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A syndrome of transient encephalopathy associated with adenovirus infection
R Straussberg1, L Harel, Y Levy
1Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tiqva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. rachelst@post.tau.ac.il
Insights
Adenovirus infection can cause a temporary brain condition in infants, leading to decreased alertness. This study describes 7 infants who recovered fully from this transient encephalopathy.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurovirology
Background:
- Adenovirus is a common pediatric pathogen affecting multiple systems.
- Neurologic complications of adenovirus include meningitis, myelitis, and encephalitis.
- Transient encephalopathy is a recognized, yet less common, neurologic syndrome associated with adenovirus.
Purpose of the Study:
- To detail the clinical presentation and electroencephalography (EEG) findings in infants with adenovirus-associated transient encephalopathy.
- To characterize this specific neurologic syndrome in a pediatric cohort.
Main Methods:
- Retrospective case series of 7 infants (7-34 months) presenting with prolonged fever and altered mental status.
- Clinical evaluation, Glasgow Coma Scale assessment, lumbar puncture, and electroencephalography (EEG).
- Adenovirus detection via immunofluorescence and serotyping (Adenovirus type 3 identified in most cases).
Main Results:
- All 7 infants exhibited moderate to severe background slowing on EEG, consistent with encephalopathy.
- Clinical symptoms included fever, decreased alertness, catarrhal symptoms, and mild hepatomegaly.
- Adenovirus was isolated from respiratory, conjunctival, and rectal samples; Adenovirus type 3 was predominant.
- Patients showed progressive recovery of alertness and complete reversal of neurologic deficits.
Conclusions:
- Transient encephalopathy associated with adenovirus infection represents a distinct neurologic entity.
- This syndrome should be considered in the differential diagnosis of encephalopathy in pediatric patients with adenovirus infection.
Background And Objective:
Adenovirus is a common pathogen in the pediatric population. Respiratory, gastrointestinal, or renal systems are often involved in adenovirus infections. Several neurologic syndromes have been attributed to adenovirus, such as adenovirus aseptic meningitis, myelitis, subacute focal encephalitis, and Reye-like syndrome. The purpose of this study was to describe the clinical features and encephalography findings in 7 infants treated in our center for a syndrome of transient encephalopathy associated with adenovirus infection.
Study Participants:
Three females and 4 males ages 7 to 34 months seen in our department between July 1983 and February 1984 and September 1998 and May 1999 presented with fever of at least 7 days' duration and a gradual decline in the state of alertness. Score on the Glasgow Coma Scale ranged from 9 to 12. Findings on lumbar puncture were normal. In all 7 patients, the encephalogram showed moderate to severe background slowing compatible with encephalopathy. All patients were catarrheal and had mild hepatomegaly with slight elevation of liver enzymes. Some had bronchopneumonia, diarrhea, and conjunctivitis either isolated or in combination.
Methods And Results:
Adenovirus was isolated by immunfluorescence technique in all patients-from the sputum in 3 patients, nasopharynx in 5, conjunctiva in 4, and rectal swab in 5. In 5 patients, serotyping was performed by an antibody neutralization method. Adenovirus type 3 was ascertained from a nasal swab in 1 patient, sputum specimens in 3, throat swab in 3, and rectal cultures in 5. The clinical course was characterized by a progressive recovery of alertness. After several days, there was a complete reversal of neurologic findings.
Conclusion:
We suggest that this syndrome of transient encephalopathy is a distinct entity and should be considered as another of the several neurologic syndromes known to be associated with adenovirus infection.