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Ten Cases of Severe Adenoviral Pneumonia in the Spring 1995

Journal of the Korean Pediatric Society 1996;39(9):1247-1253.
Published online September 15, 1996.
Ten Cases of Severe Adenoviral Pneumonia in the Spring 1995
Jeong Hee Kim1, Sang Il Lee1, Mun Hyang Lee1, I Seok Kang1, Heung Jae Lee1, Bo Kyung Kim1, Yeon-Lim Suh2
1Department of Pediatrics, Samsung Medical Center, Seoul, Korea
2Department of Diagnostic Pathology, Samsung Medical Center, Seoul, Korea
1995년 봄에 발생한 세균성 폐렴 양상의 아데노바이러스 폐렴
김정희1, 이상일1, 이문향1, 강이석1, 이흥재1, 서연림1, 김보경2
1삼성의료원 소아과
2삼성의료원 진단방사선과
Abstract
Purpose
: In the Spring 1995, there was an outbreak of adenoviral infection, which caused four death out of ten patients with adenoviral pneumonia in our hospital. Clinical courses of ten patients with severe pneumonia were similar each other, and two were confirmed as adenoviral pneumonia by postmortem autopsy. Although not proven, we believe eight patients had adenoviral pneumonia. Therefore, we report clinical features in ten cases of severe adenoviral pneumonia.
Methods
: Two cases with adenoviral pneumonia and eight cases with presumed adenoviral pneumonia were admitted in this hospital from March to June, 1995. Age and sex distribution, clinical manifestations, laboratory data, chest X-ray findings were reviewed.
Results
: They were young children between 4 to 25 months of age(mean 12.7¡¾6.1 months), and male to female ratio was 9:1. They presented with abrupt fever, cough, tachypnea, and dyspnea. Mean duration of fever were 12.7¡¾6.1 days. Crackles on auscultation were heard in all patients. Studies for Mycoplasma and Tuberculosis were all negative. Cultures of bacteria and fungi were negative, and they did not respond to the antibiotics. The chest X-ray revealed the diffuse lobar consolidation with varying amount of pleural effusions. The findings of pleural fluid showed characteristics of transudate with predominant monocyte. Eight of our severe adenoviral pneumonia patients were enjoying normal health previously. Only two patients had previous medical problems, one with chronic cytomegalovirus pneumonia and the other with neutropenia induced by phenobarbital. The course of illness suggests that the infection was hospital acquired and the final outcome was fatal. Three of them developed seizure with fever, five change of consciousness, four conjunctivitis, three otitis media, and two gastro-intestinal symptoms. Autopsy was done in two of four patients. Grossly, the lungs were heavy and dark- red in color. There were bilateral pneumonic consolidation with patchy areas of hemorrhage. Microscopically, severe necrotizing bronchitis and bronchiolitis with numerous intranuclear inclusion of Cowdry type A and B were found. Alveoli were edematous and filled with fibrinous exudate, and covered with hyaline membrane. Ultrastructurally, typical adenoviral particles showing hexagonal shape in paracrystalline array symmetry were found in the nucleus of aleveolar lining cells.
Conclusion
: Yet, occasionally, adenoviral infection becomes most aggressive form of pneumonia. We should consider adenoviral pneumonia when clinical findings of pneumonia are very similar with baterial pneumonia except poor response to broad spectrum antibiotics. There is no specific treatment for adenoviral infection. So, for prevention of adenoviral pneumonia, we recommend isolation in suspicious adenoviral infection.
Key Words: Adenovirus, Pneumonia


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