Lung function in infants with chronic pulmonary disease after severe adenoviral illness

doi:10.1016/S0022-3476(99)70289-1

The Journal of Pediatrics

Volume 134, Issue 6, June 1999, Pages 730-733

https://doi.org/10.1016/S0022-3476(99)70289-1 Get rights and content

Abstract

Objective: To evaluate pulmonary function and bronchodilator responses in young children with chronic pulmonary disease (CPD) after a severe adenoviral lower respiratory tract infection. Methods: Pulmonary function tests were performed in 13 patients (mean age, 1.32 ± 0.8 years) with CPD and were compared with a control group of 13 healthy infants (mean age, 1.16 ± 0.4 years). Results: Respiratory rate, peak tidal expiratory flow (PTEF), PTEF/tidal volume, absolute time up to PTEF, time percentage to PTEF, volume percentage for PTEF, and compliance and resistance of the respiratory system were significantly affected in the CPD group. Similarly, maximal flow at functional residual capacity (V ́maxFRC) was 56.0 ± 42 mL/s and 373 ± 107 mL/s in the CPD and control groups, respectively (P = .001). No within-group differences with baseline values or between-group differences were noted in response to treatment with ipratropium bromide or albuterol. Conclusion: Young children with CPD caused by adenovirus have pulmonary function changes characterized by severe obstruction and diminished lung distensibility not responsive to the administration of inhaled ipratropium bromide or albuterol. (J Pediatr 134:730-3)

Section snippets

Population

Three hundred seventy of 2513 children admitted to the hospital because of acute lower respiratory tract infection in Buenos Aires from January 1993 until December 1994 were diagnosed with adenovirus infection by indirect immunofluorescence. Children evaluated at the Respiratory Disease Center of the Ricardo Gutiérrez Children’s Hospital, aged 3 years or younger, were eligible for the study if they had (1) CPD after a severe lower respiratory tract infection (tachypnea, increased chest

RESULTS

Children were enrolled between January 1994 and November 1995; 16 children met inclusion criteria, 3 of whom could not have PFTs performed because of low SaO₂ ² or a very high respiratory rate.¹ Accordingly, a total of 26 children (13 in the CPD group and 13 in the control group) were included in the study (Table I).

. Demographic and anthropometric characteristics in 13 young children with CPD and 13 control children

Empty Cell	CPD group (n = 13)	Control group (n = 13)
Age (y)	1.32 ± 0.8	1.16 ± 0.4
Sex (M/F)	5/8	9/4

DISCUSSION

During the past 30 years, there have been occasional reports of children who presented with severe adenoviral lower respiratory tract infection and experienced subsequent chronic respiratory insufficiency.15, 16 Since 1984, a new genome type of adenovirus (AV7h) has been associated with epidemic outbreaks of respiratory tract infection in Argentina and Chile.17, 18 The increased pathogenicity of this serotype, a potential host genetic susceptibility,¹⁹ or environmental factors might have

Acknowledgements

We thank Leland Fan, MD, Kenneth Rogers, MD, Alejandro Hoberman, MD, and David Orenstein, MD, for their helpful suggestions; and Marcela Linares, MD, for her assistance in performing PFTs.

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La bronchiolite oblitérante (BO) postinfectieuse est caractérisée par des phénomènes inflammatoires et fibrosants des petites voies aériennes succédant à un épisode infectieux pulmonaire et évoluant vers l’oblitération plus ou moins complète. C’est une cause rare de bronchopathie chronique obstructive, probablement sous-estimée, notamment pour les formes peu étendues. Les formes cliniques diffèrent entre l’enfant et l’adulte. Chez l’enfant, l’adénovirus est le principal agent infectieux en cause, notamment les sérotypes 3,7 et 21 qui sont les plus virulents. Le polymorphisme clinique et radiologique est important avec un pronostic fonctionnel qui dépend de l’extension des lésions pulmonaires. Le diagnostic repose sur la confrontation des données anamnestiques, tomodensitométriques et fonctionnelles. Le traitement est symptomatique et les formes les plus sévères évoluant vers l’insuffisance respiratoire chronique. Chez l’adulte, la fréquence des lésions obstructives définitives est mal connue. Une atteinte parenchymateuse est souvent associée, réalisant un tableau de BO avec pneumonie en voie d’organisation. Cette association modifie la présentation clinique et l’aspect radiologique du tableau infectieux initial et pose souvent de difficile problème de prise en charge. Certains auteurs ont rapporté des cas cliniques avec efficacité présumée d’une corticothérapie systémique mais les données sont parcellaires.
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^☆: Reprint requests: Alejandro M. Teper, MD, Centro Respiratorio, Hospital de Niños “R. Gutiérrez,” Vidt 1956 Piso 1° (1425), Buenos Aires, Argentina.

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Lung function in infants with chronic pulmonary disease after severe adenoviral illness☆,☆☆

Abstract

Section snippets

Population

RESULTS

DISCUSSION

Acknowledgements

Chest

J Virol Methods

J Pediatr

Chest

Chest

J Pediatr

J Pediatr

Severe respiratory syncytial virus infection: clinical features, nosocomial acquisition and outcome

Pediatr Infect Dis J

Parainfluenza virus bronchiolitis

Am J Dis Child

Chronic pulmonary complications of early influenza virus infection in children

Am Rev Respir Dis

Severe illness due to adenovirus type 7 in children

Acta Paediatr Scand

Pediatric pulmonary disease: assessment with high-resolution ultrafast CT

Radiology

Casos fatales de infección por adenovirus

Rev Chil Pediatr

Molecular epidemiology of adenoviruses associated with acute lower respiratory disease of children in Buenos Aires, Argentina (1984-1988)

J Med Virol