Yoon Hee, Jhun Byung Woo, Kim Hojoong, Yoo Hongseok, Park Sung Bum
Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2017 Feb;32(2):287-295. doi: 10.3346/jkms.2017.32.2.287.
Adenovirus (AdV) can cause severe pneumonia in non-immunocompromised host, but limited data exist on the distinctive characteristics of AdV pneumonia in non-immunocompromised patients. We evaluated distinctive clinico-laboratory and radiological characteristics and outcomes of AdV pneumonia (n = 179), compared with non-AdV pneumonia (n = 188) in Korean military personnel between 2012 and 2016. AdV pneumonia patients had a higher rate of consolidation with ground-glass opacity (101/152) in lobar distribution (89/152) on computed tomography (CT) (P < 0.001). Laboratory findings showed a higher incidence of unusual blood profiles such as leukopenia (55/179, P < 0.001) or thrombocytopenia (100/179, P < 0.001). The patients had more systemic symptoms such as myalgia (82/179, P = 0.001) or diarrhea (23/179, P < 0.001), compared with non-AdV pneumonia patients. Bacterial co-infection was identified in 28.5% of AdV pneumonia. Most of the AdV isolates typed (69/72, 95.8%) were AdV-55. Patients with a pneumonia severity index ≥ class III were more commonly observed in AdV pneumonia patients compared with non-AdV pneumonia patients (11.2% vs. 2.1%, P < 0.001), and time to clinical stabilization from admission was longer in the AdV pneumonia patients compared with the non-AdV pneumonia patients (3.8 vs. 2.6 days, P < 0.001). Mechanical ventilation (n = 6) was only required in AdV pneumonia patients, one of whom died due to AdV-55. Our data showed that AdV pneumonia in non-immunocompromised patients had distinct characteristics and most of the isolates typed in our study were AdV-55. It is suggested that AdV-55 is an important pathogen of pneumonia in Korean military personnel.
腺病毒（AdV）可在非免疫功能低下宿主中引起严重肺炎，但关于非免疫功能低下患者腺病毒肺炎的独特特征的数据有限。我们评估了2012年至2016年期间韩国军人中腺病毒肺炎（n = 179）与非腺病毒肺炎（n = 188）独特的临床实验室、影像学特征及预后。腺病毒肺炎患者在计算机断层扫描（CT）上出现肺叶分布的实变伴磨玻璃影（101/152）的比例更高（89/152）（P < 0.001）。实验室检查结果显示，白细胞减少（55/179，P < 0.001）或血小板减少（100/179，P < 0.001）等异常血液指标的发生率更高。与非腺病毒肺炎患者相比，这些患者有更多的全身症状，如肌痛（82/179，P = 0.001）或腹泻（23/179，P < 0.001）。28.5%的腺病毒肺炎患者存在细菌合并感染。大多数分型的腺病毒分离株（69/72，95.8%）为AdV - 55。与非腺病毒肺炎患者相比，肺炎严重指数≥Ⅲ级的患者在腺病毒肺炎患者中更常见（11.2%对2.1%，P < 0.001），且腺病毒肺炎患者从入院到临床稳定的时间比非腺病毒肺炎患者更长（3.8天对2.6天，P < 0.001）。仅腺病毒肺炎患者需要机械通气（n = 6），其中1例因AdV - 55死亡。我们的数据表明，非免疫功能低下患者的腺病毒肺炎有独特特征，且我们研究中大多数分型的分离株为AdV - 55。提示AdV - 55是韩国军人肺炎的重要病原体。
