Fecal rotavirus and adenovirus antigen detection and clinical analysis of children with acute gastroenteritis in a hospital of Beijing City from 2019 to 2022 / 中华预防医学杂志

As a single-center retrospective study, we analyzed the results of rotavirus and human adenovirus antigens in stool samples with colloidal gold immunochromatography method in children with acute gastroenteritis under the age of five who were treated in our hospital from 2019 to 2022. After excluding nonconforming cases and duplicate cases, 2 896 cases were included, of which 559 cases were detected with at least one viral antigen. According to the test results, they were divided into RV positive group, HAdV positive group and RV & HAdV double positive group. The gender, age, seasonal distribution, clinical symptoms and related laboratory tests were compared and analyzed with χ2 test, analysis of variance and nonparametric test. Among the single samples from 2 896 children, the positive rate of RV antigen was 6.21% (180/2 896), the positive rate of HAdV antigen was 10.91% (316/2 896), and the double positive rate of RV & HAdV was 2.18% (63/2 896). The positive rate of HAdV antigen in 2021 was 16.11%, a significant increase compared with 6.20% in 2020. RV infection has obvious seasonality, and spring and winter are the seasons with high incidence of infection (χ2=74.018, P<0.001), while HAdV infection has no obvious seasonality (χ2=2.110, P=0.550), showing sporadic infection throughout the year. The proportions of fever and vomiting symptoms in children with RV infection were significantly higher than those in the HAdV infection group (χ2=40.401, P<0.001; χ2=32.593, P<0.001), but the positive rate of white blood cells in the stool was significantly lower than that in the HAdV infection group (χ2=13.741,P<0.01). In summary, paying attention to the epidemiological changes of RV and HAdV is of great significance for clinical diagnosis and treatment and disease prevention and control.

Epidemiological characteristics of human adenovirus 2, 3 and 7 genetypes in hospitalized children with respiratory infection in a hospital of pediatric in Hebei Province from 2018 to 2020 / 中华预防医学杂志

Objective: To investigate the epidemiological characteristics of human adenovirus (HADV) 2, 3 and 7 in hospitalized children with respiratory infection. Methods: A total of 25 686 children with respiratory infection hospitalized at Children's Hospital of Hebei Province from January 2018 to December 2020 were retrospectively included.Deep sputum or nasopharyngeal aspirates of those children were collected. Then thirteen common respiratory pathogens were detected by multiplex PCR. 510 HADV positive specimens were randomly selected via random number and classified for type 2, 3 and 7 using a multiplex real-time quantitative PCR. SPSS 21.0 software was used to perform all of the statistical analyses. Enumeration data were expressed by frequency and percentage. χ2 test was used for comparison between groups. Results: The HADV-positive rate was 7.99% (2 052/25 686). Children at age 3-<6 years had the highest HADV-positive rate (11.44%). The HADV-positive rate in 2019 was highest (10.64%). Among the 510 HADV-positive specimens, the proportion of type 3 was the highest (31.16%), followed by type 7 (21.37%) and type 2 (11.18%). The rate of type 2 in 2019 was significantly lower than that in 2018 and 2020 (χ2=8.954 and 16.354; P=0.003 and <0.01), while the rate of type 3 was significantly higher than that in 2018 and 2020 (χ2=5.248 and 4.811; P=0.022 and 0.028). The rate of type 2, type 3 and type 7 were lowest in winter, spring and autumn, respectively. The rate of type 2 increased significantly in autumn and the rate of type 3 and type 7 increased significantly in winter.The co-detection rate of HADV with other respiratory pathogens was 43.33%(221/510). Among, the co-detection rate of type 3 was highest (47.32%), and the co-detection rate of type 2, 3 and 7 was significantly higher than the alone detection rate (χ2=20.438, P<0.01; χ2=42.105, P<0.01; χ2=27.573, P<0.01).The proportion of severe pneumonia in children with type 7 positive (15.89%) was higher than that in children with non-type 7 positive (8.23%) (χ2=5.260, P=0.022). Conclusion: HADV is one of the important pathogens of children with respiratory infection in Children's Hospital of Hebei Province. The susceptible population of HADV is preschool children aged 3 to 6 years. HADV often co-detects with other respiratory pathogens. Type 3 and 7 is likely to be the dominant genotypes in this region, and type 7 may be one of the risk factors of severe pneumonia in children.

Clinical characteristics of human adenovirus infection in hospitalized children with acute respiratory infection in Beijing / 中华儿科杂志

