, hepatosplenomegaly, consciousness alteration, as well as higher rates of pneumonia, mechanical ventilation and higher fatality rate (28.6%) than other types, particularly HAdV-3 and HAdV-2. The genomes of seven HAdV-7d isolates from mild, severe, and fatal cases were sequenced and highly similar with each other. Surprisingly, two isolates (2011, 2012) had 100% identical genomes with an earlier strain from a fatal ARD outbreak in China (2009), which elucidates the virus origin and confirms the unexpected HAdV genomic conservation and stability. Phylogenetic analysis indicated that L1 52/55-kDa DNA packaging protein may be associated with the higher severity of illness and fatality rate of HAdV-7. Clinicians need to be aware of HAdVs in children with ARD.
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China.
authors.forename: Zhiwu
authors.initials: Z
authors.lastname: Yu
authors.affiliation: Biosafety Level-3 Laboratory, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, Guangdong 510515, China.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Zeng
authors.affiliation: Biosafety Level-3 Laboratory, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, Guangdong 510515, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China.
authors.forename: Yuxian
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China.
authors.forename: Manjun
authors.initials: M
authors.lastname: Chen
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China.
authors.forename: Yonghui
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Yu
authors.affiliation: Department of Ophthalmology, Howe Laboratory, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: James
authors.initials: J
authors.lastname: Chodosh
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Fu
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Che
authors.affiliation: Biosafety Level-3 Laboratory, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, Guangdong 510515, China.|Department of Ophthalmology, Howe Laboratory, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Qiwei
authors.initials: Q
authors.lastname: Zhang
mesh_terms: D000258:Adenovirus Infections, Human / Q000453:epidemiology / Q000401:mortality / Q000821:virology*; D000260:Adenoviruses, Human / Q000145:classification / Q000235:genetics / Q000502:physiology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000401:mortality / Q000821:virology*; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000821:virology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010802:Phylogeny; D011014:Pneumonia / Q000453:epidemiology / Q000821:virology*; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000821:virology; D015996:Survival Rate