Adenovirus Pneumonia in Immunocompetent Adult

Case Report

Austin Crit Care J. 2014;1(1): 2.

Adenovirus Pneumonia in Immunocompetent Adult

Saad Khan and Kashif Hussain*

West Virginia University Hospital, USA

*Corresponding author: Kashif Hussain, West Virginia University Hospital, USA

Received: July 31, 2014; Accepted: September 05, 2014; Published: September 08, 2014

Abstract

Pneumonia in immune competent adults is rare and has been described in literature as a much more common entity in immune compromised individuals. It presents as a nonspecific viral illness which can cause severe respiratory distress and lead to respiratory failure. Early detection is essential and diagnosis should be considered in patients not responding to antimicrobial therapy. More than 80 % of the adenovirus infection occurs in children less than 4 years old. Immune compromised individuals are more susceptible to this infection. We report a case of severe adenovirus pneumonia in a young healthy immune competent adult who developed respiratory distress leading to respiratory failure.

More studies need to be conducted to understand the pathophysiology and triggering factors leading to severe adenovirus infections in individuals Adenovirus.

Introduction

Adenovirus is non enveloped lytic DNA virus and was first isolated in 1950 in adenoid tissue- derived cell cultures. Adenovirus is ubiquitous in human and animal populations, survives long periods outside a host, and is endemic throughout the year. More than 80 % of the adenovirus infection occurs in children less than 4 years old. Immunocompromised individuals are more susceptible to this infection. We report a case of severe adenovirus pneumonia in a young healthy immunocompetent adult who developed respiratory distress leading to respiratory failure.

Case Presentation

32 year old white male with no significant past medical history presented with complains of dyspnea, productive cough and chest pressure. He stated that his symptoms felt like his usual "Bronchitis" that he gets every year. No preceding pharyngitis or conjunctivitis symptoms. His symptoms progressively worsened over one week. He felt feverish but did not check his temperature.

He has also had anorexia, chills, nausea, vomiting, diarrhea and abdominal pain. He described his abdominal pain as a dull pain that worsened with his coughing. He denied any hemoptysis, weight loss, rash, and dysuria. Patient is a known smoker and smoked half a pack a day for the last 21 years and drank less than 4 beers a week. He had been unemployed for quite some time and lived with girlfriend and her two children. He denied any IV drug use or any other substance abuse. He had been tested for HIV and was negative. No history of sexually transmitted disease. He did admit to exposure to dog and a rabbit both of them outside the house. He recently did have fresh water exposure along with soil, landscaping and dust exposure.

He went to an outside hospital for an evaluation and was found to have a WBC count of 3.4 with 1 band and 80% PMNs and platelet count of 94,000. He also had hyponatremia with Na of 123 and acute renal insufficiency with CR of 1.4. He was hypoxic with pO2 49 on ABG. CXR at OSF was concerning for Right lower lobe Pneumonia and was started on broad spectrum antimicrobial therapy.

At the time of transfer to our facility his Temp was 100.4 , BP 100/66mm/hg, Pulse 114 beats/ min, resp rate of 32 breaths/ min and oxygen saturation of 93 % on 4 liters. His Arterial blood gas on arrival showed 7.45/ 26/49/21.5 with his WBC count of 3.7 with 72% PMNs and Platelet count of 72,000. CXR on admission to our hospital showed extensive consolidation in the right lower lobe and left mid lung zone. He was continued on broad spectrum antimicrobial therapy but hypoxemia and dyspnea continued to get worse.

He was started on noninvasive positive pressure ventilation but he continued to be in respiratory distress prompting admission to MICU. There he was intubated and was placed on mechanical ventilation. He was continued on broad spectrum antimicrobial therapy. His blood cultures stayed negative.

He continued to spike fever and underwent a CT scan of his chest which showed the presence of ground glass opacities in the bilateral upper lungs, left side greater than right and large consolidation in the right mid-to-lower lung zones. Work up including urine legionella, Urine Strep pneumonia, and HIV test were negative. His other blood work up including Ehrlichia, Ana plasma ,Influenza, Para influenza, human meta pneumovirus, Mycoplasma IGM antibody, Leptospira antibody , Pneumococcal antibody, Histoplasma antibody, CMV by PCR , Aspergillus galactomannan all were found to be negative.

Citation: Khan S and Hussain K. Adenovirus Pneumonia in Immunocompetent Adult. Austin Crit Care J. 2014;1(1): 2. ISSN 2379-8017