1/108. Adenovirus enterocolitis in human small bowel transplants.This report describes two cases of pediatric small bowel transplant patients who developed diffuse adenovirus enterocolitis of their allografts. Based upon the presenting symptoms for this complication, in both patients a differential diagnosis of allograft rejection versus viral infection was clinically entertained. The clinical condition in both instances rapidly deteriorated and both patients died shortly after the development of the symptoms of fulminant septicemia. Autopsies were performed and histologic examination revealed extensive denudation of the gastrointestinal mucosa with edema and a marked acute and chronic inflammatory infiltrate involving the entire wall of the grafts. Numerous viral intranuclear and intracytoplasmic inclusions were evident and an immunohistochemical stain specific for adenovirus was strongly positive in the infected cells. In addition, while in the first case the adenovirus appeared confined to the GI tract, the second patient displayed numerous viral inclusions in the lung as well as within multiple liver abscesses. At this point, the incidence of adenovirus as a cause of gastroenteritis in small bowel transplant patients remains to be determined. We believe that the importance of recognizing this particular type of viral infection in this group of patients lies primarily in differentiating it from other viral organisms (e.g., CMV) that require a specific antiviral therapy. Moreover, an identification of this entity could help avoid a misdiagnosis of rejection which could lead to an unnecessary increase in immunosuppressive therapy and a possible exacerbation of the underlying condition.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/108. Disseminated adenovirus infection in two premature infants.We present two premature infants with disseminated neonatal adenovirus infection, whose epidemiology, clinical course and outcome differ to a great extent. The first infant, born vaginally at 35 weeks gestational age after premature rupture of membranes and maternal illness, developed pneumonia, hepatitis and coagulopathy and died of circulatory failure at the age of 17 days. The other infant, delivered by cesarean section at 36 weeks gestational age, did - in contrast to all documented cases in the literature - not show any signs of pneumonia and survived meningitis without sequelae. The mode of transmission of the viral infection may have been via the maternal birth canal in the first infant and transplacental in the second one. diagnosis was obtained by direct immunofluorescent test and serology in the first patient and by maternal serology and the detection of viral antigen in tracheal aspirates (ELISA) in the second patient. Disseminated neonatal adenovirus infection has a high mortality and should be considered in the differential diagnosis of neonatal sepsis, especially when pneumonia, hepatitis and neurologic symptoms develop together with thrombocytopenia or disseminated intravascular coagulopathy.- - - - - - - - - - ranking = 3.5keywords = infection (Clic here for more details about this article) |
3/108. Severe adenovirus bronchiolitis in children.Severe adenoviral infections such as the necrotizing adenovirus bronchiolitis occur sporadically in infants. Ascertaining the etiologic role of adenovirus in cases of lung disease can pose a diagnostic problem. We present two cases of severe bronchiolitis in previously healthy children in which adenovirus could be shown to be the causing agent. Both children received immunosuppressive therapy with steroids and Cyclosporin for 3 mo and a course of intravenous ribavirin for 10 d. The results were conflicting: despite therapy Patient 1 died due to respiratory failure, Patient 2 improved notably. Conclusions: Adenovirus can cause severe bronchiolitis in previously healthy children. diagnosis may be difficult to achieve. The role of antiviral therapy in the treatment of adenoviral infections remains to be cleared.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
4/108. Epithelial changes in early primary herpes simplex virus keratitis. Photomicrographic observations in a case of human infection.PURPOSE: To report the morphology of early corneal epithelial changes in primary herpes simplex virus type 1 (HSV 1), and to compare it to that of recurrent HSV 1 and adenovirus keratitis. methods: A 23-year-old man examined with the slit lamp and photographed by non-contact in vivo photomicrography. RESULTS: 3 days after onset the cornea showed myriads of clear epithelial vesicles, two rounded limbal epithelial foci, and scattered, faintly discernible incipient ones. On day 5 several partly confluent foci, and on day 6 typical HSV dendrites were present. HSV 1 was isolated. Serological tests confirmed primary disease. CONCLUSION: The early stage of primary HSV epithelial keratitis differed from recurrent disease by the presence of large numbers of clear vesicles. The photographs, however, captured similar early changes as in recurrent disease, and the subsequent development followed the same pattern. The main sign differentiating primary HSV from adenovirus infections was the early presence of epithelial foci with ulcerative features.- - - - - - - - - - ranking = 2.5keywords = infection (Clic here for more details about this article) |
5/108. Enteric adenovirus infection in pediatric small bowel transplant recipients.Three of 70 small bowel transplant recipients were diagnosed with adenovirus enteritis. The biopsies were performed for surveillance in one patient at 2.7 years after transplantation and in two symptomatic children 1.5 years and 4.5 months after transplantation. In all three patients the characteristic epithelial changes were not noted by the primary observers. Two biopsies had been called "suggestive of acute rejection" and both patients had been so treated. One biopsy had been diagnosed as "regenerative". Once the epithelial changes were recognized as being viral, confirmation was possible by stool culture in one patient, immunohistochemistry in two patients, or by lift technique of the H&E sections for electron microscopy. The immune suppression was reduced and none of the patients developed disseminated infection. As in other transplanted organs, such as lung and liver, adenovirus infection may be limited largely to the allograft but can be destructive. Early recognition of the characteristic changes that are illustrated can lead to confirmation of the virus and appropriate reduction of immune suppression. A mistaken diagnosis of rejection and augmentation of immune suppression can lead to viral dissemination and potential fatality.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