Objective: To compare the clinical characteristics of different types of human adenovirus (HAdV) infection in hospitalized children with acute respiratory infection in Beijing, and to clarify the clinical necessity of adenovirus typing. Methods: In a cross-sectional study, 9 022 respiratory tract specimens collected from hospitalized children with acute respiratory infection from November 2017 to October 2019 in Affiliated Children's Hospital, Capital Institute of Pediatrics were screened for HAdV by direct immunofluorescence (DFA) and (or) nucleic acid detection. Then the Penton base, Hexon and Fiber gene of HAdV were amplified from HAdV positive specimens to confirm their HAdV types by phylogenetic tree construction. Clinical data such as laboratory results and imaging data were analyzed for children with predominate type HAdV infection using t, U, or χ2 test. Results: There were 392 cases (4.34%) positive for HAdV among 9 022 specimens from hospitalized children with acute respiratory infection. Among those 205 cases who were successfully typed, 131 were male and 74 were female, age of 22.6 (6.7, 52.5) months,102 cases (49.76%) were positive for HAdV-3 and 86 cases (41.95%), HAdV-7, respectively, while 17 cases were confirmed as HAdV-1, 2, 4, 6, 14 or 21. In comparison of clinical characteristics between the predominate HAdV type 7 and 3 infection, significant differences were shown in proportions of children with wheezing (10 cases (11.63%) vs. 25 cases (24.51%)), white blood cell count >15 ×109/L (4 cases (4.65%) vs.14 cases (13.73%)), white blood cell count <5×109/L (26 cases (30.23%) vs.11 cases (10.78%)), procalcitonin level>0.5 mg/L (43 cases (50.00%) vs. 29 cases (28.43%)), multilobar infiltration (45 cases (52.33%) vs.38 cases (37.25%)), pleural effusion (23 cases (26.74%) vs. 10 cases (9.80%)), and severe adenovirus pneumonia (7 cases (8.14%) vs. 2 cases (1.96%)) with χ²=5.11, 4.44, 11.16, 9.19, 4.30, 9.25, 3.91 and P=0.024, 0.035, 0.001, 0.002, 0.038, 0.002, 0.048, respectively, and also in length of hospital stay (11 (8, 15) vs. 7 (5, 13) d, Z=3.73, P<0.001). Conclusions: HAdV-3 and 7 were the predominate types of HAdV infection in hospitalized children with acute respiratory tract infection in Beijing. Compared with HAdV-3 infection, HAdV-7 infection caused more obvious inflammatory reaction, more severe pulmonary symptoms, longer length of hospital stay, suggesting the clinical necessity of further typing of HAdVs.

Infección respiratoria por adenovirus en pediatría: de ayer a hoy / Adenovirus pediatric respiratory infection: past and present

Acute respiratory infections represent a world pediatric health burden. RSV, influenza and adenoviruses are among the most frequent causative agents. Adenoviruses usually produce upper respiratory infections, but they can be responsible for acute lower respiratory infection in children with severe clinical outcome. It is necessary a special clinical and epidemiological organization to avoid nosocomial adenovirus local outbreaks. Rapid diagnose, done by immunofluorescence assay and PCR, individual case isolation and supportive therapy are necessary for an appropriate management. The increasing immune compromised population represents a challenge for the adenovirus diagnosis with quantitative PCR and for nosocomial infection control and potential antiviral treatment.

Las infecciones respiratorias agudas son un problema prioritario mundial de morbimortalidad infantil y son causadas predominantemente por virus, entre los que destacan el virus respiratorio sincicial (VRS), virus influenza (FLU) y adenovirus (ADV). Los ADV normalmente causan infecciones respiratorias altas, pero pueden provocar infecciones bajas muy graves, que dejan secuelas y tienen alta letalidad. Requieren un manejo clínico y epidemiológico especial para evitar los graves brotes nosocomiales observados en Latinoamérica. Esto incluye un diagnóstico rápido hecho con técnicas de inmunodiagnóstico y reacción en cadena polimerasa (PCR), aislamiento individual del paciente y terapia de soporte. En pacientes inmunocomprometidos, la infección por ADV representa un gran desafío para el diagnóstico, con uso de PCR cuantitativo (qPCR) y eventual tratamiento antiviral. El objetivo de esta revisión es el de actualizar las propiedades, patogenia, epidemiología y diagnóstico del ADV, con énfasis en los cuadros respiratorios de mayor morbimortalidad que se producen en algunos niños.

Detection and genotyping of human adenovirus and sapovirus in children with acute gastroenteritis in Belém, Pará, between 1990 and 1992: first detection of GI. 7 and GV. 2 sapoviruses in Brazil

Abstract INTRODUCTION: Acute gastroenteritis (AGE) is one of the most common causes of morbidity and mortality, especially among children from developing countries. Human adenovirus (HAdV) and sapovirus (SaV) are among the agents that cause AGE. The present study aimed to detect and genotype HAdV and SaV in 172 fecal samples from children with AGE, collected during a surveillance study carried out in a low-income community in Belém, Pará, between 1990 and 1992. METHODS: HAdV was detected by nested PCR, using primers Hex1deg/Hex2deg and NeHex3deg/NeHex4deg. SaV was assayed by reverse transcription PCR (RT-PCR), nested PCR, and quantitative PCR. The nucleotide sequence was determined by direct cycle sequencing. RESULTS: Overall, 43% (74/172) of samples were positive for HAdV, of which 70.3% (52/74) were sequenced and classified as belonging to five different species, mostly A and F. For SaV, positivity was 5.2% (9/172) and genotypes GI.1, GI.7, GII.1, and GV.2 were detected. CONCLUSIONS: The present results reinforce the need for further studies to obtain epidemiological data about the circulation of these viruses in Brazil, especially in the Amazon Region, where data from the early 1990's are scarce. Furthermore, the study describes for the first time the detection of SaV genotypes GI.7 and GV.2 in Brazil, showing that these types circulated in the region more than 25 years ago.

