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Enteric adenovirus infection among infants with diarrhea in rural Bangladesh
K Jarecki-Khan1, S R Tzipori, L E Unicomb
1International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka.
Insights
Enteric adenoviruses (EAds), specifically types 40 and 41, are common causes of diarrhea in Bangladeshi infants. These infections present with symptoms similar to rotavirus, leading to mild to moderate dehydration.
Area of Science:
- Virology
- Pediatrics
- Public Health
Background:
- Diarrheal diseases are a major cause of infant mortality globally.
- Adenoviruses are recognized as a significant pathogen contributing to gastroenteritis in children.
- Limited data exists on the specific types and prevalence of enteric adenoviruses in developing regions like Bangladesh.
Purpose of the Study:
- To determine the prevalence and types of adenoviruses in infants with diarrhea in Matlab, Bangladesh.
- To characterize the clinical features and demographic data associated with adenovirus infections.
- To compare adenovirus infection symptoms with those of rotavirus.
Main Methods:
- Enzyme immunoassay (EIA) was used to detect adenoviruses in 4,409 stool specimens from infants.
- Positive samples were serotyped using monoclonal antibodies for adenovirus types 40 (Ad40) and 41.
- Cell culture and EIA retesting confirmed enteric adenovirus (EAd) identification.
Main Results:
- Enteric adenoviruses (EAds) were detected in 2.8% of specimens (125/4,409).
- Adenovirus type 41 was more prevalent (59.2%) than type 40 (40.8%).
- Common symptoms included watery diarrhea, frequent loose stools, vomiting, abdominal pain, and low-grade fever, similar to rotavirus infections.
Conclusions:
- Enteric adenoviruses, particularly types 40 and 41, are significant contributors to infantile diarrhea in Bangladesh.
- The clinical presentation of EAd infection closely mimics rotavirus gastroenteritis.
- Further research into the epidemiology and management of EAd in this region is warranted.
Abstract:
A total of 4,409 stool specimens from infants less than 5 years of age seeking treatment for diarrhea in Matlab, Bangladesh, were tested for the presence of adenoviruses by using an enzyme immunoassay (EIA). EIA-positive stool samples were serotyped with monoclonal antibodies specific for adenovirus type 40 (Ad40) and Ad41 and group antigen, inoculated into Graham G293 cells, and retested by EIA. Of adenovirus-positive cultures, 125 (2.8%) specimens were confirmed as enteric adenoviruses (EAds), of which 51 (40.8%) were typed as Ad40 and 74 (59.2%) were typed as Ad41, and 12 of 4,409 (0.3%) were identified as nonenteric adenoviruses. A slight peak of incidence of EAd infection was observed in the cool, dry months, and an outbreak of Ad40 infections occurred in March 1988, when the detection rate of EAd reached 12.3%. Information on age, gender, and symptoms was available for 80 infants infected with adenovirus only. Age distribution was similar for types 40 and 41 and nonenteric adenovirus; the median ages were 11, 12, and 12 months, respectively. The ratio of males to females for the 80 infants varied according to serotype; Ad40 had the highest male/female ratio, 2.17. The symptoms experienced by the 80 children were similar for each adenovirus type. The most common clinical features of EAd infection were watery diarrhea (87.5%), more than eight loose bowel movements per day in the 24-h period prior to presentation (68.8%), with vomiting (80.0%), abdominal pain (76.3%), and low-grade fever (95.0%); these symptoms are significantly similar to symptoms of infants infected with group A rotavirus. EAd infection generally gave rise to mild to moderate dehydration, which is significantly similar to dehydration produced by infection with rotavirus.