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The relationship between severe adenovirus respiratory infections and bronchiectasis or bronchiolitis obliterans in children in Canterbury

A 2018/2019 Summer Studentship research project

Finding a link between adenovirus respiratory infection in young children and subsequent severe lung disease would lead to changes in clinical practice – more investigatino of children with intitial presentations and more aggressive treatment for those found to have adenovirus infection.

Student: Madeline Newman
Supervisor: Associate Professor Philip Pattemore, Associate Professor Tony Walls
Sponsor: CureKids

Project brief


Bronchiectasis and bronchiolitis obliterans are conditions of damaged large and small airways respectively, that cause major morbidity. The conditions are potentially life long and carry a mortality risk for children and adults. Cystic fibrosis and immunodeficiency are known causes, but in addition, respiratory infections due to certain types of adenovirus were first implicated by Becroft in Auckland in 1967 (1,2) and this association was subsequently confirmed internationally. We have encountered in the alst few years a number of children with severe adenovirus respiratory infection that have gone on to develop bronchiectasis and/or bronchiolitis obliterans. There are adenovirus treatments, dused t present mostly for onvology patients. It would be an advantage to predict which children were at risk of going on to chronic respiratory disease, so that treatment or close follow up could be undertaken.

  1. Becroft, D. M. O. Histopathology of fatal adenovirus infectino of the respiratory tract in young children. J Clin Path 1967; 20 561-569.
  2. Becroft, D. M. O. Bronchiolitis obliterans, bronchiectasis, and other sequelae of adenovirus type 21 infection in young children. J Clin Path 1971; 24:72-82.


The aim of this project is to ascertain the connection between severe adenovirus respiratory infection and subsequent chronic or recurrent chest disease in children in CDHB, and if possible to quantify the risk of the latter outcome after the former exposure.


First the student, with the help of the virology laboratory, will ascertain the number of children who have had a positive respiratory virus PCR swan for adenovirus in the last 5 years in Christhurch Hospital. Secondly, these cases’ CDHB notes will be examined to see if the children had a severe respiratory infection at the time (HDU or ICY admission for respiratory disease, requiring hiflo oxygen or respiratory support and intravenous fluids). For these cases the CDHB data will be further examined for any subsequent paediatric follow up or admissions pertaining to recurrent or chronic respiratory disease. The adenovirus data will also be linked with the cases of children who have diagnosed bronchiectasis, bronchiolitis obliterans, or chronic cough in the paediatric respiratory clinic. Some approximate quantification of the risk of these outcomes after severe adenovirus infectino will be attempted. In these cases, typing of adenovirues, demographic information and any other respiratory risk factors (smoking exposure, atopy, bronchiolitis in infancy, chronic lung disease of prematurity) will also be sought to see if these factors influence the risk. Temporal patterns will be sought in the adenovirus isolations, and in severe adenovirus infections.

Student researcher’s component of the study

  • Background reading and writing a short review
  • Identification of cases through virology department database
  • Finding notes and results and collating data on virology, outcomes, etc
  • Prepare a manuscript for publication (with help)