Journal Article

Pediatric adenovirus pneumonia: clinical practice and current treatment

Zhu, Yiting, Qiu, Xinhui, Gao, Fei, Jin, Wenwen, Yuan, Hao, Zhang, Jie, Li, Jianshun, Lin, Wei, Zhou, Yiyang

2023

Overview

Graphical abstract In this review, we lay emphasis on the pathogenic mechanism, early recognition and treatment strategies of severe pediatric adenovirus pneumonia. The pathogenic mechanism of adenovirus is divided into three parts, direct damage to the target cells, inflammatory cytokines release and immune evasion of the virus. Indicators including age, clinical manifestations, imaging features and laboratory tests play an essential role in the early identification. Current treatment strategies are comprised of anti-viral drugs, respiratory support and bronchoscopy, continuous blood purification, immuno-regulation therapy and supportive care. Adenovirus pneumonia is common in pediatric upper respiratory tract infection, which is comparatively easy to develop into severe cases and has a high mortality rate with many influential sequelae. As for pathogenesis, adenoviruses can directly damage target cells and activate the immune response to varying degrees. Early clinical recognition depends on patients’ symptoms and laboratory tests, including those under 2 years old, dyspnea with systemic toxic symptoms, atelectasis or emphysema in CT image, decreased leukocytes, and significantly increased C-reaction protein (CRP) and procalcitonin (PCT), indicating the possibility of severe cases. Until now, there is no specific drug for adenovirus pneumonia, so in clinical practice, current treatment comprises antiviral drugs, respiratory support and bronchoscopy, immunomodulatory therapy, and blood purification. Additionally, post-infectious bronchiolitis obliterans (PIBO), hemophagocytic syndrome, and death should be carefully noted. Independent risk factors associated with the development of PIBO are invasive mechanical ventilation, intravenous steroid use, duration of fever, and male gender. Meanwhile, hypoxemia, hypercapnia, invasive mechanical ventilation, and low serum albumin levels are related to death. Among these, viral load and serological identification are not only “gold standard” for adenovirus pneumonia, but are also related to the severity and prognosis. Here, we discuss the progress of pathogenesis, early recognition, therapy, and risk factors for poor outcomes regarding severe pediatric adenovirus pneumonia.

• Publisher: Frontiers Media SA,Frontiers Media S.A
• Subject: Adenoviruses / Chronic obstructive pulmonary disease / Cytokines / early recognition / Endocytosis / Epidemiology / Genomes / Immune system / Medicine / Mortality / Pathogenesis / Pathogens / pediatric / Pediatrics / Pneumonia / prognosis / Proteins / severe adenovirus pneumonia / Surfactants / therapy / Viral infections / Viruses