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Fatal Household Transmission of Human Adenovirus Type 55

时间:2019-08-18 17:40 作者:未知
 

 

 

Human Adenovirus Type 55 Causes Fatal Acute Respiratory Disease with Household Transmission. Emerg Infect Dis. 2019, 25(9): 1754-1756.

Human adenoviruses are associated with mild and acute respiratory infections, depending on the virus type and host immunity. Human adenovirus type 55 (HAdV-55) (1), formerly known as HAdV-11a (2), is a reemergent respiratory pathogen that has caused severe pneumonia outbreaks in military and civilian populations in Europe and Asia (27). However, household transmission of HAdV-55 is rarely reported. We report a case of household transmission of HAdV-55 involving 3 confirmed adult cases with 1 death. Epidemiologic, clinical, and laboratory investigations, along with whole genome sequencing, elucidate the disease progression and the pathogen origin.
During April 1–May 5, 2012, 7 household members (5 males and 2 females; 3 children and 4 adults) in Anhui Province, China sequentially experienced influenza-like symptoms, including fever, productive cough, fatigue, pharyngalgia, dyspnea, and other symptoms. The youngest patient was 4 months of age, the oldest, whom we refer to as AQ-1, was a 55-year-old man. The family lived together near a farm in a house with poor sanitary and ventilation conditions.The first onset of acute respiratory disease (ARD) occurred on April 1, when the index case, a 4-year-old granddaughter of AQ-1, had a febrile respiratory infection with cough. Three days later, AQ-1’s grandson, 1 year of age, displayed similar symptoms. On April 9 and 11, AQ-1’s daughter, 28 years of age, and another grandson, 4 months of age, both had influenza-like symptoms. On April 14, AQ-1 had a fever, chills, and lumbago. He was admitted to the hospital on April 14 where clinicians diagnosed pneumonia. AQ-1 had close contact with his sick grandsons and granddaughter and had not been out of the house during the month he cared for them.While hospitalized, AQ-1 had bilateral pneumonia seen on chest computed tomography (CT), temperature of 41.0°C, and low total leukocyte (3.63 × 109/L) and platelet (42 × 109/L) counts. AQ-1 sustained high fever and yellow phlegm despite anti-inflammatory and antiviral treatment, including levofloxacin, piperacillin sodium, tazobactam sodium, and ribavirin.On April 24, AQ-1 had indications of severe pneumonia, including respiratory failure, hypoxemia, double lung rales, and a mass of shadows visible on chest CT. In addition, he had indications of liver damage and multi-organ failure. Transverse chest CT images demonstrated increased areas of patchy shadows and consolidation in both lungs compared to CT images from April 22, indicative of disease progression (AppendixFigure 1).Appendix Figure 1. Chest computed tomography (CT) findings of case-patient AQ-1 who died fromacute respiratory disease associated with human adenovirus 55 infection. A) and B) Upper and lowerchest fields on April 22, day 8 after illness onset. Transverse CT images in the parenchymal window showill-defined patchy and ground-glass opacities in all lobes of right lung and upper lobe of left lung andconsolidation of lower lobe in left lung, suggestive of inflammatory exudation changes. Air-bronchogramcan be found within the consolidation area. Note the slightly thickened right-sided pleura. C) and D)Upper and lower chest fields on the case-patient on April 24, day 10 after illness onset. Thecorresponding transverse CT images in the parenchymal window demonstrate increased areas of patchyopacities and consolidation in the bilateral lungs, as well as more obviously thickened right-sided pleura,indicative of the progression of disease.AQ-1 died on April 27, 3 days after onset of respiratory failure, and 13 days after his illness began. On the same day, his 20-year-old son, AQ-2, and 31-year-old nephew, AQ-3, who had taken care of AQ-1 for 5 days, also exhibited symptoms of influenza-like illness. Both were hospitalized and had normal chest CT scans, but AQ-2’s leukocyte count was 5.4 × 109/L and AQ-3’s was 6.7 × 109/L. After antiinflammatory and antiviral treatment, including vitamin C, sulbactam, amoxicillin, amikacin, cefoperazone, ribavirin, and oseltamivir, they recovered and were discharged on May 5 (Figure).