Abstract
Background
Severe community-acquired pneumonia (SCAP) caused by human adenovirus type 7 (HAdV-7) in immunocompetent adults has been of increasing concern recently. Clinical understanding of SCAP caused by HAdV-7 in adults remains limited, though the pathogen has been adequately identified by metagenomic next-generation sequencing (mNGS).
Methods
We conducted a retrospective review of all patients with SCAP caused by HAdV-7 in immunocompetent adults admitted to Nanjing Drum Tower Hospital, a tertiary hospital in Nanjing, China, between July 2017 and April 2020. Clinical manifestation, laboratory findings, serial radiological characteristics, mNGS results, treatments and outcomes of these patients were collected and analyzed.
Results
A total of 7 SCAP patients with confirmed HAdV-7 infections were included. All patients were positive for HAdV-7 DNA fragments by mNGS for BALF and blood specimens. The median of the identified reads of two groups were 2783 and 1038, and the median coverage rates were 99.3% and 97.7%, respectively. All the patients were male and the median age was 23 years. High fever (100%), cough (57.14%) and dyspnea (100%) were the most frequent symptoms at admission. Laboratory data showed slightly decreased leucocytes but high procalcitonin and C-reactive protein levels. At early stage, with median 5 days from onset of illness, consolidation (85.71%) and patchy ground-glass opacity (GGOs) (85.71%) in unilateral lung were the most common findings in severe HAdV CAP. Within median 8 days after illness onset into progressive stage, consolidation developed and was the predominant finding in all patients, and 6 patients (85.71%) showed bilateral consolidations. In convalescent stage with median 18 days after illness onset, the parenchymal abnormalities began to absorb.
Conclusions
MNGS of blood or BALF could identify HAdV-7 infection accurately. Doctors should be aware of SCAP caused by HAdV-7 infection and perform mNGS as soon as possible when patients had persistent high fever, cough,decreased WBC༌high C-reactive protein and consolidation and GGO in unilateral or bilateral lungs shown by chest CT scan.
Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia
