Title : Severe adenovirus infection in an immunocopemtment host
Abstract:
Adenovirus is a frequent cause of mild respiratory tract infection and gastroenteritis in children, it can cause severe respiratory illness in immunocompromised patients. Outbreaks and aggressive respiratory symptoms have been reported in military camps. Epidemics are well known to occur in close or crowded settings.
We report a case of severe adenovirus pneumonia in a young 38 year old immunocompetent female who lives in a refugee camp in Co. Wexford. Ireland. She presented with fever associated with mild respiratory symptoms that progressed rapidly to severe pneumonia with bilateral consolidation on chest x ray and ground glass opacities on high resolution Computed tomography.
On admission, she was febrile at 40oC, other vital signs were normal, she did not require oxygen support. Initial bloods showed high C – reactive protein with normal White Cell counts and differential and Chest X ray showed patchy right lower lobe infiltration. Full cultures, throat swab, Pneumococcal and legionella urinary antigen in addition to viral serology and immunoglobulin levels were requested, and she was started on broad spectrum antibiotics. 48 hours later, she deteriorated clinically and required oxygen support, she was continuously spiking fever and her chest x ray showed worsening of the pneumonic patches to multilobar pneumonia. By day 4 of admission, she required high flow oxygen with Fi02 up to 80 % to maintain her partial pressure of oxygen around 10. High resolution CT thorax showed multiple ground glass opacities. Echocardiography excluded any cardiogenic causes for her respiratory deterioration. Adenovirus was detected in the nasopharyngeal swab with adenovirus PCR DNA of 1.31x10^7 in serum. Sputum culture and serial blood cultures were negative .Tuberculosis cultures and B-D glucan level / galactomannan level were negative. Serum immunoglobulins and HIV test were negative. HBA1c was normal. Our patient improved successfully, she recovered by day 15 with supportive management, no antiviral was given.
Severe adenovirus infection is rare in immunocompetent adults. This case demonstrates a rapidly progressive respiratory course. Specific groups including refugee camps, military recruits etc, should be evaluated and assessed cautiously to prevent outbreak and poor outcomes. Signs of mild viral illness in the population should be handled carefully with a high index of suspicion and early isolation of specific groups including immunocompromised patients is advisable.