Seasonal variation on the presence of adenoviruses in stools from non-diarrheic patients

Human adenoviruses (HAdV), members of the Adenoviridae family, are excreted through the fecal route and may be present in the feces of humans consuming contaminated food or water. The presence of HAdV from different serotypes in the feces of healthy individuals was already reported using conventional polymerase chain reaction; however, real-time PCR (qPCR) may reveal not only the rates of detection as well as demonstrate the viral loads excreted by healthy persons. Aiming to identify and characterize the presence of adenoviruses in stool samples, 147 fecal samples from patients with no records of diarrhea were analyzed (74 from winter season and 73 from summer) by Real-Time PCR (qPCR) assay and conventional PCR. HAdV genome was present in 43.8% (32/73) of stools samples collected during summer season and 21.6% (16/74) during winter. The rate of detection of genomic copies (gc) ranged from 4.04×10² to 6.72×10⁵gc/g of feces among the 147 samples analyzed, of which the ranged of genomic copies of DNA HAdV was major in summer. All samples were negative when tested for rotaviruses (RV) and noroviruses (NoV) by PCR conventional and qPCR respectively. HAdV is excreted constantly by infected individuals in the absence of clinical signs and the occurrence may vary seasonally.

Clinical and epidemiological aspects related to the detection of adenovirus or respiratory syncytial virus in infants hospitalized for acute lower respiratory tract infection / Aspectos clínicos e epidemiológicos relacionados à detecção de adenovírus ou vírus sincicial respiratório em crianças hospitalizadas por doença aguda do trato respiratório inferior

OBJECTIVE: To characterize and compare clinical, epidemiological, and laboratory aspects ofinfants with acute lower respiratory infection (ALRI) associated with the detection of adenovirus(ADV) or respiratory syncytial virus (RSV). METHODS: A preliminary respiratory infection surveillance study collected samples of nasopharyngeal aspirate (NPA) for viral research, linked to the completion of a standard protocol, from children younger than two years admitted to a university hospital with ALRI, between March of 2008 and August of 2011. Polymerase chain reaction (PCR) was used for eight viruses: ADV, RSV, metapneumovirus, Parainfluenza 1, 2, and 3, and Influenza A and B. Cases with NPA collectedduring the first 24 hours of admission, negative results of blood culture, and exclusive detection of ADV (Gadv group) or RSV (Grsv group) were selected for comparisons. RESULTS: The preliminary study included collection of 1,121 samples of NPA, 813 collected in thefirst 24 hours of admission, of which 50.3% were positive for at least one virus; RSV was identifiedin 27.3% of cases surveyed, and ADV was identified in 15.8%. Among the aspects analyzed inthe Gadv (n = 58) and Grsv (n = 134) groups, the following are noteworthy: the higher meanage, more frequent prescription of antibiotics, and the highest median of total white blood cellcount and C-reactive protein values in Gadv. CONCLUSIONS: PCR can detect persistent/latent forms of ADV, an aspect to be considered wheninterpreting results. Additional studies with quantitative diagnostic techniques could elucidatethe importance of the high frequency observed. .

OBJETIVO: Caracterizar e comparar aspectos clínicos, epidemiológicos e laboratoriais delactentes com evidências de infecção aguda do trato respiratório inferior (IATRI) associada à detecção do adenovírus (ADV) ou do vírus sincicial respiratório (VSR). MÉTODOS: Um estudo preliminar de vigilância de infecções respiratórias desenvolveu coleta de aspirado nasofaríngeo (ANF) para pesquisa viral, vinculada ao preenchimento de protocolo padrão, de menores de dois anos internados com quadro de IATRI em hospital universitário, entre março de 2008 e agosto de 2011. Utilizou-se técnica da reação em cadeia da polimerase (PCR) para oito vírus: ADV, VSR, metapneumovírus, parainfluenza 1, 2 e 3 e influenza A e B. Foram selecionados para comparações os casos com ANF coletado nas primeiras 24 horas da admissão, resultado de hemocultura negativo e detecção exclusiva de ADV (grupo Gadv) ou VSR (grupo Gvsr). RESULTADOS: O estudo preliminar incluiu coleta de 1.121 amostras de ANF, sendo 813 coletadas nas primeiras 24 h da admissão, das quais 50,3% foram positivas para ao menos um dos vírus, com VSR em primeiro lugar, em 27,3%, e ADV em segundo, em 15,8% dos casos pesquisados. Dentre os aspectos analisados nos grupos Gadv (n = 58) e Gvsr (n = 134), destacaram-se a média da idade mais elevada, maior frequência da prescrição de antibióticos e medianas mais elevadas para contagem total de leucócitos e valores da proteína C-reativa no Gadv. CONCLUSÕES: A PCR utilizada pode detectar formas persistentes/latentes de ADV, aspecto aser considerado ao interpretar os resultados. Estudos complementares com técnicas diagnósticas quantitativas, por exemplo, poderiam evidenciar a importância da elevada frequência verificada. .

