Infección letal por adenovirus: presentación de un caso / Lethal infection for adenovirus: case report

Adenovirus (ADV) can cause serious, localized or disseminated, sometimes lethal disease. There is no specific treatment, only support management according to requirements and severity of disease. Extracorporeal membrane oxygenation (ECMO) has been used in severe ADV infection. Cidofovir has been reported as a therapeutic option. This case reports a lethal case of ADV respiratory infection despite the treatment with cidofovir an ECMO.

El adenovirus (ADV) puede causar infección respiratoria grave, localizada o diseminada y letal en pacientes susceptibles. No existe terapia específica, solo de soporte según requerimientos y gravedad. En este sentido el manejo con oxigenación por membrana extracorpórea (ECMO) ha sido utilizado en niños con infección grave por ADV. Si bien no existe terapia específica actual se ha reportado uso de cidofovir que ha ganado espacio como posibilidad terapéutica en caso de enfermedad grave. Se presenta el caso clínico de un paciente que cursó con infección letal por ADV a pesar del tratamiento de soporte con ECMO y el tratamiento con cidofovir.

Comparative study of clinical characteristics between adult patients with adenovirus type 7 and type 55 infections in China during 2012-2018 / 中华传染病杂志

Objective To compare and explore the differences of clinical characteristics between human adenovirus type 7 (HAdV7) and type 55 (HAdV55) infections in adults,and to provide evidences for clinical management.Methods The data of clinical manifestations,laboratory examinations,chest computed tomography and prognosis of 214 cases with HAdV7 and 235 cases with HAdV55 infections from 2012 to 2018 were retrospectively collected and analyzed.The chi-square test was used for the categorical variables,and the rank sum test was used for the continuous variables of non-normal distribution.Results Compared with patients in HAdV55,those in HAdV7 group displayed more diarrhea (12.1％ [26/214] vs 2.6％ [6/235],x2 =15.583),more laryngeal lymphatic follicles (33.2％ [71/214] vs 17.9％ [42/235],x2 =23.566),more tonsil enlargement (56.5％ [121/214] vs 20.0％ [47/235],x2 =63.870) with secretions (33.2％ [71/214] vs 11.5％ [27/235],x2 =30.878),more leukocytosis (24.8％ [53/214] vs 14.0％ [33/235],x2 =8.318),more monocytosis (78.0％ [167/214] vs 52.8％ [124/235],x2 =31.364),more thrombocytosis (7.1％ [15/212] vs 3.8％ [9/235],x2 =5.835),more elevated level of C-reactive protein (80.8％ [97/120] vs 64.3％ [137/213],x2 =10.020),more abnormalities of liver function (alamne aminotransferase [ALT]:13.5％ [28/207] vs 5.6％ [13/232],x2 =8.111) and myocardial enzymes (creatine kinase [CK]:37.6％ [77/205] vs 26.4％ [61/231],x2 =6.246),creatine kinase isoenzymes ([CK-MB]:35.6％ [73/205] vs 11.1％ [24/216],x2 =35.600),and all the differences were statistically significant (all P ＜ 0.05,0.01).Compared with patients in HAdV7 group,those in HAdV55 group displayed longer duration of diseases (7 [5]days vs 6[5] days,Z=-2.632),more sore throat (72.8％ [171/235] vs 62.1％ [133/214],x2 =0.016),more headache (62.1％ [146/235] vs 16.4％ [35/214],x2 =97.527),more pharyngeal congestion (93.6％ [220/235]vs 74.8％ [160/214],x2 =30.602),more leukopenia (14.0％ [33/235] vs 24.8％ [53/214],x2 =8.318),and more elevated level of lactate dehydrogenase (12.6％ [29/230] vs 6.3％ [13/205],x2 =4.881),more pneumonia (71.5％ [168/235] vs31.8％ [68/214],x2 =70.846) (all P＜0.05,0.01).Conclusions The clinical characteristics of HAdV7 and HAdV55 infections in adults are different.The type 55 infection is more likely to develop to pneumonia,while the type 7 infection has wider tissue tropism.

Causes of epidemic keratoconjunctivitis and therapeutic measures

Epidemic keratoconjunctivitis is the most common type of infectious conjunctivitis, and is caused by adenoviruses. The mode of transmission is mainly through direct contact with ocular secretions. Epidemic keratoconjunctivitis is generally diagnosed based on a patient's clinical features, and additional measures, such as cell cultures, polymerase chain reaction, and rapid antigen detection tests, can further confirm the diagnosis. The most common symptoms include a foreign body sensation, tearing, and photophobia. The symptoms are usually expressed unilaterally in the initial phase, but gradually become bilateral. Frequently occurring complications include pseudomembrane formation and subepithelial infiltrates. Currently, no antiviral agent has been proven effective to alter the natural course of the disease, and treatment merely has a supportive role instead of a curative role. Therefore, preventive measures in medical offices and in the community are the most important methods of controlling the propagation of this disease.

