Am. J. Respir. Crit. Care Med.,
Volume 157, Number 2, February 1998, 645-649
Multiple Cases of Life-threatening Adenovirus
Pneumonia in a Mental Health Care Center
JAMES R.
KLINGER,
MARIA PIA
SANCHEZ,
LINDA A.
CURTIN,
MARGARET
DURKIN,
and
BELA
MATYAS
Divisions of Pulmonary and Critical Care Medicine and Infectious Diseases, Rhode Island Hospital and Brown University School of
Medicine, and The Rhode Island Department of Health, Providence, Rhode Island
Eighteen cases of pneumonia developed during an outbreak of adenovirus infection in a chronic psychiatric care facility. The six patients most severely affected were admitted to the intensive care unit
(ICU) at our institution. Four of these patients developed septic shock. We report the presentation,
disease progression, and response to treatment of these patients. Clinical features consisted of high
fever, nonproductive cough, and dense lower lobe infiltrates. Laboratory abnormalities included transient fall in white blood cell and platelet counts, and elevations of transaminases, lactate dehydrogenase (LDH), and creatinine phosphokinase (CPK). Five patients were intubated for hypoxemia and
four developed the acute respiratory distress syndrome (ARDS) and septic shock (mean cardiac output, 14.1 ± 1.3 L /min; cardiac index, 6.4 ± 0.4 L /min/min2; systemic vascular resistance, 326 ± 107 dyne
cm/s2). All patients recovered and were discharged back to the chronic care facility except for one patient with chronic renal failure who died 2 mo after admission. Adenovirus (serotype 35) was isolated from the respiratory secretions of five patients and antibody titers increased 6-fold in the other.
These patients constitute the largest series of patients with ARDS and septic shock caused by adenovirus pneumonia and the first outbreak of multiple cases of adenovirus pneumonia in immunocompetent civilian adults occurring from a single source.
