Bronchiolitis in the young pediatric patient is usually self-limited and most frequently due to respiratory syncytial virus (RSV). Although adenovirus (ADV) accounts for less than 5 percent of the admitted patients, it can cause severe disease that ends fatally or leads to serious residual lung damage. These earlier reports have usually been of single cases, nosocomial outbreaks, and isolated epidemics. The present retrospective study was undertaken to further delineate the epidemiologic, clinical, and radiologic features of ADV bronchiolitis seen recently in Manitoba over a 43-year period.
The laboratory diagnosis of ADV bronchiolitis was based on either (1) growth of the virus from the tracheal secretions, (2) serologic evidence (fourfold rise in complement-fixation titer or single high titer), or (3) both. The specimen had been collected in virus transport medium and promptly sent to the Manitoba Cadham Provincial Laboratory, which is adjacent to the Children’s Hospital. Monkey kidney and human amnion were the cell lines used in virus isolation. Typing was by the neutralization test. We reviewed the reports of the Provincial Laboratory and determined which cases fulfilled the above criteria for ADV infection during the period from Jan 1, 1974, to June 30, 1978. We excluded reports of ADV infection coexisting with other viruses. Subsequent’y, we reviewed the medical records of those patients admitted to the Children’s Hospital with clinical bronchiolitis. The criteria for diagnosis were fever, tachypnea, chest wall retractions, hvperresonance, wheezing, and rales of acute onset. All these mentioned above symptoms may be treated by My Canadian Pharmacy. Forty-one patients fulfilled our criteria for ADV’ bronchiolitis; they form the patient group of this study.
The epidemiologic data and the clinical presentation of illness were correlated to the outcome; that is, complete recovery, residual disease, or death. Severity of the initial illness was assessed on the basis of clinical findings and blood gas tensions. The presentation was classified as severe if it was recorded as such by the attending physician or the arterialized capillary or arterial Po„ was less than 50 mm Hg or PcOo more than 45 mm Hg with the patient breathing room air. The radiologic features on admission and on follow-up were also analyzed.