Infecciones respiratorias agudas bajas por adenovirus en niños hospitalizados en el Centro Hospitalario Pereira Rossellen el año 2008 / Acute lower respiratory infections by adenovirus in hospitalized children at the Pereira Rosel Hospital in 2008

El adenovirus (ADV) causa 2%-15% de las hospitalizaciones por infecciones respiratoria agudas bajas (IRAB) virales en niños. Numerosas series han reportado alta tasa de mortalidad y secuelas pulmonares. Se realizó un estudio retrospectivo con el objetivo de describir las características epidemiológicas, clínicas y radiológicas de niños hospitalizados por IRAB causada por ADV entre abril y setiembre de 2008. Se identificaron 100 casos. El 66% ocurrió en junio-julio, 60% eran varones y 54% menores de 6 meses. Presentaron comorbilidad 15 niños. Las manifestaciones clínicas y los hallazgos radiológicos fueron similares a las encontradas en otras series. La media de estadía hospitalaria fue de 8,8 días. Ingresaron a unidad de cuidados intensivos (UCI) 12 niños y nueve requirieron asistencia ventilatoriamecánica (AVM). Un niño falleció y uno evolucionó a la oxigeno-dependencia. En 31 niños hubo infección mixta con VRS, su evolución no mostró mayor gravedad. Los casos de infección intrahospitalaria fueron 20%; sus características clínicas y su evolución fueron similares a los casos extrahospitalarios. En el período analizado las hospitalizaciones por IRAB por ADV fueron más numerosas que en años anteriores y presentaron menor severidad que la observada anteriormente...

Infección por adenovirus en hospital de niños con enfermedades respiratorias crónicas / Adenovirus infection in a children's hospital with chronic pulmonary diseases

Introducción: Las infecciones por adenovirus se diseminan rápidamente en recintos cerrados causando brotes asociados a gran morbimortalidad. Objetivos: Identificar tasa de ataque (TA) de infección por adenovirus en hospital de niños con enfermedades respiratorias crónicas (ERC) y evaluar factores asociados que faciliten la infección. Pacientes y Método: Entre junio y octubre de 2010 se evaluaron 50 niños con ERC del Hospital Josefina Martínez. Ellos estuvieron expuestos durante el invierno a pacientes con infección respiratoria aguda baja. A los pacientes con ERC sintomáticos (fiebre y cambio en su signología respiratoria basal) se les realizó Inmunofluorescencia Directa (IFD) Viral. "Caso" fue definido como "paciente sintomático e IFD positiva para Adenovirus". Se evaluaron TA primaria, secundaria y global. Variables como género, edad, traqueostomía y gastrostomía fueron analizadas buscando asociación con los casos. Resultados: El 44 por ciento de los pacientes eran lactantes. El 68 por ciento tenía traqueostomía y 54 por ciento gastrostomía. El primer paciente con Adenovirus ingresó en junio y el caso primario apareció dos semanas después. Hubo 25 casos secundarios que representaron TA secundaria de 51 por ciento. La TA global fue 52 por ciento. No hubo fallecidos. Los lactantes tuvieron un riesgo tres veces mayor que los niños mayores de contraer la infección (OR 3,31 [IC95 por ciento 1,02-10,72; p = 0,046]). No hubo asociación significativa con traqueostomía, gastrostomía ni género. Conclusiones: La alta diseminación de la infección por adenovirus en recintos cerrados obliga a extremar las medidas de prevención de IAAS especialmente en lactantes.

Introduction: Intrahospital adenovirus infections spread rapidly in closed environments causing outbreaks associated with high morbidity and mortality. Objectives: To identify the attack rate (AR) of adenovirus in a hospital treating children with Chronic Respiratory Diseases (CRD) and to evaluate associated factors that facilitate infection. Patients and Methods: Fifty children with CRD were evaluated between June 2010 and October 2010 at Josefina Martinez Hospital. They were exposed to patients with acute lower respiratory infection during winter. Patients with CRD symptoms (fever and change in basal nasal mucus) underwent Viral Direct Immunofluorescence (DIF). The case was defined as "symptomatic patient with positive DIF for Adenovirus". Primary, secondary and global ARs were evaluated. Variables such as gender, age, tracheostomy and gastrostomy were analyzed looking for associations with the cases. Results: 44 percent of patients were infants; 68 percent of children had tracheostomy and 54 percent had gastrostomy. The first patient with Adenovirus was admitted in June and the primary case was reported two weeks later. 25 cases presented secondary AR corresponding to 51percent Global AR was 52 percent overall. No mortality was reported. The risk was three times higher in infants than older children (OR 3.31 [IC95 percent 1.02-10.72; p = 0.046]). No significant associations with tracheostomy, gastrostomy and gender were found. Conclusions: The rapid spread of adenovirus infection in closed environments requires extreme prevention measures especially regarding infants.

