Adenovirus-Associated Acute Appendicitis: An Under-Recognized Relationship?

Area of Science:

• Infectious Disease Epidemiology
• Surgical Pathology

Background:

• Acute appendicitis (AA) is a common surgical emergency, particularly in young adults aged 10-29.
• Adenovirus (ADV) is a known cause of intussusception and a rare cause of AA in children.
• Military trainees experience high rates of adenoviral upper respiratory infections.

Purpose of the Study:

• To investigate the association between ADV, CMV, EBV, and enterovirus with AA in young adult military trainees.
• To determine the frequency of viral detection in appendectomy specimens.

Main Methods:

• Retrospective review of 112 appendectomy cases from military trainees (2003-2011).
• Analysis of pathological tissue samples using quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC).

Main Results:

• ADV DNA was detected in 14% of AA cases via qPCR, with ADV 4 being the most common type.
• IHC detected ADV in only 0.9% of cases, highlighting qPCR's superior sensitivity.
• No association was found between AA and CMV, EBV, or enterovirus.

Conclusions:

• ADV is significantly associated with AA in young adults, at a higher frequency than previously documented.
• qPCR is more sensitive than IHC for detecting ADV in appendiceal tissue.
• The ADV vaccine may offer a strategy for primary prevention of AA.