Clinical characteristics of Adenovirus infections and effective monitoring in patients undergoing allogeneic hematopoietic stem cell transplantation / 中华检验医学杂志

Objective To investigate the clinical characteristics of the human Adenovirus (HAdv) infections in allogeneic hematopoietic stem cell transplantation ( allo-HSCT) patients and explore the clinical significance of HAdv monitoring .Methods A total of 845 cases underwent allo-HSCT were included retrospectively in Perking University People′s Hospital from October 2012 to August 2014.Peripheral blood HAdv load were monitored twice weekly within 100 days after allo-HSCT, or whenever necessary quantitatively by real-time PCR. Meanwhile, other clinical samples such as stool , urine, and bronchoalveolar lavage fluid ( BLAF ) were also detected qualitatively whenever necessary .The follow-up period was at least six months after allo-HSCT.All clinical data were collected and analyzed .Results The total positive rate of HAdv was 3.4% ( 29/845 ) .The incidence of HAdv infection was higher in children [3.8%(6/155), 2 ) clinically, 1 cases with pneumonia.There were 8 cases of death at the end of follow-up.Conclusions HAdv is an important pathogen causing infection in patients after allo-HSCT. The infenction is characterized with multiple organ involvement .CMV and EBV coinfection is common .HAdv monitoring was of great significance in allo-HSCT patients.

Human adenovirus type 7 associated respiratory infections and its laboratory examination / 中华检验医学杂志

In recent years , respiratory tract infectious diseases and public health events caused by human adenovirus type 7(HADV-7) had been rising.Especially in Asia, the outbreaks of acute respiratory illness caused by HADV-7, accounting for more than 60%in the world, had brought great influence to the public health.In order to prevent the occurrence of HADV-7 epidemic and improve the diagnostic performance of laboratory , the research progress of HADV biological features and typing , HADV-7 epidemiological characteristics , clinical and differential diagnosis and laboratory examination methodologies were reviewed in this paper.

Application of hexon gene sequencing of adenovirus in pathogen detection of epidemic keratoconjunctivitis / 中华实验眼科杂志

Background Epidemic keratoconjunctivitis is a common eye disease,and adenovirus is one of the common pathogens.The hexon protein,one main capsid protein of the virus,is an important target of antibody binding.Thus,sequencing the coding region of the hexon protein is an important way for adenovirus fast typing.Objective This study was to complete a molecular epidemiology survey of epidemic keratoconjunctivitis and investigate its association with adenovirus in Shanghai area by sequencing the coding region of hexon protein.Methods Two hundred and fourteen sacconjunctival swab specimens were collected from 214 patients with suspicious epidemic keratoconjunctivitis who visited Shanghai Eye Disease Prevention and Treatment Center and the clinical sites supervised by the Shanghai Prevention and Monitoring Office of Acute Hemerragic Conjunctivitis under the informed consent from January 2010 to December 2012.DNA was extracted from the specimens and then the 140 bp conserved sequence in hexon protein coding region was amplified by PCR initially to determine an adenovirus pathogen.Furtherly,956 bp conserved sequence of the hexon codind district was sequencied to clarify the serotype of adenovirus in the adenovirus-positive specimens.Results 50.93％ patients (109/214) were detected to be adenovirus-positive by generic PCR,in which AdV1 + was in 4 patiens,AdV2+ was in 33 patients,AdV3+ was in 15 patients,AdV4+ was in 12 patients,AdV8+ was in 19 patiens,AdV19+ was in 15 patients,AdV37+ was in 8 patients.The subgenus D adenoviruses,including AdV8+,AdV19+ and AdV37+ often resulted in corneal inflammation,pseudomembranous conjunctivitis and preauricular lymph nodes;while subgenus B adenovirus induced much frequent tract infection and less corneal response.Conclusions PCR-sequence of conserved region of hexon protein coding district is applicable for the detection and serotyping of adenovirus in epidemic keratoconjunctivitis.

