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Fatal adenovirus infection associated with new genome type
A S Mistchenko1, J F Robaldo, F C Rosman
1Virology Laboratory, R. Gutiérrez Children's Hospital, Buenos Aires, Argentina.
Insights
The first fatal case of adenovirus type 7i in an infant is reported. This severe respiratory infection led to Reye
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Critical Care Medicine
Background:
- Adenoviruses are common respiratory pathogens.
- Severe adenovirus infections can lead to significant morbidity and mortality, particularly in infants.
- Specific viral genome types may exhibit varying virulence.
Observation:
- An 8-month-old infant with long-term respiratory support developed Reye's syndrome, acute respiratory distress, and bronchiolitis obliterans.
- Adenovirus type 7i was identified in nasopharyngeal secretions and confirmed by viral DNA analysis.
- Elevated serum cytokine and interferon levels (IL-6, IL-8, IFN-alpha) were detected.
Findings:
- This case represents the first fatal outcome attributed to adenovirus genome type 7i.
- Autopsy revealed bronchiolitis obliterans, diffuse alveolar damage, and periportal fatty degeneration.
- The patient exhibited a severe inflammatory response with high levels of specific interleukins and interferons.
Implications:
- This case highlights the potential for severe, fatal adenovirus infections, even in previously healthy infants.
- Understanding the specific characteristics of adenovirus genome type 7i is crucial for clinical management.
- Further research is needed to elucidate the pathogenesis of severe adenovirus infections and optimize supportive care strategies.
Abstract:
The first fatal case caused by the new genome type 7i is described in an 8-month-old boy requiring long-term respiratory support who developed Reye's syndrome, acute respiratory distress, and bronchiolitis obliterans with fatal evolution. Adenovirus was detected in nasopharyngeal secretions and was persistently positive during hospitalization. IgM and IgG adenovirus antibody titers measured in serum by enzyme-linked immunoassay (EIA) were 1:32 and 1:800, respectively. Serum interleukins (IL) and interferons (IFN) measured by EIA were as follows: IL-2, 110 pg/ml; IL-6, 300 pg/ml; IL-8, 7,000 pg/ml; TNF-alpha, 35 pg/ml, IL-1 and IL-4 undetectable, IFN-alpha 2,200 pg/ml, and IFN-gamma 700 pg/ml. Virologic studies showed that adenovirus isolated belonged to subgenus B, and digestion of viral DNA with Bam HI, Sma I, Bgl II, and Hind III identified the isolate as belonging to genome type 7i. Autopsy showed bronchiolitis obliterans with diffuse alveolar damage and perivenular fatty degeneration with polymorphonuclear infiltrates in the periportal spaces. The difficulty in obtaining adequate oxygenation with minimization of iatrogenic oxygen injury is discussed.