Infectious Etiologies of Intussusception Among Children <2 Years Old in 4 Asian Countries

Abstract

Background The etiology of intussusception, the leading cause of bowel obstruction in infants, is unknown in most cases. Adenovirus has been associated with intussusception and slightly increased risk of intussusception with rotavirus vaccination has been found. We conducted a case-control study among children <2 years old in Bangladesh, Nepal, Pakistan, and Vietnam to evaluate infectious etiologies of intussusception before rotavirus vaccine introduction. Methods From 2015 to 2017, we enrolled 1-to-1 matched intussusception cases and hospital controls; 249 pairs were included. Stool specimens were tested for 37 infectious agents using TaqMan Array technology. We used conditional logistic regression to estimate odds ratio (OR) and 95% confidence interval (CI) of each pathogen associated with intussusception in a pooled analysis and quantitative subanalyses. Results Adenovirus (OR, 2.67; 95% CI, 1.75–4.36) and human herpes virus 6 (OR, 3.50; 95% CI, 1.15–10.63) were detected more frequently in cases than controls. Adenovirus C detection <20 quantification cycles was associated with intussusception (OR, 18.59; 95% CI, 2.45–140.89). Wild-type rotavirus was not associated with intussusception (OR, 1.07; 95% CI, 0.52–2.22). Conclusions In this comprehensive evaluation, adenovirus and HHV-6 were associated with intussusception. Future research is needed to better understand mechanisms leading to intussusception, particularly after rotavirus vaccination.

Point-of-Care Ultrasound May Reduce Misdiagnosis of Pediatric Intussusception

“…A previous study reported fever in 40% of the intussusception cases ( 31 ). Viruses commonly cause intussusception in young children ( 4 ). A strong association between intussusception and the recent adenovirus infection has been reported in various populations, which may lead to the presentation of viral illness, including symptoms of fever or diarrhea, before the onset of intussusception ( 32 ).…”

“…Intussusception is a common abdominal emergency in children ( 1 – 3 ). Its misdiagnosis and delayed diagnosis in children is common because its symptoms at presentation are highly atypical, mimicking other conditions such as acute gastroenteritis and viral infections ( 4 , 5 ). The misdiagnosis and delayed treatment of intussusception may lead to severe morbidities including intestinal ischemia, necrosis, perforation, or even mortality ( 6 – 8 ).…”

Profile of Children Treated for Uncomplicated Intussusception in a Tertiary Hospital in Enugu, Nigeria

“…These viral infections were characterized by cough, nasal discharge, and diarrhea. Other studies also found an association between viral infections and intussusception [19,20].…”

Intussusception in an Infant With SARS-CoV-2 Infection: A Case Report and a Review of the Literature

“…However, there is a very strong casual association between viruses, mesenteric lymphoid hyperplasia and intussusception ( 9 ). In particular, adenovirus, enterovirus, norovirus, rotavirus and human herpes virus 6 have been associated with intussusception in infants and young children ( 10 ). To the best of our knowledge, eight cases of intussusception being the presentation of COVID-19 in infants have been reported so far ( 11 – 17 ).…”