Clinical characteristics of clustering infection of human adenovirus-B type 7 in a military camp / 中华传染病杂志

Objective To investigate the clinical characteristics of a clustering infection caused by human adenovirus-B type 7 (HAdV-B7) which occurred in one military camp located at the southeastern coastal region in January 2014.Methods All clinical characteristics of the 70 patients were collected for analysis,including clinical symptoms and signs,chest computer tomography (CT) scans and laboratory results.Throat swabs were collected and real time polymerase chain reaction (RT-PCR) was performed to detect viral nucleotide.Results The prominent symptoms of these patients with HAdV-B7 infection included fever (100.0％,70/70),cough (82.9％,58/70),productive cough (72.9％,51/70) and sore throat (61.4％,43/70).All patients showed posterior pharyngeal wall linear congestion with ovoid follicle.Fifty-four (77.1 ％) patients had enlarged tonsils and 46 (65.7 ％) patients had tonsils covered by white secretions.Fifty-eight (82.9 ％) patients had pharyngeal follicular hyperplasia.Fifty-one (72.9 ％) patients had abnormalities on chest radiograph,including lung-marking fuzzy,pulmonary interstitial inflammation and parenchymal serous exudation.Of the 54 throat swabs from patients,34(63.0％) were identified as HAdV-B7.All patients were cured.Conclusions The clinical features of patients with HAdV-B7 infection are different from other viral infection.HAdV-B7 is easy to cause clustering infection in particular populations.Early detection and early intervention are needed to avoid exacerbation and transmission.

Uso de ganciclovir 0,15 por cento gel para tratamento de ceratoconjuntivite adenoviral / Ganciclovir 0.15 percent ophthalmic gel in the treatment of adenovirus keratoconjuntivitis

OBJETIVOS: Determinar a efetividade e a toxicidade do ganciclovir 0,15 por cento gel no tratamento de ceratoconjuntivites adenovirais e na prevenção de complicações tais como infiltrados corneanos, membranas ou pseudomembranas conjuntivais. MÉTODOS: Ensaio clínico duplo-cego, intervencionista, randomizado. Os 33 pacientes com diagnóstico clínico de ceratoconjuntivite adenoviral com início dos sintomas há menos de cinco dias foram randomizados em dois grupos: Grupo 1 (tratamento) com 19 pacientes que usaram ganciclovir e Grupo 2 (controle) com 14 pacientes que usaram lágrima artificial sem conservante. Todos pacientes responderam a um questionário de sinais e sintomas e foram submetidos a um exame oftalmológico. No 6º dia de tratamento responderam ao mesmo questionário por telefone e no 10º dia foram reavaliados pelo mesmo examinador e responderam novamente ao questionário. Os sinais e sintomas foram comparados. Para análise estatística foi utilizado os testes T de Student, Mann-Whitney e Wilcoxon, com significância estatística p<0,05. RESULTADOS: Tendência de melhor resposta no grupo tratamento em relação à percepção pelos pacientes, além da melhora mais rápida desse grupo em relação ao grupo controle (p=0,26). Houve menor transmissão para o olho adelfo (p=0,86) e para pessoas do convívio (p=0,16) no grupo tratamento. Comparando os dois grupos não houve diferença estatística em relação aos sintomas e sinais da conjuntivite. Comparando isoladamente cada grupo entre o pré-tratamento e no decorrer do tratamento, observou-se melhora estatisticamente significativa da dor, prurido e fotofobia apenas no grupo tratamento. Ganciclovir não mostrou toxicidade e teve maior tolerância pelos pacientes. Não houve diferença significativa no aparecimento de complicações da conjuntivite entre os dois grupos. CONCLUSÕES: O estudo evidenciou uma tendência à melhora mais rápida dos sinais e sintomas dos pacientes tratados com ganciclovir em relação ao grupo ...

PURPOSE: To evaluate the efficacy and the toxicity of 0.15 percent ganciclovir gel in the treatment of adenoviral conjunctivitis and in preventing ocular complications after adenoviral conjunctivitis, such as corneal infiltrates and pseudomembranes. METHODS: Double blind, interventional and randomized clinical trial. Thirty-three patients with clinical diagnosis of adenoviral conjunctivitis with onset of symptoms for five or less days were randomized in two groups: Group 1 (treatment) with 19 patients used ganciclovir gel and Group 2 (control) with 14 patients used artificial tears without preservative. Patients answered a questionnaire of signs and symptoms and were submitted to an ophthalmologic exam. On the 6th and 10th days of treatment they answered the same questions and were re-examined by the same ophthalmologist. Signs and symptoms were compared. T Student, Mann-Whitney e Wilcoxon tests were used to statistical analysis. RESULTS: Trend of better response in the treatment group in relation of patients' perception, besides faster improvement of this group compared to the control group (p=0.26). There were lower transmission to the fellow eye (p=0.86) and to people living together (p=0.16) in the treatment group. No statistical difference related to signs and symptoms of conjunctivitis were found comparing both groups. We observed statistical difference in pain, itch and photophobia only in the treatment group, comparing each group alone. No toxicity and more tolerance of the ganciclovir were observed. There was no statistical difference in the ocular complications after conjunctivitis between both groups. CONCLUSIONS: This study showed trend of better and faster response of the signs and symptoms of the patients treated with ganciclovir compared with the control group, but with no statistical significant. These results need to be confirmed by additional studies, with more patients and longer follow-up. Clinical Trails.gov: NCT01349452.