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Adenovirus type 3 infection with systemic manifestation in apparently normal children
Abstract:
Between July 1983 and February 1984, eight children with adenovirus Type 3 infection, proven by virus isolation from sputum, stool or nasopharyngeal swabs and a fourfold increase in complement fixation antibody titers against the virus, were treated in our department. All eight patients had fever lasting at least 7 days, hepatomegaly, diffuse pulmonary infiltrates and abnormal liver function tests. Seven of the patients exhibited dyspnea and pulmonary wheezing. Six of the patients developed changes in state of consciousness, and three had repeated convulsions. EEG patterns in three of the patients were compatible with encephalopathy. Other clinical manifestations included: follicular tonsillitis in two patients, diarrhea in two, pneumothorax in one, and shock with disseminated intravascular coagulation in one. The spectrum of adenovirus Type 3 infection reported here has been described previously only in the viral hemorrhagic fevers. This adenovirus Type 3 infection shares the potential for disseminated disease that has been described previously for Type 7, simulating Reye's syndrome.
Insights
Severe adenovirus Type 3 infections in children can cause widespread illness, including respiratory and neurological symptoms. This study highlights the potential for disseminated disease, mimicking viral hemorrhagic fevers.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Critical Care Medicine
Background:
- Adenovirus infections are common, but severe manifestations are less understood.
- Previous reports suggest Adenovirus Type 7 can cause disseminated disease.
- The full spectrum of Adenovirus Type 3 clinical presentations requires further elucidation.
Purpose of the Study:
- To describe the clinical spectrum of severe adenovirus Type 3 infection in children.
- To compare Adenovirus Type 3 manifestations with previously described viral hemorrhagic fevers and Adenovirus Type 7 infections.
- To document neurological complications associated with Adenovirus Type 3.
Main Methods:
- Retrospective case series of eight pediatric patients treated between July 1983 and February 1984.
- Diagnosis confirmed by virus isolation (sputum, stool, swabs) and serological testing (complement fixation antibody titers).
- Clinical data including symptoms, physical examination findings, laboratory tests, and EEG patterns were analyzed.
Main Results:
- All eight patients presented with prolonged fever (>7 days), hepatomegaly, diffuse pulmonary infiltrates, and abnormal liver function tests.
- Respiratory symptoms (dyspnea, wheezing) occurred in seven patients; neurological symptoms (altered consciousness, convulsions, encephalopathy) in six.
- Rare complications included pneumothorax, shock, and disseminated intravascular coagulation; disease spectrum mimicked viral hemorrhagic fevers and Reye's syndrome.
Conclusions:
- Adenovirus Type 3 can cause severe, disseminated disease in children with a broad range of clinical manifestations.
- The presentation can simulate viral hemorrhagic fevers and Reye's syndrome, emphasizing the need for prompt diagnosis and management.
- Neurological involvement is a significant feature of severe Adenovirus Type 3 infection in this pediatric cohort.