SESSION TYPE: Infectious Disease Case Report Posters I
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Adenovirus, a DNA virus, is most frequently associated with upper respiratory tract syndromes such as pharyngitis and coryza but can also cause pneumonia. It tends to affect infants and young adults but is rare to cause pneumonia in immunocompetent adults. Among adults, adenoviral disease typically occurs in military recruits and, occasionally, hospitalized patients.
CASE PRESENTATION: A 32 year old immunocompetent male developed high grade fevers of 103 F, chills and myalgia’s, productive cough and shortness of breath .He did not receive his flu vaccine last year. He presented to an outside hospital with worsening of symptoms and was found to have a right lower lobe pneumonia. He was treated with antimicrobial therapy for CAP and transferred to our facility. . His respiratory status continued to deteriorate and he was transferred to the ICU and intubated . His CXR showed bilateral consolidations. He was started on broad spectrum antimicrobial therapy. Blood work up including a HIV test and Hepatitis panel were found to be negative.. Immunoglobulin levels including IgG and IgM were found to be borderline low. . He underwent bronchoscopy and samples were sent for bacterial , viral and fungal cultures. RLL and LLL BAL samples grew adenovirus DNA > 2000000 colonies/ml. Infectious disease was consulted and they agreed that his presentation was consistent with adenovirus pneumonia. He was placed in droplet and contact isolation. His antimicrobials were continued for a total of 10 days to rule out any superimposed bacterial infection.
DISCUSSION: In adults adenovirus pneumonia tends to occur in immunocompromised hosts including BMT patients. Severe pneumonia progressing to respiratory failure in immunocompetent adults is rare. Patients with adenovirus pneumonia frequently present with bilateral pneumonia, high fever, hypoxia progressing to respiratory failure. T cell immunity is considered important for recovery from adenovirus infection.
CONCLUSIONS: In conclusion we present a rare case of adenovirus pneumonia in a young immunocompetent adult. Adenovirus infection tends to affect infants and children more and is seen more in immunocompromised hosts. Presentation of pneumonia with hypoxia progressing to respiratory failure in healthy immunocompetent adult is rare. Antiviral treatment regimen can be considered in patients who are immunocompromised and have severe disease. Immediate respiratory isolation should be initiated to prevent the spread of disease.
1) Severe adenovirus pneumonia in immunocompetent adults: a case report and review of the literature. Hakim FA, Tleyjeh IM. Eur J Clin Microbiol Infect Dis. 2008 Feb;27(2):153-8
DISCLOSURE: The following authors have nothing to disclose: Saad Khan, Kashif Hussain
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