Case Reports and Series Adenovirus Type 7 causing severe lower respiratory tract infection in immunocompetent adults: a comparison of two contrasting cases from an intensive care unit in North West England ☆ , ☆☆ Tom Wingfield a,c,d, ⁎, Luke Dearden e , Pete Calvert e , Orod Osanlou f , Brian Johnston e , Anu Chawla g , Ian Hart g , Catherine Thompson h , Lance Turtle b , Richard Wenstone e a LIV-TB Collaboration and Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK b Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, UK c Tropical and Infectious Diseases Unit, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UK d Social Medicine, Infectious Diseases and Migration Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden e Intensive Care Unit, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UK f Department of Clinical Pharmacology, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UK g Liverpool Specialist Virology Centre, Royal Liverpool University and Broadgreen Hospitals NHS Trust, Liverpool, UK h Respiratory Virus Unit, Virus Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK abstract article info Article history: Received 8 March 2019 Received in revised form 24 July 2019 Accepted 30 July 2019 Available online xxxx Objectives: Severe lower respiratory tract infection caused by adenovirus is well described in immunocompro- mised hosts and can cause significant morbidity and mortality. We compare and contrast the clinical presenta- tion, radiological, and virological features of two rare cases in immunocompetent adults admitted to an intensive care unit in a large, teaching hospital in North West England. We then provide a concise, comprehen- sive literature review. Methods: The first case was a 35-year old female asthmatic who presented with respiratory distress and pneumo- nitis during peak influenza season, and recovered after a prolonged hospital stay. The second case was a 73-year old male who presented with diarrhoea, vomiting, and general malaise outside of influenza season, developed respiratory compromise, and died. Adenovirus type 7 was identified in bronchoalveolar lavages and plasma sam- ples of both patients, each of whom received cidofovir. No other infectious aetiology was identified. Results: Clinical and radiological features of severe lower respiratory tract adenoviral infection are similar to other infectious causes of pneumonia and ARDS, including severe influenza. This can create diagnostic uncertainty, es- pecially during influenza season. Positive adenovirus polymerase chain reaction results can support a diagnosis of severe lower respiratory tract adenovirus infection in patients with a clinically compatible syndrome and no other identified aetiology, with higher viral loads being associated with worse prognosis. Although treatment is predominantly supportive, early use of cidofovir may improve outcomes. Conclusions: These rare cases highlight that severe lower respiratory tract adenoviral infection should be consid- ered in the differential diagnoses of immunocompetent patients presenting with pneumonia and ARDS. © 2019 The Authors. Published by Elsevier Ltd on behalf of British Infection Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Keywords: Severe lower respiratory tract infection Pneumonia Pneumonitis Acute respiratory distress Adenovirus Critical care Intensive care Clinical Infection in Practice xxx (xxxx) xxx ☆ Sources of support: TW is supported by grants from: the Wellcome Trust, UK (209075/Z/17/Z); the Academy of Medical Sciences, UK; the Swedish Health Research Council, Sweden. BJ is a National Institute for Health Research Academic Clinical Fellow. LT is a Wellcome Trust Clinical Career Development Fellow, supported by grant number 205228/Z/16/Z. NJB and LT receive support from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections, a partnership between the University of Liverpool, Liverpool School of Tropical Medicine, and Public Health England (PHE). The views expressed here are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. ☆☆ Contributions: All authors contributed to the data collection and write-up of this manuscript. All authors have approved the final submitted version of the manuscript. ⁎ Corresponding author at: Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. E-mail address: tom.wingfield@lstmed.ac.uk (T. Wingfield). CLINPR-100007; No of Pages 5 Contents lists available at ScienceDirect Clinical Infection in Practice journal homepage: https://www.journals.elsevier.com/clinpr Please cite this article as: T. Wingfield, L. Dearden, P. Calvert, et al., Adenovirus Type 7 causing severe lower respiratory tract infection in immunocompetent adults: a comp..., Clinical Infection in Practice, https://doi.org/10.1016/j.clinpr.2019.100007 https://doi.org/10.1016/j.clinpr.2019.100007 2590-1702/© 2019 The Authors. Published by Elsevier Ltd on behalf of British Infection Association. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/).