LAUSR

In recent years, human adenovirus (HAdV) infection has been prevalent in various regions in China (Duan et al. 2021). Research in Guangzhou reported that 9.14% of fatal pneumonia cases showed HAdV-PCR positive (Ou et al. 2007). The severity and high mortality caused by HAdV have aroused the attention of pediatricians. Plastic bronchitis (PB) is a critical disease characterized by the formation of the casts of the bronchial tree that obstructs the airway, while the pathogenesis is not yet clear. PB is divided into two types according to its pathological manifestations (Seear et al. 1997), in which type I (inflammatory) is composed of fibrin and a large number of inflammatory cells (eosinophils, neutrophils, etc.), and it occurs in infectious disease mostly. Influenza virus and Mycoplasma pneumoniae were the most common pathogens of PB in China (Guo et al. 2017; Ding et al. 2014). So far, adenovirus PB was rarely reported. Herein we summarized a total of 10 cases with adenovirus PB from July 2012 to December 2019 diagnosed in our hospital, hoping to provide a reference for clinical diagnosis and treatment. There are four males and six females in our study, the age of onset ranged from 10 months to 15 years and 7 months, 80% of the children were younger than 5 years old. All children had no underlying diseases such as congenital heart disease, asthma or pulmonary cystic fibrosis, but one patient (number 3 in Table 1) had bronchiectasis, bronchial stenosis, and a history of left lower pulmonary lobectomy. All patients had fever and cough, and the peak temperature ranged from 38.6 C to 41.0 C, with an average course of fever being 9.80 ± 6.563 days. Eight patients had dyspnea, five had wheezing, and two were dispirited. Reduced breath sounds of the lungs were found in all patients, among which eight showed moist rales or wheezing sounds. Among the 10 patients, five children had a white blood cell count less than 4 9 10/L (normal reference range 4 9 10/L–10 9 10/L), and six children had elevated C-reactive protein (CRP) (normal reference range\ 8 mg/L), while five patients had significantly increased procalcitonin (PCT) (normal reference range\ 0.05 ng/L). Five children had elevated transaminase, seven patients had increased lactate dehydrogenase, two patients developed abnormal coagulation function, three patients developed hypoproteinemia and seven patients developed anemia. To investigate the pathogens in those PB patients, all children underwent sputum and bronchoalveolar lavage fluid (BALF) ELISA test (D3 Ultra DFA Respiratory Virus Screening & ID Kit, ShangHai, China) for pathogen antigens (respiratory syncytial virus, adenovirus, influenza A virus, influenza B virus, type 1–3 parainfluenza virus) and nucleic acid test for adenovirus [Respiratory Adenovirus DNA Diagnostic Kit (PCR-Fluorescence Probing)], and Mycoplasma pneumoniae [Mycoplasma Pneumoniae DNA Diagnostic Kit (PCR-Fluorescence Probing), Shengxiang Biotechnology, Hunan, China). Serum ELISA tests for enterovirus EV-A71 IgM (EV71 -IgM kit, EI20201207A, Wantai Biopharm, Beijing, China), Coxsackie group B virus IgM (Coxsackie group B virus IgM kit, Beier, Beijing, China), Mycoplasma pneumoniae IgM [Diagnostic Kit for Measurement of Antibodies to Mycoplasma pneumoniae (Fassive Particle Agglutination), SERODIA-MYCO II], Epstein-Barr virus IgM and IgG (EBV IgM kit, E201201BV; EBV IgG Kit, E201201BX, EUROIMMUN PerkinElmer company) antibodies were performed as well. & Na Zang [email protected]