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Enteric adenovirus infection and childhood diarrhea: an epidemiologic study in three clinical settings
K L Kotloff1, G A Losonsky, J G Morris
1Department of Pediatrics, University of Maryland School of Medicine, Baltimore.
Insights
Enteric adenovirus is a significant cause of infantile diarrhea in young children, identified in over 4% of cases. This pathogen leads to severe symptoms like vomiting and dehydration, comparable to rotavirus infections.
Area of Science:
- Pediatric Gastroenterology
- Virology
- Infectious Diseases
Background:
- Gastroenteritis is a common illness in infants.
- Enteric adenovirus is a known cause of diarrhea.
Purpose of the Study:
- To investigate the role of enteric adenovirus in infantile diarrhea.
- To determine the frequency and clinical presentation of adenovirus-associated diarrhea in children under two years old.
Main Methods:
- A 2-year prospective case-control study.
- Enzyme-linked immunosorbent assay (ELISA) using monoclonal antibodies specific for adenovirus serotypes 40 and 41.
- Inclusion of outpatient, inpatient, and nosocomial diarrhea cases, along with asymptomatic controls.
Main Results:
- Enteric adenovirus was identified in 4.1% of outpatient, 6.2% of inpatient, and 6.2% of nosocomial diarrhea cases.
- Asymptomatic infections were rare (1.3%).
- Adenovirus-associated diarrhea presented with prolonged watery diarrhea (mean 5.4 days), vomiting, and dehydration, comparable in severity to rotavirus.
Conclusions:
- Enteric adenovirus is the third most common cause of infantile diarrhea in the studied population.
- Adenovirus infections can lead to severe diarrheal illness in infants.
- Household contact with gastroenteritis is a predisposing factor.
Abstract:
During a 2-year prospective study of gastroenteritis in children less than 2 years of age, the role of enteric adenovirus as a cause of infantile diarrhea was examined in three clinical settings in a case-control fashion. Using a monoclonal antibody-based enzyme-linked immunosorbent assay with specificity for adenovirus serotypes 40 and 41, enteric adenovirus was identified in 10 of 246 episodes of diarrhea in outpatients (4.1%), 13 of 211 children admitted to the hospital with diarrhea (6.2%), and 5 of 81 children in whom nosocomial diarrhea developed (6.2%), making this agent the third most commonly identified etiologic agent of diarrheal disease. Asymptomatic infections were uncommon (5 of 372 control subjects, or 1.3%) and were seen most frequently in the nosocomial setting. Cases occurred in every calendar month except March and April of each year. A syndrome of watery diarrhea of longer duration compared with other patients with diarrhea (mean 5.4 vs 3.8 days, P = .01), associated with vomiting and dehydration, was present in most cases. Compared with patients with rotavirus, patients were as likely to experience fever and dehydration and more likely to vomit. Household contact with gastroenteritis, often with a child 2 to 5 years of age, was a predisposing factor. It was concluded that enteric adenovirus is an important cause of infantile diarrhea in Baltimore children. Although far less common than rotavirus, this agent was associated with diarrheal illnesses that were at least as severe as those seen with rotavirus.