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Published on: August 11, 2014
Relationship between adenovirus infection and intussusception via pathological evidence confirms
Lung-Huang Lin1, Chi-Jung Huang2, Cheng-Yu Lo3
1Department of Pediatrics, Cathay General Hospital, Taipei City, Taiwan.
Insights
Adenovirus infection is directly linked to infant intussusception. Polymerase chain reaction (PCR) testing of intestinal tissue is more sensitive than immunohistochemistry (IHC) for confirming this adenovirus link in intussusception cases.
Area of Science:
- Pediatric Gastroenterology
- Viral Pathogenesis
- Surgical Pathology
Background:
- The etiology of intussusception in infants often remains unknown, unlike in older children where pathological causes like lymphoma or polyps are sometimes identified.
- Previous studies suggest a connection between adenovirus infection and pediatric intussusception, but evidence has primarily relied on indirect sources like stool or throat swabs.
- Direct analysis of intestinal tissue offers a more definitive approach to investigate the adenovirus-intussusception relationship.
Purpose of the Study:
- To directly investigate the association between adenovirus infection and intussusception in children under six years of age.
- To analyze intestinal tissue samples for evidence of adenovirus using immunohistochemistry (IHC) and polymerase chain reaction (PCR).
- To compare the diagnostic utility and sensitivity of IHC and PCR in detecting adenovirus in intussusception.
Main Methods:
- Retrospective review of pediatric patients (<6 years) with intussusception requiring surgery.
- Processing of surgical pathological tissue into formalin-fixed paraffin-embedded (FFPE) sections for analysis.
- Application of adenovirus immunohistochemistry (IHC) and PCR testing on tissue samples, with a control group of children undergoing incidental appendectomies.
Main Results:
- Adenovirus was detected in 37.5% of intussusception tissue samples via IHC and 50% via PCR (specifically adenovirus type C).
- All control group samples tested negative for adenovirus by both IHC and PCR.
- PCR demonstrated higher sensitivity than IHC in detecting adenovirus in the studied intussusception tissues.
Conclusions:
- The study provides direct pathological evidence confirming the link between adenovirus infection and intussusception in young children.
- Polymerase chain reaction (PCR) is a more sensitive and reliable method than immunohistochemistry (IHC) for diagnosing adenovirus in pediatric intussusception cases.
Aims:
Although some cases of intussusception in older children are associated with pathological changes such as lymphoma or polyps, the cause of most cases in infants is unknown. Several reports have identified an association between adenovirus infection and intussusception in children. However, much of the evidence is indirect, such as stool samples or throat swab data. Our study analysed intestinal tissue, which may be more direct evidence of the relationship between adenovirus infection and intussusception.
Methods:
We retrospectively reviewed children<6 years of age with intussusception who underwent surgery for failed reduction. The pathological tissue was processed into formalin-fixed paraffin-embedded (FFPE) sections. Adenovirus immunohistochemistry (IHC) and PCR testing were performed to obtain direct evidence of the relationship between adenovirus infection and intussusception.
Results:
Our study included 29 patients, 27 appendiceal and 8 intestinal tissues. Only eight appendix specimens were successfully processed into FFPE tissue. IHC testing was positive in three cases (37.5%), and PCR testing was positive for adenovirus type C in four cases (50%). The control group consisted of eight children <6 years who underwent incidental appendectomies, and all control subjects had negative IHC and PCR analyses. PCR is as useful and reliable as IHC in diagnosing adenovirus in intussusception and has greater sensitivity than IHC.
Conclusion:
We directly confirmed the relationship between adenovirus infection and intussusception through IHC analysis and PCR detection of pathological evidence. PCR is more sensitive than IHC for diagnosing adenovirus in intussusception.
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