Severe acute respiratory distress syndrome (ARDS) induced by human adenovirus B21: Report on 2 cases and literature review

Abstract

a b s t r a c t a r t i c l e i n f oSevere pneumonia and ARDS caused by human adenovirus B21 infections (HAdV-B21) is a rare, but a devastating disease with rapid progression to multiorgan failure and death. However, only a few cases were reported so far. Infections appear associated with increased disease severity and higher mortality in infected critically ill patients. Possible factors contributing to infection are underlying psychiatric disease resulting in institutionalization of respective patients, and polytoxicomania. Controlled data on the therapy of severe adenovirus infections are lacking and remains experimental. In conclusion, data on HAdV-B21 infections causing severe pneumonia or ARDS are scarce. Controlled clinical trials on the therapy of adenovirus pneumonia are non existent and thus there is no established therapy so far. ICU physicians should be aware of this potentially devastating disease and further studies are needed. (C.A. Pfortmueller), mariateresa.barbani@ifik.unibe.ch (M.T. Barbani), joerg.schefold@insel.ch (J.C. Schefold), heim.albert@mh-hannover.de (A. Heim), stefan.zimmerli@insel.ch (S. Zimmerli).

First Identification of Human Adenovirus Subtype 21a in China With MinION and Illumina Sequencers

“…As noted above, HAdV21 commonly leads to mild clinical symptoms such as fever, cough, shortness of breath, fatigue, nausea, rhinorrhea, and myalgia (Scott et al, 2016). However, HAdV21a is linked to severe pneumonia or acute respiratory distress syndrome, with some fatal outcomes (Hage et al, 2014;Pfortmueller et al, 2019).…”

“…Human adenovirus types 3, 4, 7, 11, 14, 21, and 55 are common AdV pathogens responsible for human respiratory tract infections or respiratory outbreaks in many regions (Lewis et al, 2009;Kajon et al, 2010;Li et al, 2014;Scott et al, 2016;Bautista-Gogel et al, 2019;Prusinkiewicz and Mymryk, 2019;Sammons et al, 2019;Zhang et al, 2019). Clinical symptoms caused by HAdVs are usually mild and self-limiting in healthy people; however, immunologically compromised individuals such as young children, elderly persons, and immunosuppressed patients might have a higher risk of severe disease and even death (Ison, 2006;Kandel et al, 2010;Lee et al, 2010;Scott et al, 2016;Pfortmueller et al, 2019). Notably, HAdV-associated respiratory outbreaks are commonly seen in closed population clusters, including schools and hospitals (Scott et al, 2016;Radke and Cook, 2018).…”

“…The circulation of human adenovirus type 21 (HAdV21) has been mainly documented in care facilities, military hospitals, or military recruit training centers (Hage et al, 2014;Kajon et al, 2015;Scott et al, 2016;Philo et al, 2018;Pfortmueller et al, 2019). Human adenovirus type 21 can cause upper respiratory tract infection, pneumonia, hemorrhagic cystitis, myocarditis, and encephalitis.…”

“…Human adenovirus type 21 infections or respiratory outbreaks have been reported in Germany (Hage et al, 2014), Denmark (Barnadas et al, 2018), Switzerland (Pfortmueller et al, 2019), Argentina (Barrero et al, 2012), and the United States (Kajon et al, 2015;Scott et al, 2016). However, respiratory infections due to HAdV21 or related strains have rarely been reported in China to date.…”

Adenovirus serotype 26 utilises sialic acid bearing glycans as a primary cell entry receptor

“…As pathogens, human adenoviruses (HAdV) have been isolated from severe infections in both immunocompromised and healthy individuals( 1, 2 ). Some adenoviruses have been associated with acute infection of the eye( 3 ), respiratory( 4, 5 ), and gastrointestinal tract( 1, 6 ). In rare cases infections prove fatal, as observed in a recent neonatal infection of HAdV-D56( 7 ), among adult patients in New Jersey with HAdV-B7d( 8 ), and infamously with HAdV-E4 where large epidemics of adenovirus infection have been seen in military recruits( 9, 10 ).…”