Three Nonfatal Cases of Neonatal Adenovirus Infection

Abstract

Neonatal adenovirus infection is considered a rare and fatal disease. Three nonfatal neonatal adenovirus infections manifesting as conjunctivitis or conjunctivitis with other nonspecific symptoms are described. Adenovirus DNA was detected by PCR in eye swabs from two patients and in both cerebrospinal fluid and eye swabs in the third patient. CASE REPORTS Case 1. A female neonate (18 days old) presented with a 2-day history of vomiting after feeds, high fever, and irritability. A screen for bacterial sepsis, which included examination of the cerebrospinal fluid (CSF), was initiated. Intravenous antibiotics were administered but discontinued once negative bacterial culture results for CSF and blood were obtained. At 20 days of age, the patient's symptoms resolved, but residual conjunctivitis was noted. Eye swabs (left and right eye) were taken for Chlamydia trachomatis investigation, and chloramphenicol treatment was commenced. The patient's symptoms settled, and she was discharged from the hospital 3 days after admission.Case 2. A 1.9-kg male was born via vaginal delivery at 35 weeks of gestation. His 17-year-old mother was well during delivery and showed no signs or symptoms of infection prenatally. Examination of the neonate at delivery was entirely normal, but jaundice that was mild and did not require phototherapy developed on day 4. On day 8, the patient developed conjunctivitis and received chloramphenicol. Eye swabs showed only very scanty growth of coliforms.Case 3. A 3-kg female neonate was born at 38 weeks of gestation by Caesarean section. Conjunctivitis was noted on day 5 of life, and a conjunctival swab was investigated for C. trachomatis. At 35 days of age, the baby presented with symp-

Fatal adenovirus infection in a neonate and transmission to health-care workers

“…The infant's and the pediatrician's isolates were identified as HAdV9 by hemagglutination inhibition assay using mono-specific reference antisera. Molecular analysis of a partial region of the hexon gene coding hexon protein including hypervariable regions 1-6 (HVR [1][2][3][4][5][6] showed 100% nucleotide identity between the sequences from the two isolates, demonstrating viral transmission. For sequence-based typing, deduced amino acid sequences of HVR 1-6 obtained from the two clinical strains were compared with previously reported sequences and phylogenetic analysis was done using the neighborjoining method.…”

“…Vertical transmission, via canal birth or viremia, is suggested by the presence of symptoms in mothers preceding or shortly after delivery and the occurrence of symptoms in the neonates evident within the first 3 days of life. 2,5 In this case, transmission from maternal viremia was ruled out (negative PCR), and acquisition of the virus from the genital tract was unlikely because of the late occurrence of symptoms in the neonate (10 days). Horizontal transmission at delivery or in the perinatal period was therefore suspected despite the absence of ocular or respiratory infections in the mother, other family members or care workers.…”

“…10 For molecular typing, deduced amino acid sequences from hexon gene demonstrated sufficient genetic divergence for molecular classification, with the exception of types HAdV15 and HAdV29, which also cannot be differentiated by antigenic method. 7 Nucleic acid and amino acid sequences for prototype strains 15 and 29 were identical over HVR [1][2][3][4][5][6] . Sequence variability on complete hexon gene between different strains of HAdV15 was in the same range as the difference between HAdV15 and HAdV29, suggesting that HAdV29 was only a variant of HAdV15.…”

Computational analysis and identification of an emergent human adenovirus pathogen implicated in a respiratory fatality

“…In neonates, adenoviral infections (including keratoconjunctivitis) are rare, but when they occur are often fatal (Abbondanzo et al, 1989; Abzug and Levin, 1991; Bhat et al, 1984; Elnifro et al, 2005; Kim et al, 1997). In adults, adenovirus keratoconjunctivitis occurs commonly and is caused predominantly by HAdV-D8, HAdV-D19, and HAdV-D37 (Ford, Nelson, and Warren, 1987).…”

Severe Pneumonia with and without Adenovirus Infection in Children Under the Age of 5 in Guangzhou, 2009-2019: A Retrospective Cohort Study

“…It has been con rmed that ADV mainly infects immunocompromised people, so the children aged around one year may be at higher risk of ADV infection. However, fatal cases had also been reported among newborns (19,20), therefore, more evidence is needed to support this hypothesis.…”