Human adenovirus detection among immunocompetent and immunocompromised patients presenting acute respiratory infection

INTRODUCTION: Human adenoviruses (HAdV) play an important role in the etiology of severe acute lower respiratory infection, especially in immunocompromised individuals. The aim of the present study was detect the HAdV through different methods: direct fluorescence assay (DFA) and nested-polymerase chain reaction (PCR-nested) from patients with acute respiratory infection (ARI) up to 7 days of symptoms onset. METHODS: Samples (n=643) were collected from different risk groups during from 2001 to 2010: 139 adults attended in an Emergency Room Patients (ERP); 205 health care workers (HCW); 69 from Renal Transplant Outpatients (RTO); 230 patients in hematopoietic stem cell transplantation (HSCT) program. RESULTS: Among all patients (n=643) adenovirus was detected on 13.2% by DFA and/or PCR: 6/139 (4.3%) adults from ERP, 7/205 (3.4%) from HCW samples, 4/69 (5.8%) from RTO and 68/230 (29.5%) from HSCT patients. Nested PCR showed higher detection (10%) compared to DFA test (3.8%) (p < 0.001). HSCT patients presented significantly higher prevalence of HAdV infection. CONCLUSIONS: Adenovirus detection through nested-PCR assay was higher. However the inclusion of molecular method in laboratorial routine diagnostic should be evaluated considering the reality of each specific health service. .

Sentinel surveillance of influenza and other respiratory viruses, Brazil, 2000-2010

There are scanty data on the epidemiology of influenza and other respiratory viruses in South America and Brazil. The aim of this study was to summarize the data from the Brazilian surveillance system of influenza and other respiratory viruses and discuss the patterns of viral circulation. The system is based on detecting cases of influenza-like illness in sentinel sites and weekly collection of five nasopharyngeal secretions samples, which are processed in state public health laboratories for respiratory viruses by indirect immunofluorescence assay. Data from 2000 to 2010 were described over time, by region, gender, and age group, and an analysis of Spearman correlation was performed between monthly influenza detection and rainfall and temperature data in two state capitals with the highest number of positive samples, one from the northeast region (Maceió) and other from the southern region (Curitiba). There were 3,291,946 visits for influenza-like illness; of these, 37,120 had samples collected and 6421 tested positive: 1690 (26%) influenza A, 567 (9%) influenza B, 277 (4%) parainfluenza 1, 571 (9%) parainfluenza 2, 589 (9%) parainfluenza 3, 742 (12%) adenovirus, and 1985 (31%) respiratory syncytial virus. Overall, increased activity of respiratory syncytial virus was observed from March to June, preceding the peak of influenza activity, from May to August, but with regional differences. In Maceió, there was a weak correlation between temperature and influenza detection (ρ = 0.05), but a moderate positive correlation between rainfall and influenza detection (ρ = 0.36). In Curitiba, a high correlation was observed between the decrease in temperature and rainfall and the increase in influenza detection (ρ = -0.83 and -0.78 respectively). These data are important to guide public health control measures as the best time for influenza vaccination and use of antivirals.

Prevalência baixa de adenovírus em crianças com diarreia em Belo Horizonte-MG / Low prevalence of adenoviruses in children with acute diarrhea in Belo Horizonte-MG

INTRODUÇÃO: Diversos microrganismos são reconhecidos como agentes de diarreia aguda, entre eles, os adenovírus, cuja associação com a doença apresenta variações geográficas e é pouco conhecida no Brasil. OBJETIVOS: Investigar a presença de adenovírus em fezes de crianças com diarreia aguda e sem diarreia, em Belo Horizonte-MG, e estudar os fatores epidemiológicos associados à adenovirose intestinal. MATERIAL E MÉTODOS: O teste imunocromatográfico qualitativo (kit VIKIA® Rota-Adeno, bioMérieux) foi utilizado para pesquisa de antígenos de adenovírus em amostras fecais obtidas de 268 crianças com diarreia aguda e 124 sem diarreia, em 2005 e 2006, no Hospital Infantil João Paulo II, Belo Horizonte-MG. Dados laboratoriais, clínicos e epidemiológicos foram registrados em banco de dados (SPSS Statistical package, IBM). RESULTADOS: Adenovírus foi detectado nas fezes de 16 crianças (4,1%): 12 (4,5%) com diarreia e quatro (3,2%) sem diarreia. A virose foi mais comum em meninas e a distribuição etária da infecção foi homogênea. Entre as 16 crianças com infecção pelo vírus, 11 (68,8%) tinham até 12 meses de idade. Entretanto, diferença significativa não foi observada para os parâmetros analisados. Distribuição sazonal da infecção por adenovírus não foi detectada. CONCLUSÃO: Nossos dados demonstram que a prevalência da adenovirose é baixa na população pediátrica no nosso meio.

