Department of Infectious Disease, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, 3333 Binsheng Road, Hangzhou, 310052, China.
Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, 3333 Binsheng Road, Hangzhou, 310052, China.
Virol J. 2021 Nov 29;18(1):234. doi: 10.1186/s12985-021-01705-x.
HAdV is one of the common pathogens in hospitalized children with acute respiratory infections (ARIs). We aim to describe the clinical and laboratory features, epidemiological characteristics, and HAdV species and/or types of inpatients with HAdV respiratory infections.
Respiratory samples were gathered from inpatients diagnosed ARIs in Children's Hospital, Zhejiang University School of Medicine, and were detected by using Direct Immunofluorescence Assay from 2018 to 2019. PCR amplification and sequencing of the hypervariable zone of hexon gene were used for genotyping. The clinical and laboratory features, and HAdV genotyping, and epidemiological characteristic analysis were retrospectively performed.
Of 7072 samples collected, 488 were identified as HAdV-positive. The overall detection rate was 6.9%. The peaked detection rate was 14.1% in January 2019. HAdV-positive cases with ARIs mainly appeared in winter. The detection rate was highest among children between 6 months and 2 years (8.7%, 123/1408). Clinical diagnosis included pneumonia (70.3%, 343/488), bronchitis (7.0%, 34/488) and acute upper respiratory tract infection (22.7%, 111/488). The common clinical manifestations were fever (93.4%, 456/488), cough (94.7%, 462/488), wheezing (26.2%, 128/488), and shortness of breath (14.8%, 72/488). 213 (43.6%) cases had co-infection and 138 (28.3%) cases had extrapulmonary symptoms. 96(19.7%) cases had intrapulmonary and intrathoracic complications.78 (16.0%) had an underlying condition, most of which were congenital heart diseases (20.5%, 16/78). The proportions of hyperpyrexia, duration of fever > 10 days, severe pneumonia, and wheezing in the co-infection group were remarkably higher than those in HAdV single-infection group (all p < 0.05). The proportions of duration of hospitalization, duration of fever > 10 days, wheezing, shortness of breath, change in level of consciousness, serosal fluids, extrapulmonary symptoms, co-infections and underlying diseases were significantly higher in severe pneumonia group than those in the mild pneumonia group (all p < 0.05). Four HAdV species were successfully identified in 155 cases and presented by 8 genotypes. HAdV-B3 (56.1%, 87/155) and HAdV -B7 (31.0%, 48/155) were the most predominant detected types and occurred commonly in different severity groups (p = 0.000), while, HAdV-B55 was detected only in the severe group. HAdV-B7's detection rate in the severe pneumonia group was significantly higher than the non-severe pneumonia group.
HAdV detection rate is related to age and season. Bronchopneumonia accounts for about 70% HAdV-positive inpatients. The common clinical manifestations include hyperpyrexia, cough, wheezing, and shortness of breath. HAdV-B3 and HAdV-B7 are the most common types in children diagnosed with respiration infections.
人腺病毒（HAdV）是引起住院儿童急性呼吸道感染（ARI）的常见病原体之一。本研究旨在描述住院呼吸道感染患儿的临床和实验室特征、流行病学特征以及 HAdV 种属和/或型别。
2018 年至 2019 年，我们从浙江大学医学院附属儿童医院确诊为 ARI 的住院患者中采集呼吸道样本，并采用直接免疫荧光法进行检测。采用聚合酶链反应（PCR）扩增和六邻体基因高变区测序进行基因分型。回顾性分析临床和实验室特征、HAdV 基因分型和流行病学特征。
在采集的 7072 份样本中，488 份被鉴定为 HAdV 阳性，总检出率为 6.9%。检出率最高的是 2019 年 1 月的 14.1%。HAdV 阳性的 ARI 患儿主要出现在冬季。6 个月至 2 岁的儿童检出率最高（8.7%，123/1408）。临床诊断包括肺炎（70.3%，343/488）、支气管炎（7.0%，34/488）和急性上呼吸道感染（22.7%，111/488）。常见的临床症状包括发热（93.4%，456/488）、咳嗽（94.7%，462/488）、喘息（26.2%，128/488）和呼吸急促（14.8%，72/488）。213 例（43.6%）患儿合并感染，138 例（28.3%）患儿出现肺外症状。96 例（19.7%）患儿出现肺部和胸腔内并发症。78 例（16.0%）患儿存在基础疾病，其中先天性心脏病最多（20.5%，16/78）。在合并感染组中，高热、发热持续时间>10 天、重症肺炎和喘息的比例明显高于 HAdV 单一感染组（均 P<0.05）。在重症肺炎组中，住院时间、发热持续时间>10 天、喘息、呼吸急促、意识水平改变、浆膜腔积液、肺外症状、合并感染和基础疾病的比例明显高于轻症肺炎组（均 P<0.05）。在 155 例成功鉴定 HAdV 种属的病例中，共发现 8 种基因型，其中 HAdV-B3（56.1%，87/155）和 HAdV-B7（31.0%，48/155）是最主要的两种检测类型，在不同严重程度组中均较常见（P=0.000），而 HAdV-B55 仅在重症组中检出。HAdV-B7 在重症肺炎组中的检出率明显高于非重症肺炎组。
HAdV 的检出率与年龄和季节有关。支气管肺炎占 HAdV 阳性住院患儿的 70%左右。常见的临床表现包括高热、咳嗽、喘息和呼吸急促。HAdV-B3 和 HAdV-B7 是儿童呼吸道感染最常见的类型。
