Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 15;13(10):e0205795.
doi: 10.1371/journal.pone.0205795. eCollection 2018.

Epidemiology, clinical presentation and respiratory sequelae of adenovirus pneumonia in children in Kuala Lumpur, Malaysia

Limin Li  1 , Yen Yen Woo  2 , Jessie Anne de Bruyne  1 , Anna Marie Nathan  1 , Sze Ying Kee  3 , Yoke Fun Chan  2 , Chun Wei Chiam  2 , Kah Peng Eg  1 , Surendran Thavagnanam  1 , I-Ching Sam  2
Affiliations

Epidemiology, clinical presentation and respiratory sequelae of adenovirus pneumonia in children in Kuala Lumpur, Malaysia

Limin Li et al. PLoS One. .

Erratum in

Abstract

Objectives: To describe the severity, human adenovirus (HAdV) type and respiratory morbidity following adenovirus pneumonia in children.

Methodology: Retrospective review of children under 12 years of age, admitted with HAdV pneumonia, between January 2011 and July 2013, in a single centre in Malaysia. HAdV isolated from nasopharyngeal secretions were typed by sequencing hypervariable regions 1-6 of the hexon gene. Patients were reviewed for respiratory complications.

Results: HAdV was detected in 131 children of whom 92 fulfilled inclusion criteria. Median (range) age was 1.1 (0.1-8.0) years with 80% under 2 years. Twenty percent had severe disease with a case-fatality rate of 5.4%. Duration of admission (p = 0.02) was independently associated with severe illness. Twenty-two percent developed respiratory complications, the commonest being bronchiolitis obliterans (15.2%) and recurrent wheeze (5.4%). The predominant type shifted from HAdV1 and HAdV3 in 2011 to HAdV7 in 2013. The commonest types identified were types 7 (54.4%), 1(17.7%) and 3 (12.6%). Four out of the five patients who died were positive for HAdV7. Infection with type 7 (OR 8.90, 95% CI 1.32, 59.89), family history of asthma (OR 14.80, 95% CI 2.12-103.21) and need for invasive or non-invasive ventilation (OR 151.84, 95% CI 9.93-2.32E) were independent predictors of respiratory complications.

Conclusions: One in five children admitted with HAdV pneumonia had severe disease and 22% developed respiratory complications. Type 7 was commonly isolated in children with severe disease. Family history of asthma need for invasive or non-invasive ventilation and HAdV 7 were independent predictors of respiratory complications.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow of the 92 patients with adenovirus pneumonia.
Fig 2
Fig 2. A sharp increase in the number of adenovirus infections as well as an increase in the number of severe cases was detected in 2013.
Fig 3
Fig 3. Changing human adenovirus types detected over the study period (Jan 2011 to July 2013).
As HAdV3 and HAdV1 declined, HAdV7 increased to become the predominant circulating type.
Fig 4
Fig 4
Phylogenetic analysis of partial hexon genes of human adenovirus of species B (A, 767 bases analysed) and species C (B, 800 bases). The maximum likelihood trees were constructed using the general time reversible model with proportion of invariant sites, and inferred following bootstrap analyses using 1000 replicates. Strain names are in the format: accession number_adenovirus type_strain name_country of isolation_year of isolation. The Malaysian sequences from this study are coloured red (with respiratory complications) or blue (without respiratory complications).
Fig 5
Fig 5. Respiratory sequelae of the 92 patients with adenovirus pneumonia.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Castro-Rodriguez JA, Daszenies C, Garcia M, Meyer R, Gonzales R (2006) Adenovirus pneumonia in infants and factors for developing bronchiolitis obliterans: a 5-year follow-up. Pediatr Pulmonol 41;(10):947–953. 10.1002/ppul.20472 - DOI - PubMed
    1. Tabain I, Ljubin-Sternak S, Cepin-Bogovic J, Markovinovic L, Knezovic I, Mlinaric-Galinovic G (2012) Adenovirus respiratory infections in hospitalized children: clinical findings in relation to species and serotypes. Pediatr Infect Dis J 31;(7):680–684. 10.1097/INF.0b013e318256605e - DOI - PubMed
    1. Hashimoto S, Gonzalez G, Harada S, Oosako H, Hanaoka N, Hinokuma R, et al. (2018) Recombinant type Human mastadenovirus D85 associated with epidemic keratoconjunctivitis since 2015 in Japan. J Med Virol 90;(5):881–889. 10.1002/jmv.25041 - DOI - PubMed
    1. Group HAW (2017). http://hadvwg.gmu.edu
    1. Foong Ng K, Kee Tan K, Hong Ng B, Nair P, Ying Gan W (2015) Epidemiology of adenovirus respiratory infections among hospitalized children in Seremban, Malaysia. Trans R Soc Trop Med Hyg 109;(7):433–439. 10.1093/trstmh/trv042 - DOI - PubMed

Publication types

MeSH terms

Grants and funding

This study was funded by University Malaya (Research Grant UM.TNC2/RC/HTM/RP026-14HTM to AMN, Postgraduate Research Grant PO027-2015A to YYW and High Impact Research Grant UM.C/625/1/HIR/MOHE/MED/42 to ICS. The funders had no role in the study design, data collection and analysis, decision to publish nor preparation of the manuscript.