Persistent Hyperinflammation in Children with Adenovirus Pneumonia Requiring Intensive Support

Human adenovirus (HAdV) is one of the most common causes of pneumonia in children. It can lead to severe adenovirus pneumonia, increasing the risk of serious complications, morbidity, and mortality. Both innate and adaptive immunity systems respond to adenovirus infection. However, this immune response may be excessive, causing a pathologic immune condition called ‘hyperinflammation’. Evidence on mechanisms and management of hyperinflammation in children with adenovirus pneumonia is lacking. The aim of this review is to explore current evidence that involves data on persistent hyperinflammation in children with adenovirus pneumonia requiring intensive support. In the early phase, adenovirus pneumonia is characterized by non-specific symptoms such as fever, wheezing, and cough. This infection may induce hyperinflammation that can further worsen the condition, leading to severe adenovirus pneumonia that may require intensive support. Excessive cytokine release may occur, resulting in what’s described “cytokine storm”, leading to hypoxia, vascular leakage, pulmonary edema, and potentially acute respiratory distress syndrome. These cytokines include interleukin-1α (IL-1α), IL1β, IL-6, IL-8, IL-12, IFN-γ, IFN-α2, and tumor necrosis factor (TNF). Various approaches were introduced to mitigate the effects of hyperinflammation, including blood purification, glucocorticoids, and immunoglobulins. Further research is urgently needed to elucidate the immunopathology of adenovirus-induced hyperinflammation and to establish evidence-based treatment protocols tailored to the pediatric population.