Isolation of adenovirus type 11 from the brain of a neonate with pneumonia and encephalitis

Abstract

We describe a fatal case of adenovirus pneumonia accompanied by encephalitis in a neonate who showed lethargy on the 6th day and died on the 12th day. Adenoviral particles as well as viral intranuclear inclusions were noted in pulmonary alveolar epithelium cells. Neuropathological examination revealed diffuse oedema, perivascular cuffing and gliosis in the white matter. Adenovirus type 11 was isolated from lung, hilar lymph node, and brain tissue. This is the first instance of adenovirus isolation from brain tissue in a newborn infant. The virological and neuropathological findings suggest the invasion of neural tissue by adenovirus and substantiate the significance of neurological symptoms observed in neonatal adenovirus infection.

The Role of Adenovirus in Respiratory Tract Infections

“…Although most are benign, the disease course may be more progressive and severe, particularly when less common serotypes are involved. In neonates, there have been case reports of fatal adenoviral pneumonia associated with serotypes 11 and 35 [11,12]. This variation in clinical presentation with different serotypes was also reported in immunocompetent adults.…”

“…More recently, reports have been published of severe adenoviral respiratory infections associated with acute respiratory distress syndrome (ARDS) in immunocompetent adults [10•]. This clinical presentation has also been reported in two fatal cases of pneumonia in neonates, associated with serotypes 11 and 35 [11,12]. Table 1 lists the most common respiratory clinical syndromes and their associated serotypes.…”

Disseminated Adenoverus Infection in Two Premature Infants

“…Although neurologic symptoms are a consistent finding in disseminated adenovirus infection in newborns, few patients with meningitis or meningoencephalitis are described. Only one case of encephalitis has been reported so far [10]. In our second patient aseptic meningitis was present and the infant has survived without sequelae so far.…”

“…Patient one and those previously described in the literature [3,[8][9][10][11][12] had common epidemiologic features, such as vaginal delivery or prolonged rupture of membranes and/or maternal symptoms of an infection. In case two none of these features were present.…”

Meningoencephalitis Due to Adenovirus in a Healthy Infant Mimicking Severe Bacterial Sepsis

“…13,14,19,21,22,24,25 In addition, several reports described cases with long-term neurologic sequelae. 11,13,15 However, the largest study included in this review reported full clinical recovery in 91% of cases.…”