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Clinical features of adenovirus enteritis: a review of 127 cases
M Krajden1, M Brown, A Petrasek
1Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract:
We retrospectively analyzed the clinical features of 127 hospitalized pediatric patients whose fecal samples were positive for adenovirus (Ad) by electron microscopy during an 18-month period. Serotyping results obtained by microneutralization tests and restriction endonuclease analysis were available for 105 of 127 cases. There were 69 males and 58 females and 94% of patients were less than 4 years of age. The average body temperature was 38 degrees C rectal (range, 36.2-40.8 degrees C) with an average duration of fever of 1.6 days. The average duration of clinical illness was 8.8 days (range, 1 to 32 days). Although Ad 40 and Ad 41 were isolated in the majority of cases (59 of 105 (56%], Ad 31 was associated with 18 of 105 cases (17%). Of the 18 cases associated with Ad 31, 14 were nosocomial and associated with diarrhea. Our survey confirms the importance of fastidious enteric Ad in infantile diarrhea (Ad 40, Ad 41) and suggests that Ad 31 produces a clinical syndrome indistinguishable from that caused by Ad 40 and Ad 41. The occurrence of Ad enteritis in patients admitted for unrelated illnesses well after initial hospitalization suggests that Ad is also an important cause of nosocomial enteritis in our hospital.
Insights
Adenovirus (Ad) causes significant infantile diarrhea, with fastidious types Ad 40 and Ad 41 being common. Adenovirus 31 also causes similar symptoms and is a notable cause of nosocomial enteritis in children.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Clinical Microbiology
Background:
- Adenovirus (Ad) is a common cause of gastroenteritis in children.
- Specific adenovirus types, particularly fastidious enteric adenoviruses (Ad 40 and Ad 41), are well-established causes of infantile diarrhea.
- The role of other adenovirus serotypes in pediatric enteritis, especially in a hospital setting, requires further clarification.
Purpose of the Study:
- To retrospectively analyze the clinical features of pediatric patients hospitalized with adenovirus-positive fecal samples.
- To identify the predominant adenovirus serotypes causing enteritis in this cohort.
- To investigate the clinical presentation and potential for nosocomial transmission of adenovirus infections in hospitalized children.
Main Methods:
- Retrospective analysis of 127 hospitalized pediatric patients with adenovirus detected in fecal samples via electron microscopy.
- Serotyping of adenovirus isolates using microneutralization tests and restriction endonuclease analysis for 105 cases.
- Clinical data including age, sex, body temperature, duration of fever, and illness duration were collected and analyzed.
Main Results:
- The majority of patients (94%) were under 4 years of age.
- Adenovirus types 40 and 41 accounted for 56% of identified cases, while adenovirus 31 was associated with 17% of cases.
- Adenovirus 31 infections were frequently nosocomial (78%) and presented with diarrhea, clinically indistinguishable from infections caused by Ad 40 and Ad 41.
Conclusions:
- Fastidious enteric adenoviruses (Ad 40, Ad 41) are significant causes of infantile diarrhea.
- Adenovirus 31 can cause a clinical syndrome similar to that of Ad 40 and Ad 41.
- Adenovirus is an important cause of nosocomial enteritis in hospitalized children, even in those admitted for unrelated conditions.