Terapevticheskii arkhiv · 2014
[Adenovirus pneumonia with a fatal outcome in adults].
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Yatsyshina S B, Samchuk V V, Vasilyev V V, Ageeva M R, Vorobyeva N S, Savochkina Yu A, Bulanenko V P, Shipulin G A, Maleev V V
Аннотация
AIM: To retrospectively analyze the medical records of patients who have died from complications of community-acquired pneumonia (CAP) caused by adenovirus serotype 7.
SUBJECTS AND METHODS: CAP was diagnosed in patients (6 men aged 19-24 years and 1 woman aged 49 years) on the basis of clinical, laboratory, and radiological findings. Adenoviral pneumonia was established by real-time polymerase chain reaction (PCR). Adenovirus DNA was detected in the patients' autopsy samples (lungs, brain, spleen, liver, blood). The adenoviruses were referred to as B1 serotype 7 on the basis of hexone gene sequencing results. Other potential causative agents of pneumonia were excluded by a battery of molecular genetic tests for a wide range of viral and bacterial pathogens of acute respiratory tract infections.
RESULTS: In all cases, the disease began acutely with fever (37.8 to 39 °C), weakness, headache, a sore throat, a dry, unproductive cough or runny nose. Clinical deterioration during symptomatic therapy led to hospital admission for CAP on disease days 2-11. The patients continued to feel worse during massive antibiotic therapy, by switching a drug one to six times and by simultaneously using 2-4 antibiotics and intensive therapy. Death occurred on disease days 10-24. Postmortem examination of all the patients revealed acute respiratory distress syndrome and multiple organ failure.
CONCLUSION: Adenovirus pneumonia causes diagnostic and therapeutic problems for clinicians. The clinical introduction of PCR methods for the diagnosis of viral infections allow the clinicians to elaborate and timely use effective management tactics in patients with adenoviral pneumonia and to prevent their death. It is necessary to design etiotropic therapy agents and to introduce the specific prevention of adenovirus infection in risk groups.
SUBJECTS AND METHODS: CAP was diagnosed in patients (6 men aged 19-24 years and 1 woman aged 49 years) on the basis of clinical, laboratory, and radiological findings. Adenoviral pneumonia was established by real-time polymerase chain reaction (PCR). Adenovirus DNA was detected in the patients' autopsy samples (lungs, brain, spleen, liver, blood). The adenoviruses were referred to as B1 serotype 7 on the basis of hexone gene sequencing results. Other potential causative agents of pneumonia were excluded by a battery of molecular genetic tests for a wide range of viral and bacterial pathogens of acute respiratory tract infections.
RESULTS: In all cases, the disease began acutely with fever (37.8 to 39 °C), weakness, headache, a sore throat, a dry, unproductive cough or runny nose. Clinical deterioration during symptomatic therapy led to hospital admission for CAP on disease days 2-11. The patients continued to feel worse during massive antibiotic therapy, by switching a drug one to six times and by simultaneously using 2-4 antibiotics and intensive therapy. Death occurred on disease days 10-24. Postmortem examination of all the patients revealed acute respiratory distress syndrome and multiple organ failure.
CONCLUSION: Adenovirus pneumonia causes diagnostic and therapeutic problems for clinicians. The clinical introduction of PCR methods for the diagnosis of viral infections allow the clinicians to elaborate and timely use effective management tactics in patients with adenoviral pneumonia and to prevent their death. It is necessary to design etiotropic therapy agents and to introduce the specific prevention of adenovirus infection in risk groups.