Clinical characteristics and half-year outcomes of 53 children with severe adenovirus pneumonia complicated with encephalitis or encephalopathy

Abstract The clinical characteristics and prognosis of children with human adenovirus pneumonia complicated with encephalitis or encephalopathy remain unclear. We analyzed clinical datas of 53 children who were admitted to the Respiratory Department of Children's Hospital o f Chongqing Medical University in 2019 with severe adenovirus pneumonia and complicated with viral encephalitis or encephalopathy retrospectively, and 78 cases diagnosed with severe adenovirus pneumonia but without encephalitis or encephalopathy were selected as controls. Among the 53 children, 32 (60.4%) were males with a median age of 18.0(7.5-37.0) months. All of them had fever and cough, and the median fever duration was 12.0(9.5-15.0) days, 90.6%(48/53) had listlessness, 62.3%(33/53) had dysphoria, 47.2%(25/53) had hypersomnia, 13.2%(7/53) had seizure, and 30.2%(16/53) had positive signs in nervous system physical examination. The median leukocyte count of children with encephalitis or encephalopathy was 7.39 (3.53-10.73) *10^9/L, the median procalcitonin was 1.885(0.390-4.555)ng/ml, and the median lactate dehydrogenase was 980.50 (516.40-1938.00) U/L, these were significant differences compared with the control group ( P values were 0.011, 0.001, 0.000), but there was no difference in nasopharyngeal adenovirus load. Children with encephalitis or encephalopathy are more likely to be complicated with leukopenia, hypoproteinemia, liver function impairment, coagulopathy, anemia, pleural effusion, abdominal effusion, hemophagocytic lymphohistiocytosis. 75.47% (40/53) of the children needed mechanical ventilation, and the rate of tracheal intubation and mechanical ventilation time were significantly increased compared with the control group ( P values were 0.039, 0.000). The rates of gamma globulin, albumin and blood transfusion were 92.45% (49/53), 52.83% (28/53) and 26.42% (14/53), which were significantly higher than those in the control group ( P values were 0.004, 0.000, 0.028). At the follow-up of half a year later, 35.85% (19/53) showed obliterative bronchiolitis, which was significantly higher than 11.54% (9/78) in the control group ( c2 =11.098, P =0.001), and there was no obvious sequelae in the nervous system. Conclusion It is necessary to be aware of the possibility of encephalitis/encephalopathy in children with severe adenovirus pneumonia when the consciousness state changes such as listlessness. The clinical manifestations of these children are severe and the prognosis of the nervous system is not bad, but the incidence of bronchiolitis obliterans is high in the later stage.