Adenovirus-associated pneumonia in South African children : presentation, clinical course and outcome

Master Thesis


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University of Cape Town

Background: Pneumonia is an important cause of morbidity and mortality in children. Viruses have emerged as important aetiological agents in childhood pneumonia. The aim of this study was to document the clinical presentation, severity and outcome of adenoviral-associated pneumonia (AVP) in children and identify risk factors associated with poor outcome. Methods: A retrospective study of laboratory-confirmed AVP cases was conducted between 1 January and 31 December 2011. The medical records of adenovirus PCR positive respiratory tract samples identified through the National Health Laboratory Service (NHLS) database were retrieved. Demographic, clinical and outcomes data of children with AVP were extracted and analysed. Outcome measures were death and development of chronic lung disease (CLD). Results: 1910 respiratory samples were submitted to the NHLS from which 206/1910 (11%) AVP cases were identified. The median age was 12 months (IQR 6-24), 70 (34%) children were malnourished and 14 (7%) HIV-infected. Fever was the commonest presenting symptom occurring in 159 (77%) of cases. Seventy six (37%) required intensive care unit (ICU) admission. There was a high prevalence of co-morbid conditions with 98 (47%) having at least one; cardiac disease was the most common (48 (23%). Twenty nine (14%) developed CLD which was associated with hypoxia at presentation (26/29, 90%, p = 0.01) and admission to ICU (18/29, 62%, p < 0.01). Eighteen (9%) children died. Admission to ICU (OR 8.3, 95% CI 2.3-29.0) and blood stream infection (OR 11.2; 95% CI 2.3-54.1) were independent risk factors for mortality. Conclusion: Adenoviral-associated pneumonia is an important cause of pneumonia and CLD in young children in South Africa. Admission to ICU and blood stream infection were associated with poor outcome

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