6/108. Coexistent adenoviral keratoconjunctivitis and acanthamoeba keratitis.A 17-year-old youth presented with bilateral follicular conjunctivitis and nummular subepithelial corneal infiltrates. Failure of this to settle in an outpatient setting led to corneal scraping with microscopy and culturing for bacteria, fungi, herpes simplex, adenovirus and Acanthamoeba as an inpatient. polymerase chain reaction analysis of corneal cells was positive for adenovirus, and culture on live escherichia coli-coated agar plates was positive for Acanthamoeba by phase contrast microscopy on day two. We conclude that Acanthomoeba infection can complicate adenoviral keratoconjunctivitis. This observation is in keeping with previously reported modes of infection by Acanthamoeba, whereby any epithelial breach seems to allow inoculation of the eye by this opportunistic organism.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
7/108. Acute necrotizing tubulointerstitial nephritis due to systemic adenoviral infection.To date, all the reported cases of acute necrotizing tubulointerstitial nephritis (TIN) secondary to systemic adenovirus infection have occurred in individuals with primary or secondary immunodeficiency, and have resulted in renal failure and death. We present the case of a 12-year-old, immunologically competent girl who developed acute necrotizing TIN with acute renal failure (ARF), hepatitis and meningoencephalitis secondary to a systemic adenoviral infection who completely recovered with supportive care.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
8/108. Two fatal cases of adenovirus-related illness in previously healthy young adults--illinois, 2000.Adenoviruses are common pathogens that often are associated with respiratory and gastrointestinal illness and/or conjunctivitis in young persons. Adenovirus serotypes 4 and 7 have caused outbreaks of self-limited febrile respiratory illness in young adults in basic military training. During the 1950s and 1960s, up to 10% of recruits were infected with adenovirus, and these pathogens were responsible for approximately 90% of pneumonia hospitalizations. Beginning in 1971, all military recruits received oral, live, enteric-coated vaccines that were licensed by the food and Drug Administration as safe and effective in preventing illness from adenovirus serotypes 4 and 7. In 1996, the sole manufacturer ceased production of adenoviral vaccines and, as supplies dwindled during the next few years, outbreaks of adenoviral respiratory illness reemerged in military settings. Since 1999, approximately 10%-12% of all recruits have become ill with adenovirus infection in basic training, similar to the prevaccine era. This report describes the first two deaths probably associated with adenovirus infection identified in military recruits since the vaccines became unavailable. The military has requested proposals for a new adenovirus vaccine manufacturer; however, these deaths suggest that efforts by policymakers and pharmaceutical companies to reestablish adenoviral vaccine production should be intensified.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
9/108. Fatal adenovirus type 7b infection in a child with smith-lemli-opitz syndrome.Adenovirus type 7 causes worldwide respiratory tract infections, mainly in children. Severe systemic infections can occur, especially in immunocompromised patients and in patients with underlying chronic diseases. This report describes the first case of a fatal disseminated adenovirus type 7 infection in a child with smith-lemli-opitz syndrome, a rare autosomal recessive disorder due to a primary enzymatic defect in cholesterol metabolism. Nasopharyngeal secretions and autopsy specimens including liver, lung, pleural fluid, and rectum were collected for viral culture. Adenovirus serotype 7 strains were obtained from all anatomic sites, except the liver. All these clinical isolates were analyzed using restriction endonuclease digestion of the genome, identifying them as genome type 7b, a virulent type. In this case, the fatal evolution could have been accelerated by the presence of an immunodeficiency although immunodeficiency is not included in the definition of smith-lemli-opitz syndrome. The frequent recurrent banal infections in smith-lemli-opitz syndrome could be prevented by a cholesterol supplementation regimen. Finally, this report emphasizes the need for efficient therapy for disseminated adenovirus infections, especially for virulent genome types.- - - - - - - - - - ranking = 4.5keywords = infection (Clic here for more details about this article) |
10/108. Adenovirus ascending cholangiohepatitis.Three children, two with liver transplants and one with acquired human immunodeficiency virus (hiv) infection, presented with hepatitis accompanied by elevated gamma glutamyl transpeptidase. Biopsies revealed cholangiohepatitis caused by adenovirus infection. There was a progressive loss of interlobular bile ducts in two of the patients. In one patient, infection of the biliary tree was marked by a necrotizing cholangitis, with adenoviral inclusions noted in the biliary epithelium. In each patient, there was evidence of adenovirus gastrointestinal infection. This is the first report of adenoviral infection of the biliary tree in humans. It is hypothesized that adenovirus cholangiohepatitis occurs as a result of ascending infection from the gastrointestinal tract to the biliary tree.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
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