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Open Access Research article

Epidemiology of severe pediatric adenovirus lower respiratory tract infections in Manitoba, Canada, 1991-2005

Saleh Alharbi1, Paul Van Caeseele23, Raquel Consunji-Araneta2, Taoufik Zoubeidi4, Sergio Fanella2, Abdul-Kader Souid5 and Ahmed R Alsuwaidi5*

Author Affiliations

1 Umm Al-Qura University, Makkah, P.O. Box 6707, Saudi Arabia

2 Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3T 2N2, Canada

3 Cadham Provincial Laboratory, Winnipeg, MB R3E 3J7, Canada

4 Department of Statistics, United Arab Emirates University, Al Ain, P.O. Box 17666, United Arab Emirates

5 Department of Pediatrics, United Arab Emirates University, Al Ain, P.O. Box 17666, United Arab Emirates

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BMC Infectious Diseases 2012, 12:55  doi:10.1186/1471-2334-12-55

Published: 13 March 2012

Abstract

Background

Most pediatric adenovirus respiratory infections are mild and indistinguishable from other viral causes. However, in a few children, the disease can be severe and result in substantial morbidity. We describe the epidemiologic, clinical, radiologic features and outcome of adenovirus lower respiratory tract infections (LRTI) in Aboriginal and Non-Aboriginal children in Manitoba, Canada during the years 1991 and 2005.

Methods

This was a retrospective study of 193 children who presented to the department of pediatrics at Winnipeg Children's Hospital, Manitoba, Canada with LRTI and had a positive respiratory culture for adenovirus. Patients' demographics, clinical and radiologic features and outcomes were collected. Adenovirus serotype distributions and temporal associations were described. Approximate incidence comparisons (detection rates) of adenovirus LRTI among Aboriginal and Non-Aboriginal children were estimated with 95% confidence intervals.

Results

Adenovirus infections occurred throughout the year with clusters in the fall and winter. Serotypes 1 to 3 were the predominant isolates (two thirds of the cases). The infection was more frequent among Canadian Aboriginals, as illustrated in 2004, where its incidence in children 0-4 years old was 5.6 fold higher in Aboriginals (13.51 vs. 2.39 per 10,000, p < 0.000). There were no significant differences in length of hospitalization and use of ventilator assistance between the two groups (p > 0.185 and p > 0.624, respectively) nor across serotypes (p > 0.10 and p > 0.05, respectively). The disease primarily affected infants (median age, 9.5 months). Most children presented with bronchiolitis or pneumonia, with multi-lobar consolidations on the chest x-ray. Chronic (residual) changes were documented in 16 patients, with eight patients showing bronchiectasis on the chest computerized tomography scan.

Conclusions

Adenovirus infection is associated with significant respiratory morbidities, especially in young infants. The infection appears to be more frequent in Aboriginal children. These results justify a careful follow-up for children with adenovirus LRTI.