INTRODUCTION: Several microorganisms, among them enteric adenovirus, are widely recognized as etiological agents of acute diarrhea. The association between adenovirus and the disease varies among geographical regions and is poorly known in Brazil. OBJECTIVES: To investigate the presence of adenovirus in stool samples from children with and without diarrhea in Belo Horizonte-MG. To study factors associated with enteric adenovirus infection. MATERIAL AND METHOD: A qualitative immunochromatographic assay (kit VIKIA® Rota-Adeno, bioMérieux) was performed to detect adenovirus antigens in stool samples from 268 children with acute diarrhea and 124 without diarrhea at Hospital Infantil João Paulo II from January/2005 to December/2006. Clinical, laboratory, and epidemiologic data were recorded in SPSS database (SPSS Statistical package, IBM). RESULTS: Adenovirus was detected in 16 samples (4.1%): 12 of them (4.5%) were from children with acute diarrhea and 4 of them (3.2%) from children without diarrhea. The viral infection was more prevalent among girls and the age distribution was homogenous. Among the 16 children infected by adenovirus,11 (68.8%) were younger than 12 months old. However, no significant statistical difference was observed within the analyzed parameters. There was no seasonal distribution of adenovirus infection. CONCLUSION: Our data demonstrate that the prevalence of enteric adenovirus infection is low among children with diarrhea in Belo Horizonte-MG.

Brote de queratoconjuntivitis epidémica en un Servicio de Oftalmología / A nosocomial outbreak of epidemic keratoconjunctivitis

We describe a nosocomial outbreak of keratoconjunctivitis at the Ophthalmology Clinic in Hospital Carlos Van Buren, that affected 150 patients, during August and September of 2006. This outbreak was concomitant with a community outbreak produced by the same agent in the city of Valparaiso that affected 681 other patients. Although adenovirus was not isolated in the nosocomial cases, positive cultures were obtained from community cases, so the diagnosis was based on clinical and epidemiological criteria. The infection rate within the Clinic patients was 5.2 percent considering the population that attended the Clinic in this period. The evaluation of patient care practices showed that common risk factors among affected cases were measurement of ocular tension with a tonometer in the Ophthalmology Clinic (without disinfection of the tonometer between patients), contamination of work surfaces (equipment, furniture), and poor compliance of hand hygiene. Control measures adopted were cleaning, disinfection of tonometer, equipment and work surfaces, and reinforcement of hand hygiene measures. With these measures, it was possible to control the nosocomial outbreak, despite the continued outpatient care of community-acquired cases.

Se describe un brote nosocomial de queratoconjun-tivitis epidémica en la Policlínica de Oftalmología del Hospital Carlos Van Burén, que afectó a 150 pacientes, durante los meses de agosto y septiembre de 2006. Este brote se presentó en el contexto de un brote en la ciudad de Valparaíso que afectó a otros 681 pacientes. Aun cuando no se logró aislar adenovirus (ADV) en los casos nosocomiales, se aisló ADV en pacientes del brote comunitario, por lo que el diagnóstico de los casos nosocomiales se basó en criterios clínicos y epidemiológicos. La tasa de ataque del brote nosocomial fue de 5,2 por ciento considerando la población consultante del período. La evaluación de prácticas de atención directa mostró que los factores de riesgo de los casos serían la medición de la tensión ocular mediante tonómetro en la Policlínica de Oftalmología (sin desinfección del tonómetro entre paciente y paciente), contaminación de superficies de trabajo (equipos, mobiliario) y bajo cumplimiento de la higienización de manos. Las medidas de control fueron limpieza, desinfección del tonómetro, equipos y superficies de trabajo, junto a reforzamiento de lavado de manos. Con estas medidas se logró controlar el brote intrahospitalario a pesar de mantenerse las consultas provenientes del brote en la comunidad.

Enfermedad por adenovirus en niños receptores de trasplante alogénico de células progenitoras hematopoyéticas / Adenovirus disease in children undergoing allogeneic hematopoietic stem cell transplantation

Introducción: Las infecciones virales son una causa conocida de morbi-mortalidad en pacientes receptores de trasplante alogénico de células progenitoras hematopoyéticas (TACPH). Los avances en la prevención y tratamiento de la infecciones por los virus del grupo Herpes obliga a centrar la atención en virus emergentes como el Adenovirus (Adv). Objetivos: Analizar la incidencia, evolución y factores de riesgo de la enfermedad por Adv en pacientes pediátricos trasplantados en un mismo centro. Métodos: Cohorte retrospectiva. Se analizaron los TACPH realizados entre abril/94 y abril/10. Se comparó la frecuencia de enfermedad por Adv antes y después del inicio del programa de TACPH con donantes no relacionados, en el año 2008. Resultados: n TCPH: 303. Incidencia enfermedad por Adv: 18p (5,4%), según período: 1994-2007: 2,8% vs 2008-2010: 18,9% (p<0,001). Pacientes con Adv: 61% varones, mediana edad: 8 años (r 0,6 - 18), días del trasplante: 55 (r 4- 295). La enfermedad por Adv tuvo una mortalidad del 22% y fue causa del 5,6% de la mortalidad relacionada con el trasplante. Los factores de riesgo para enfermedad por Adv fueron el antecedente de TACPH no relacionado (OR 6,6 IC95% 1,6-27,8) y la enfermedad por CMV (OR 12,3 IC95% 3,4- 44,5). Doce pacientes con viremia y/o enfermedad grave por Adv que recibieron tratamiento con Cidofovir (75%) tuvieron toxicidad renal moderada-severa y 33% de mortalidad por Adv. Conclusión: La enfermedad por Adv representa una causa importante de morbi-mortalidad en el TACPH. Los pacientes con factores de riesgo requieren estrategias de diagnóstico temprano y tratamiento oportuno (AU)

