Clinical diagnosis and treatment of severe adenovirus pneumonia with ARDS: three cases report and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHANG Xiaohui , HUANG Jian’an ,  CHEN Cheng

Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P. R. China;

Corresponding author：

CHEN Cheng, Email: 291576591@qq.com

Keywords：

Adenoviridae Infections; pneumonia; extracorporeal membrane oxygenation; metagenomic next generation sequencing

DOI：

10.7507/1671-6205.202108057

Video：

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Objective To explore the diagnosis and treatment of severe adenovirus pneumonia patients with severe acute respiratory distress syndrome (ARDS) in a short time and reduce the complications after rehabilitation. Methods The clinical data, laboratory results, treatment process and imaging outcomes of three severe community-acquired adenovirus pneumonia patients with normal immune function were analyzed. Results All the three patients developed ARDS in a very short time. In the early stage, alveolar lavage fluid obtained by fiberoptic bronchoscopy was taken for macrogenomic second-generation sequencing (mNGS), adenovirus was detected and antiviral drugs were immediately used. The first two patients received cidofovir antiviral therapy and the third patient received ribavirin antiviral therapy. All three patients received very high respiratory support, of which the first two received extracorporeal membrane oxygenation treatment. The lungs of all three patients recovered well after treatment. Conclusions The diagnosis and treatment of severe adenovirus pneumonia is still based on individualized symptomatic support, immune regulation and treatment of complications. mNGS can help diagnose and direct treatment of adenovirus pneumonia as early as possible, which is beneficial to reduce complications and improve survival rate.

Citation： ZHANG Xiaohui, HUANG Jian’an, CHEN Cheng. Clinical diagnosis and treatment of severe adenovirus pneumonia with ARDS: three cases report and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(12): 861-866. doi: 10.7507/1671-6205.202108057 Copy

