A Syndrome of Transient Encephalopathy Associated With Adenovirus Infection

Abstract

ABSTRACT. Background and Objective. Adenovirus is a common pathogen in the pediatric population. Respiratory, gastrointestinal, or renal systems are often involved in adenovirus infections. Several neurologic syndromes have been attributed to adenovirus, such as adenovirus aseptic meningitis, myelitis, subacute focal encephalitis, and Reye-like syndrome. The purpose of this study was to describe the clinical features and encephalography findings in 7 infants treated in our center for a syndrome of transient encephalopathy associated with adenovirus infection.Study Participants. Three females and 4 males ages 7 to 34 months seen in our department between July 1983 and February 1984 and September 1998 and May 1999 presented with fever of at least 7 days' duration and a gradual decline in the state of alertness. Score on the Glasgow Coma Scale ranged from 9 to 12. Findings on lumbar puncture were normal. In all 7 patients, the encephalogram showed moderate to severe background slowing compatible with encephalopathy. All patients were catarrheal and had mild hepatomegaly with slight elevation of liver enzymes. Some had bronchopneumonia, diarrhea, and conjunctivitis either isolated or in combination.Methods and Results. Adenovirus was isolated by immunfluorescence technique in all patients-from the sputum in 3 patients, nasopharynx in 5, conjunctiva in 4, and rectal swab in 5. In 5 patients, serotyping was performed by an antibody neutralization method. Adenovirus type 3 was ascertained from a nasal swab in 1 patient, sputum specimens in 3, throat swab in 3, and rectal cultures in 5. The clinical course was characterized by a progressive recovery of alertness. After several days, there was a complete reversal of neurologic findings.Conclusion. We suggest that this syndrome of transient encephalopathy is a distinct entity and should be considered as another of the several neurologic syndromes known to be associated with adenovirus infection. Pediatrics 2001;107(5). URL: http://www. pediatrics.org/cgi/content/full/107/5/e69; encephalitis, adenovirus, encephalopathy.

Pneumonia Complicated by Transient Encephalopathy: Unusual Presentation of Adenovirus

“…Most of these cases presented with high grade fever, respiratory symptoms and some had vomiting and diarrhea. Further radiological imaging showed bronchopneumonia, the patients gradually started to be lethargic with decrease in GCS to as low as 9, most had no seizures [12] while others reported to have multiple attacks of seizures [13] which is similar to our patient who developed multiple generalized seizures, progressive neurological deterioration inform of lethargy, decrease level of consciousness with GCS declining to 9/15 and EEG finding of generalized slowing which is also was found in some of the reported cases [12].…”

“…These neurological complications are sometimes associated with disseminated adenovirus diseases that are far more common in young children and immunocompromised individuals [3]. Now for the past two decades there are few reported cases similar to the patients in our report [12,13]. Most of these cases presented with high grade fever, respiratory symptoms and some had vomiting and diarrhea.…”

“…This collection of symptoms with positive adenovirus was called by a 2001 article [12] as "Transient encephalopathy associated with adenovirus infection" which is diagnosed by positive adenovirus PCR or DFA either by sputum, conjunctiva and rectal swaps; with the exclusion of all other more sever neurological complication. This syndrome has a good outcome and usually a complete resolution of the neurological symptoms as our patient.…”

Ocular Flutter Following Adenoviral Conjunctivitis in an Adult

“…Straussberg et al 2 described three paediatric cases of transient encephalopathy in association with adenovirus conjunctivitis. Similar post-infectious syndromes with ataxia and ocular flutter have been described following enterovirus (which does not cause sub-epithelial opacities), 3 cytomegalovirus (CMV), 4 mumps, 5 and human immunodeficiency virus (HIV) 6 infections.…”

Drastically lowering the titer of waterborne bacteriophage PRD1 by exposure to immobilized hydrophobic polycations

“…Bacteriophage PRD1 resembles human adenoviruses causing a number of major illnesses, including gastroenteritis, cystitis, meningitis, and pneumonia (Crabtree et al 1997, Straussberg et al 2001. Although PRD1 infects Gram-negative bacteria while adenoviruses infect vertebrate animals, both are icosohedral viruses containing double-stranded DNA whose coat proteins are quite similar in terms of their folds and coating arrangements, as are their capsids and spikes (Bamford et al 2002).…”