Introduction: Viral infections are a well-known cause of morbidity and mortality in patients who underwent allogeneic hematopoietic stem cell transplantation (AHSCT). Advances in the prevention and treatment of herpes virus infections have led to increased focus on other emerging viruses such as the adenovirus (ADV). Objectives: To analyze the incidence, evolution, and risk factors for ADV disease in pedia - tric patients who underwent AHSCT in a single center. Methods: All patients who underwent HSCT between April 1994 and April 2010 were retrospectively analyzed. Incidence rates of ADV disease before and after the introduction of the program of AHSCT from non-related donors in 2008 were compared. Results: HSCT n = 303. Incidence of ADV disease: 18p (5.4%), 1994-2007: 2.8% vs 2008-2010: 18.9% (p<0,001). Patients with ADV: 61% boys, mean age: 8 years (r 0.6 - 18), mean days after transplantation: 55 (r 4- 295). Mortality due to ADV disease was 22% and ADV was de cause of 5.6% of transplant-related mortality. Risk factors for disease due to ADV were AHSCT from a non-related donor (OR 6.6 CI 95% 1.6-27.8) and CMV disease (OR 12.3 CI 95% 3.4- 44.5). Twelve patients with viremia and/or severe disease due to ADV who received treatment with Cidofovir (75%) developed moderate- to-severe kidney toxicity and mortality due to ADV was 33%. Conclusion: ADV disease is an important cause of morbidity and mortality in AHSCT. At-risk Patients require early diagnostic strategies and adequate treatment (AU)

Queratoconjuntivitis por adenovirus generadas a partir de una consulta oftalmológica / Adenovirus keratoconjunctivitis acquired in an ophtalmology clinic

Introduction: Eye infection is a common cause of ophtalmologic consultation. Adenovirus keratoconjunctivitis outbreaks are common worldwide but its impact and clinical characteristic in Chilean population is unkown. Objective: To describe a series of adenovirus keratoconjunctivitis cases. Patients and Method: The Índex case and contacts received medical care in the Hospital Clínico Universidad de Chile between April and August 2006. A complete ophthalmologic exam and microbiologic evaluation was performed. Results: Nine patients presented a pattern of characteristic epidemic keratoconjunctivitis. In x cases sub-corneal epithelial infiltrates were observed for a period of more than six months. Three affected patients were ophtalmologists, staff at the Hospital. In seven patients ADV was isolated all bellonging to type D genus. Conclusions: Adenovirus type D caused epidemic keratoconjunctivitis in a series of Chilean individuals. Ophthalmologist may have transmitted the virus to patients.

Introducción: La patología ocular infecciosa es frecuente en la consulta oftalmológica, especialmente la conjuntivitis y queratoconjuntivitis epidémica (QCE). Brotes de esta patología son causados por adenovirus (ADV) en el extranjero; en Chile se desconoce su impacto y características. Objetivos: Describir una serie de casos de queratonconjuntivitis epidémica por adenovirus. Material y Pacientes: Al caso índice y los contactos de una serie de casos de QCE por ADV que consultaron en el Hospital Clínico de la Universidad de Chile, entre abril y agosto de 2006, se les realizó examen oftalmológico completo y estudio de ADV por aislamiento viral, detección de antígenos y de genoma viral. Se estableció el género de ADV mediante reacción de polimerasa en cadena. Resultados: Los 9 pacientes infectados presentaron QCE característica. En algunos casos se observaron infiltrados sub-epiteliales corneales que se extendieron por más de seis meses. Tres pacientes eran médicos oftalmólogos. En 7 de los 9 pacientes examinados se aisló ADV; todos del género D. Conclusiones: En Chile, la QCE puede ser causada por el subgénero tipo D. El médico oftalmólogo es un potencial vector en la transmisión de ADV en un brote de QCE, por lo que es fundamental que sea considerado en las estrategias de prevención de esta patología.

Molecular epidemiology of adenovirus conjunctivitis in Rio de Janeiro, Brazil, between 2004 and 2007 / Epidemiologia molecular de adenovírus associados à conjuntivite no Rio de Janeiro, Brasil, no periodo de 2004 a 2007

Viral conjunctivitis is a common, highly contagious disease often caused by adenovirus. We investigate the frequency of adenoviral conjunctivitis in the population of Rio de Janeiro, Brazil, between March 2004 and May 2007 and identified the predominant serotype circulating among this population. Seventy-five ocular swabs were collected from 66 patients with clinical presentation of conjunctivitis. The specimens were analyzed for detection of adenovirus (AdV) by polymerase chain reaction (PCR). The PCR products were further analyzed for virus typing by sequence analysis and/or heteroduplex mobility assay (HMA). Forty-five samples (60%) were positive for AdV of which 21 samples were typed as AdV19 (46.7%), 7 AdV8 (15.5%), 3 AdV31 (6.7%), and one each AdV1, AdV2, AdV3, AdV4 and AdV6. For nine samples the serotype was not determined. AdV19 was the predominant serotype circulating in Rio de Janeiro during the studied period.