1.	Scott MK, Chommanard C, Lu XY, et al. Human adenovirus associated with severe respiratory infection, Oregon, USA, 2013-2014. Emerg infect Dis, 2016, 22(6): 1044-1051.
2.	Ruuskanen O, Lahti E, Jennings LC, et al. Viral pneumonia. Lancet, 2011, 377(9773): 1264-1275.
3.	人腺病毒呼吸道感染预防控制技术指南编写审定专家组. 人腺病毒呼吸道感染预防控制技术指南(2019年版). 中华预防医学杂志, 2019, 53(11): 1088-1093.
4.	Karkhane M, Pourhosiensholi MA, Akbariyan Torkabad MR, et al. Annual antibiotic related economic burden of healthcare associated infections; a cross-sectional population based study. Iran J Pharm Res, 2016, 15(2): 605-610.
5.	Graf EH, Simmon KE, Tardif KD, et al. Unbiased detection of respiratory viruses by use of RNA sequencing-based metagenomics: a systematic comparison to a commercial PCR panel. J Clin Microbiol, 2016, 54(4): 1000-1007.
6.	Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature, 2020, 579(7798): 270-273.
7.	Thoendel MJ, Jeraldo PR, Greenwood-Quaintance KE, et al. Identification of prosthetic joint infection pathogens using a shotgun metagenomics pproach. Clin Infect Dis, 2018, 67(9): 1333-1338.
8.	Li ZG, Breitwieser FP, Lu J, et al. Identifying corneal infections in formalin-fixed specimens using next generation sequencing. Invest Ophthalmol Vis Sci, 2018, 59(1): 280-288.
9.	Wilson MR, O'Donovan BD, Gelfand JM, et al. Chronic meningitis investigated via metagenomic next-generation sequencing. JAMA Neurol, 2018, 75(8): 947-955.
10.	Grumaz S, Stevens P, Grumaz C, et al. Next-generation sequencing diagnostics of bacteremia in septic patients. Genome Med, 2016, 8(1): 73.
11.	Xie LY, Zhang B, Xiao NG, et al. Epidemiology of human adenovirus infection in children hospitalized with lower respiratory tract infections in Hunan, China. J Med Virol, 2019, 91(3): 392-400.
12.	Chen QG, Liu J, Liang WW, et al. Clinical features, replication competence, and innate immune responses of human adenovirus type 7 infection. J Infect Dis, 2021, 223(8): 1390-1399.
13.	Fu Y, Tang Z, Ye Z, et al. Human adenovirus type 7 infection causes a more severe disease than type 3. BMC Infect Dis, 2019, 19(1): 36.
14.	Zeng SZ, Xie LY, Yu T, et al. Persistent viral shedding of human adenovirus type 7 in children with severe pneumonia. J Med Virol, 2021, 93(8): 4846-4855.
15.	Kim SJ, Kim K, Park SB, et al. Outcomes of early administration of cidofovir in non-immunocompromised patients with severe adenovirus pneumonia. PloS One, 2015, 10(4): e0122642.
16.	Ko JH, Lim JU, Choi JY, et al. Early cidofovir administration might be associated with a lower probability of respiratory failure in treating human adenovirus pneumonia: a retrospective cohort study. Clin Microbiol Infect, 2020, 26(5): 646.e9-646.e14.
17.	Alcamo AM, Wolf MS, Alessi LJ, et al. Successful use of cidofovir in an immunocompetent child with severe adenoviral sepsis. Pediatrics, 2020, 145(1): e20191632.
18.	Le TK, Brown BK, Namtu KC, et al. Use of cidofovir with extracorporeal membrane oxygenation to treat adenovirus-associated acute respiratory distress syndrome in paediatric patients- a case series. J Clin Pharm Ther, 2020, 45(6): 1505-1510.
19.	Morfin F, Dupuis-girod S, Frobert E, et al. Differential susceptibility of adenovirus clinical isolates to cidofovir and ribavirin is not related to species alone. J Antiviral therapy, 2009, 14(1): 55-61.
20.	Shen KL, Wang YR, Li P, et al. Clinical features, treatment and outcomes of an outbreak of type 7 adenovirus pneumonia in centralized residence young adults. J Clin Virol, 2022, 154: 105244.
21.	Lee M, Kom S, Kwon OJ, et al. Treatment of adenoviral acute respiratory distress syndrome using cidofovir with extracorporeal membrane oxygenation. J Intensive Care Med, 2017, 32(3): 231-238.
22.	Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med, 2013, 368(23): 2159-2168.
23.	Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med, 2017, 195(9): 1253-1263.
24.	Ha SO, Kim HS, Park S, et al. Severe ARDS caused by adenovirus: early initiation of ECMO plus continuous renal replacement therapy. SpringerPlus, 2016, 5(1): 1909.
25.	Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med, 2018, 378(21): 1965-1975.
26.	Goligher EC, Tomlinson G, Hajage D, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc bayesian analysis of a randomized clinical trial. JAMA, 2018, 320(21): 2251-2259.
27.	Combes A, Peek G J, Hajage D, et al. ECMO for severe ARDS: systematic review and individual patient data meta-analysis. Intensive care medicine, 2020, 46(11): 2048-57.
28.	Mauri T, Alban L, Turrini C, et al. Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates. Intensive Care Med, 2017, 43(10): 1453-1463.
29.	Mauri T, Turrini C, Eronia N, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med, 2017, 195(9): 1207-1215.
30.	Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med, 2015, 372(23): 2185-2196.

