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

The clinical characteristics and prognosis of children with human adenovirus pneumonia complicated with encephalitis/encephalopathy remain unclear. Clinical data of 53 children admitted to the Respiratory Department of Children’s Hospital o f Chongqing Medical University in 2019 with severe adenovirus pneumonia and complicated with encephalitis/encephalopathy were retrospectively analyzed, 78 cases without encephalitis/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, the median fever duration was 12.0 (9.5–15.0) days, and 90.6% (48/53) had listlessness, 62.3% (33/53) had dysphoria, 47.2% (25/53) had hypersomnia, 13.2% (7/53) had seizure. The median leukocyte count, procalcitonin and lactate dehydrogenase of children with encephalitis/encephalopathy were 7.39 (3.53–10.73)*10^9/L, 1.885 (0.390–4.555) ng/ml, and 980.50 (516.40–1938.00) U/L, these were significant differences compared with the control group ( P values were 0.011, 0.001, <0.001), while nasopharyngeal adenovirus load showed no difference. Children with encephalitis/encephalopathy were more likely to be complicated with leukopenia, hypoproteinemia, liver function impairment, coagulopathy, anemia. 75.47% (40/53) 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, <0.001). The rates of using gamma globulin, albumin and blood transfusion were 92.45% (49/53), 52.83% (28/53) and 26.42% (14/53) respectively. 94.3% (50/53) children survived and follow-up at half a year later, 38.0% (19/50) showed bronchiolitis obliterans, which was significantly higher than 11.54% (9/78) in the control group ( P value 0.001), and no obvious neurological sequelae were observed. Encephalitis/encephalopathy should be considered in children with severe adenovirus pneumonia in the presence of altered mental status. The clinical manifestations of these children are severe and even life-threatening. Survivors exhibited generally favourable neurological outcomes, however, the incidence of bronchiolitis obliterans was relatively high at six-month follow-up, regular follow-up and active intervention are needed for these patients.