Adenovirus Versus Respiratory Syncytial Virus in Children With Severe Viral Acute Respiratory Failure

BACKGROUND: Respiratory syncytial virus (RSV) commonly causes severe lower respiratory tract disease. Adenovirus is detected less often, but severe pneumonia may occur. The pediatric intensive care unit (PICU) course associated with adenovirus detection compared with RSV-only detection is not well defined. METHODS: We studied clinician-tested, virus-positive PICU admissions of children aged 1 month to 18 years from 37 PICUs in 7 Latin American countries (2017-2025). Children with RSV and/or adenovirus detection who used respiratory support were grouped as RSV-only, adenovirus-only or RSV-adenovirus codetection. The primary outcome was PICU death or worse functional status at discharge. Adjusted associations were estimated with logistic regression; Firth penalization was used for mortality. RESULTS: Among 3196 PICU admissions, 2859 had RSV-only, 257 adenovirus-only and 80 codetection. PICU mortality was 12/257 (4.7%) in adenovirus-only, 13/2859 (0.5%) in RSV-only and 2/80 (2.5%) in codetection. Compared with RSV-only detection, adenovirus-only detection was associated with mortality [adjusted odds ratio (OR): 10.56; 95% confidence interval (CI): 4.57-24.43] and with PICU death or worse functional status at discharge [21/222 (9.5%) vs 45/2308 (1.9%); adjusted OR: 6.57; 95% CI: 3.59-12.03]. Among nonsurvivors, the median PICU day of death was 3 (IQR: 2-6) with adenovirus-only detection and 8 (IQR: 3-9) with RSV-only detection. CONCLUSIONS: In this multicenter Latin American PICU cohort, adenovirus-only detection was associated with a higher-risk acute course than RSV-only detection, including higher mortality and worse functional status at PICU discharge.

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Journal
The Pediatric Infectious Disease Journal
Published
2026-08-26
DOI
https://doi.org/10.1097/inf.0000000000005382
Primary Topic
Respiratory viral infections research
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article
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article

Adenovirus Versus Respiratory Syncytial Virus in Children With Severe Viral Acute Respiratory Failure

Hernan Salazar, Sebastián González‐Dambrauskas, Javier Martínez, Soledad Menta et al.
The Pediatric Infectious Disease Journal
Respiratory viral infections research
article

Adenovirus Versus Respiratory Syncytial Virus in Children With Severe Viral Acute Respiratory Failure

Hernan Salazar, Sebastián González‐Dambrauskas, Javier Martínez, Soledad Menta, Pablo Cruces, Franco Díaz, Nicolás Monteverde-Fernández, Jesús Alberto Serra, Paula Caporal, Luis Martinez Arroyo, Cristóbal Carvajal, Juan Camilo Jaramillo-Bustamante, Rubén Eduardo Lasso Palomino, Eliana Zemanate Zúñiga, Roberto Jabornisky, Pablo Vásquez‐Hoyos, Juan Sebastián Barajas-Romero, O.-E. Lund, M. Decia, Francisca Castro-Zamorano, on behalf of the Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Mario Andrés Reyes-Téllez
article en

Abstract

BACKGROUND: Respiratory syncytial virus (RSV) commonly causes severe lower respiratory tract disease. Adenovirus is detected less often, but severe pneumonia may occur. The pediatric intensive care unit (PICU) course associated with adenovirus detection compared with RSV-only detection is not well defined. METHODS: We studied clinician-tested, virus-positive PICU admissions of children aged 1 month to 18 years from 37 PICUs in 7 Latin American countries (2017-2025). Children with RSV and/or adenovirus detection who used respiratory support were grouped as RSV-only, adenovirus-only or RSV-adenovirus codetection. The primary outcome was PICU death or worse functional status at discharge. Adjusted associations were estimated with logistic regression; Firth penalization was used for mortality. RESULTS: Among 3196 PICU admissions, 2859 had RSV-only, 257 adenovirus-only and 80 codetection. PICU mortality was 12/257 (4.7%) in adenovirus-only, 13/2859 (0.5%) in RSV-only and 2/80 (2.5%) in codetection. Compared with RSV-only detection, adenovirus-only detection was associated with mortality [adjusted odds ratio (OR): 10.56; 95% confidence interval (CI): 4.57-24.43] and with PICU death or worse functional status at discharge [21/222 (9.5%) vs 45/2308 (1.9%); adjusted OR: 6.57; 95% CI: 3.59-12.03]. Among nonsurvivors, the median PICU day of death was 3 (IQR: 2-6) with adenovirus-only detection and 8 (IQR: 3-9) with RSV-only detection. CONCLUSIONS: In this multicenter Latin American PICU cohort, adenovirus-only detection was associated with a higher-risk acute course than RSV-only detection, including higher mortality and worse functional status at PICU discharge.

The Pediatric Infectious Disease Journal
National University of Salta (AR), Cato Institute (US), Johns Hopkins University (US), University of Cauca (CO), Universidad de la República de Uruguay (UY), University of Guayaquil (EC), Drammen Hospital (NO), Centro Hospitalario Pereira Rossell (UY), National University of the Northeast (AR), Universidad Nacional de Colombia (CO), Universidad Juan Pablo II (CR), Hospital Clínico Universitario de Valencia (ES), Fundación Valle del Lili (CO), Municipality of Medellín (CO), Universidad Católica del Uruguay (UY), Universidad Católica de Salta (AR), Finis Terrae University (CL), Hospital Pablo Tobon Uribe (CO), Hospital Padre Hurtado (CL), Fundación Universitaria de Ciencias de la Salud (CO), Instituto Nacional de Investigación Agropecuaria (UY), Wikimedia Uruguay (UY), Hospital Central de las Fuerzas Armadas (UY), Clínica CES (CO), Hospital San Borja Arriarán (CL), Centro Uruguayo de Imagenología Molecular (UY), Children's Specialized Hospital (US), Icesi University (CO), Universidad del Rosario (CO)
Good health and well-being
Openalex Percentile: Top 10%
Respiratory viral infections research
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