1. Scott MK, Chommanard C, Lu XY, et al. Human adenovirus associated with severe respiratory infection, Oregon, USA, 2013-2014. Emerg infect Dis, 2016, 22(6): 1044-1051.
2. Ruuskanen O, Lahti E, Jennings LC, et al. Viral pneumonia. Lancet, 2011, 377(9773): 1264-1275.
3. 人腺病毒呼吸道感染预防控制技术指南编写审定专家组. 人腺病毒呼吸道感染预防控制技术指南(2019年版). 中华预防医学杂志, 2019, 53(11): 1088-1093.
4. Karkhane M, Pourhosiensholi MA, Akbariyan Torkabad MR, et al. Annual antibiotic related economic burden of healthcare associated infections; a cross-sectional population based study. Iran J Pharm Res, 2016, 15(2): 605-610.
5. Graf EH, Simmon KE, Tardif KD, et al. Unbiased detection of respiratory viruses by use of RNA sequencing-based metagenomics: a systematic comparison to a commercial PCR panel. J Clin Microbiol, 2016, 54(4): 1000-1007.
6. Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature, 2020, 579(7798): 270-273.
7. Thoendel MJ, Jeraldo PR, Greenwood-Quaintance KE, et al. Identification of prosthetic joint infection pathogens using a shotgun metagenomics pproach. Clin Infect Dis, 2018, 67(9): 1333-1338.
8. Li ZG, Breitwieser FP, Lu J, et al. Identifying corneal infections in formalin-fixed specimens using next generation sequencing. Invest Ophthalmol Vis Sci, 2018, 59(1): 280-288.
9. Wilson MR, O'Donovan BD, Gelfand JM, et al. Chronic meningitis investigated via metagenomic next-generation sequencing. JAMA Neurol, 2018, 75(8): 947-955.
10. Grumaz S, Stevens P, Grumaz C, et al. Next-generation sequencing diagnostics of bacteremia in septic patients. Genome Med, 2016, 8(1): 73.
11. Xie LY, Zhang B, Xiao NG, et al. Epidemiology of human adenovirus infection in children hospitalized with lower respiratory tract infections in Hunan, China. J Med Virol, 2019, 91(3): 392-400.
12. Chen QG, Liu J, Liang WW, et al. Clinical features, replication competence, and innate immune responses of human adenovirus type 7 infection. J Infect Dis, 2021, 223(8): 1390-1399.
13. Fu Y, Tang Z, Ye Z, et al. Human adenovirus type 7 infection causes a more severe disease than type 3. BMC Infect Dis, 2019, 19(1): 36.
14. Zeng SZ, Xie LY, Yu T, et al. Persistent viral shedding of human adenovirus type 7 in children with severe pneumonia. J Med Virol, 2021, 93(8): 4846-4855.
15. Kim SJ, Kim K, Park SB, et al. Outcomes of early administration of cidofovir in non-immunocompromised patients with severe adenovirus pneumonia. PloS One, 2015, 10(4): e0122642.
16. Ko JH, Lim JU, Choi JY, et al. Early cidofovir administration might be associated with a lower probability of respiratory failure in treating human adenovirus pneumonia: a retrospective cohort study. Clin Microbiol Infect, 2020, 26(5): 646.e9-646.e14.
17. Alcamo AM, Wolf MS, Alessi LJ, et al. Successful use of cidofovir in an immunocompetent child with severe adenoviral sepsis. Pediatrics, 2020, 145(1): e20191632.
18. Le TK, Brown BK, Namtu KC, et al. Use of cidofovir with extracorporeal membrane oxygenation to treat adenovirus-associated acute respiratory distress syndrome in paediatric patients- a case series. J Clin Pharm Ther, 2020, 45(6): 1505-1510.
19. Morfin F, Dupuis-girod S, Frobert E, et al. Differential susceptibility of adenovirus clinical isolates to cidofovir and ribavirin is not related to species alone. J Antiviral therapy, 2009, 14(1): 55-61.
20. Shen KL, Wang YR, Li P, et al. Clinical features, treatment and outcomes of an outbreak of type 7 adenovirus pneumonia in centralized residence young adults. J Clin Virol, 2022, 154: 105244.
21. Lee M, Kom S, Kwon OJ, et al. Treatment of adenoviral acute respiratory distress syndrome using cidofovir with extracorporeal membrane oxygenation. J Intensive Care Med, 2017, 32(3): 231-238.
22. Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med, 2013, 368(23): 2159-2168.
23. Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med, 2017, 195(9): 1253-1263.
24. Ha SO, Kim HS, Park S, et al. Severe ARDS caused by adenovirus: early initiation of ECMO plus continuous renal replacement therapy. SpringerPlus, 2016, 5(1): 1909.
25. Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med, 2018, 378(21): 1965-1975.
26. Goligher EC, Tomlinson G, Hajage D, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc bayesian analysis of a randomized clinical trial. JAMA, 2018, 320(21): 2251-2259.
27. Combes A, Peek G J, Hajage D, et al. ECMO for severe ARDS: systematic review and individual patient data meta-analysis. Intensive care medicine, 2020, 46(11): 2048-57.
28. Mauri T, Alban L, Turrini C, et al. Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates. Intensive Care Med, 2017, 43(10): 1453-1463.
29. Mauri T, Turrini C, Eronia N, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med, 2017, 195(9): 1207-1215.
30. Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med, 2015, 372(23): 2185-2196.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical diagnosis and treatment of severe adenovirus pneumonia with ARDS: three cases report and literature review

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