MULTIPLE CASES OF LIFE-THREATENING ADENOVIRUS PNEUMONIA IN A MENTAL-HEALTH-CARE CENTER

Eighteen cases of pneumonia developed during an outbreak of adenovirus infection in a chronic psychiatric care facility. The six patients mo st severely affected were admitted to the intensive care unit (ICU) at our institution. Four of these patients developed septic shock. We re port the presentation, disease progression, and response to treatment of these patients. Clinical features consisted of high fever, nonprodu ctive cough, and dense lower lobe infiltrates. Laboratory abnormalitie s included transient fall in white blood cell and platelet counts, and elevations of transaminases, lactate dehydrogenase (LDH), and creatin ine phosphokinase (CPK). Five patients were intubated for hypoxemia an d four developed the acute respiratory distress syndrome (ARDS) and se ptic shock (mean cardiac output, 14.1 +/- 1.3 L/min; cardiac index, 6. 4 +/- 0.4 L/min/min(2); systemic vascular resistance, 326 +/- 107 dyne cm/s(2)). All patients recovered and were discharged back to the chro nic care facility except for one patient with chronic renal failure wh o died 2 mo after admission. Adenovirus (serotype 35) was isolated fro m the respiratory secretions of five patients and antibody titers incr eased 6-fold in the other. These patients constitute the largest serie s of patients with ARDS and septic shock caused by adenovirus pneumoni a and the first outbreak of multiple cases of adenovirus pneumonia in immunocompetent civilian adults occurring from a single source.