A conjuntivite viral é doença ocular comum, altamente contagiosa, frequentemente causada por adenovírus. Neste estudo, investigamos a frequência de conjuntivite por adenovírus na população do Rio de Janeiro, Brasil, entre março de 2004 e maio de 2007, e identificamos o sorotipo predominante circulando nesta população. Setenta e cinco swabs de secreção ocular foram coletados de 66 pacientes com conjuntivite. As amostras foram analisadas para detecção de adenovírus (AdV) por reação em cadeia da polimerase (PCR). Os produtos da PCR foram caracterizados por sequenciamento e/ou ensaio de mobilidade do heteroduplex (Heteroduplex Mobility Assay - HMA) para identificação do sorotipo viral. Quarenta e cinco (60%) amostras foram positivas para AdV das quais 21 foram identificadas como pertencentes ao sorotipo AdV19 (46,7%), sete AdV8 (15,5%), três AdV31 (6,7%), e uma de cada: AdV1, AdV2, AdV3, AdV4 e AdV6. Para nove amostras o sorotipo não pode ser identificado. O AdV 19 foi o sorotipo predominante circulando no Rio de Janeiro durante o período estudado.

Adenovirus, calicivirus and astrovirus detection in fecal samples of hospitalized children with acute gastroenteritis from Campo Grande, MS, Brazil

We analyzed fecal samples from hospitalized children up to three years of age with acute gastroenteritis at Campo Grande, Mato Grosso do Sul, Brazil, from May 2000-January 2004. Astrovirus and calicivirus were detected by Reverse Transcription-Polymerase Chain Reaction and adenovirus was detected using the Rotavirus and Adenovirus combined immunoenzyme assay. Astrovirus, adenovirus and calicivirus were detected at rates of 3.1 percent, 3.6 percent and 7.6 percent, respectively. These results re-emphasize the need for the establishment of regional vigilance systems to evaluate the impact of enteric viruses on viral gastroenteritis.

Adenoviruses C in non-hospitalized Mexican children older than five years of age with acute respiratory infection

Adenoviruses (AdV) are commonly involved in acute respiratory infections (ARI), which cause high morbidity and mortality in children. AdV are grouped in six species (A-F), which are associated with a wide range of diseases. The aim of this study was to identify the AdV species infecting non-hospitalized Mexican children with ARI symptoms, attending to the same school. For that, a PCR/RFLP assay was designed for a region of the hexon gene, which was chosen, based on the bioinformatical analysis of AdV genomes obtained from GenBank. A total of 100 children's nasopharyngeal samples were collected from January to June, 2005, and used for viral isolation in A549 cells and PCR/RFLP analysis. Only 15 samples produced cytopathic effect, and in all of them AdV C was identified. AdV C was also identified in eight additional nasopharyngeal samples which were negative for viral isolation. In summary, this outpatient population showed a rate of AdV infection of 23 percent, and only AdV C was detected.

Coinfection of Viral Agents in Korean Children with Acute Watery Diarrhea

Currently, there are a few reports on viral coinfection that causes an acute watery diarrhea in Korean children. So, to evaluate the features of coinfectious viral agents in children with acute watery diarrhea, we enrolled 155 children with acute watery diarrhea from July 2005 to June 2006. Fecal samples were collected and evaluated for various viral infections such as rotavirus, norovirus, adenovirus and astrovirus. The mean (+/-standard deviation) age of the children was 2.71+/-2.37 yr. The detection rate of viral agents was most common in children between the ages of 1 and 3 yr. Rotavirus was detected in 63 children (41.3%), norovirus in 56 (36.2%), adenovirus in 11 (7.1%), and astrovirus in 1 (0.6%). Regarding rotavirus, there were 38 (60.3%) cases with monoinfection and 25 (39.7%) with coinfection. For norovirus, there were 33 (58.9%) cases with monoinfection and 23 (41.1%) with coinfection. Coinfection with rotavirus and norovirus was most common, and occurred in 20/155 cases (12.9%) including coinfection with adenovirus. So, rotavirus and norovirus were the most common coinfectious viral agents in our study population with acute watery diarrhea.

Antigenic and genomic characterization of adenovirus associated to respiratory infections in children living in Northeast Brazil

From January to December 1998, nasopharyngeal aspirates were obtained from 482 children with acute respiratory infections attended in emergence department and wards of a teaching hospital in the city of Salvador, Brazil. The samples were tested for the presence of adenovirus by isolation in tissue culture and indirect immunofluorescence assay. Eleven adenoviruses were detected by both methods in the same clinical samples. Infections by adenovirus were observed during seven months of the year without association with rainy season. Genome analysis was performed on these 11 isolates. Species C was represented by serotypes 1, 2 and 5. Within species B, only serotype 7 (Ad7) was detected. Two genomic variants of Ad1, two variants of Ad2, one of Ad5, and one of Ad7 (7h) were identified. This is the first study of molecular epidemiology of adenovirus associated to acute respiratory infections in children living in Northeast Brazil, and contributes to a better understanding of adenovirus infections in the country.