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

Reyes-Andrade, Joaquin; Sánchez‐Céspedes, Javier; Olbrich, Peter; Falcón, Lola; Sanchez-Ganfornina, Inmaculada; Tebruegge, Marc; Pérez‐Romero, Pilar; Neth, Olaf

doi:10.1097/inf.0000000000000128

Cited by 15 publications

(8 citation statements)

References 26 publications

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“…Rare manifestations of AdV infections include: encephalitis [159][160][161][162][163] ; meningitis 162,164,165 ; myocarditis and cardiomyopathy 166,167 ;mononucleosis-like syndromes 168 ; pulmonary dysplasia 169 ; intestinal intussusception in children 170 ; sudden infant death. 171…”

Section: Rare Manifestationsmentioning

confidence: 99%

Adenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention

Lynch

Kajon

2016

Semin Respir Crit Care Med

408

178

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Adenoviruses (AdVs) are DNA viruses that typically cause mild infections involving the upper or lower respiratory tract, gastrointestinal tract, or conjunctiva. Rare manifestations of AdV infections include hemorrhagic cystitis, hepatitis, hemorrhagic colitis, pancreatitis, nephritis, or meningoencephalitis. AdV infections are more common in young children, due to lack of humoral immunity. Epidemics of AdV infection may occur in healthy children or adults in closed or crowded settings (particularly military recruits). The disease is more severe and dissemination is more likely in patients with impaired immunity (e.g., organ transplant recipients, human immunodeficiency virus infection). Fatality rates for untreated severe AdV pneumonia or disseminated disease may exceed 50%. More than 50 serotypes of AdV have been identified. Different serotypes display different tissue tropisms that correlate with clinical manifestations of infection. The predominant serotypes circulating at a given time differ among countries or regions, and change over time. Transmission of novel strains between countries or across continents and replacement of dominant viruses by new strains may occur. Treatment of AdV infections is controversial, as prospective, randomized therapeutic trials have not been conducted. Cidofovir is the drug of choice for severe AdV infections, but not all patients require treatment. Live oral vaccines are highly efficacious in reducing the risk of respiratory AdV infection and are in routine use in the military in the United States, but currently are not available to civilians.

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Section: Rare Manifestationsmentioning

confidence: 99%

Adenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention

Lynch

Kajon

2016

Semin Respir Crit Care Med

408

178

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“…Adenovirus encephalopathy has only been reported in a handful of cases [7][8][9][10]. It was first reported in 1956 in France, by Chany et al where adenovirus was isolated from CSF fluid [10].…”

Section: Discussionmentioning

confidence: 99%

17-Month-Old Girl With Severe, Prolonged Lethargy and Somnolence

Lure¹,

Coppola²,

Guyer³

et al. 2021

Cureus

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A 17-month-old girl arrived at the pediatric ED with decreased responsiveness. She was lethargic, localizing only to noxious stimuli with vital signs significant for fever of 103.8 °F, heart rate of 185 beats/min, respiratory rate of 12 breaths/min, blood pressure of 100/59 mmHg, and oxygen saturation level of 88% on room air. She was admitted to the pediatric intensive care unit (PICU) due to concerns of septic meningitis with altered mental status and respiratory distress, and was treated with antibiotics. A respiratory viral panel (RVP) was positive for adenovirus, resulting in all antibiotics being discontinued. She remained lethargic until day nine of illness, when she had improved almost completely to her baseline. Polymerase chain reaction (PCR) of her cerebral spinal fluid returned positive for adenovirus serotype A, thus confirming our case of transient adenovirus encephalopathy. This case illustrates the importance of keeping adenovirus in the differential for encephalopathy versus a neurologic abnormality or other malignant or infectious etiology.

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“…Nevertheless, in many reports, the diagnosis of adenovirus encephalitis was not based on a positive cerebrospinal fluid result, but rather on the detection of the virus from other sites (nasopharynx, throat, or sputum) in patients with neurological symptoms. 5,6 This suggests that the central nervous system dysfunction may not require direct viral invasion. 7 In the present case, prolonged seizures and excitotoxic neuronal damage may be related to the acute encephalopathy with biphasic seizures and late reduced diffusion pathogenesis.…”

Section: Discussionmentioning

confidence: 99%

Acute Encephalopathy With Biphasic Seizures and Late Reduced Diffusion Associated With Adenoviral Pneumonia

Lee

Heo

2019

Child Neurology Open

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Acute encephalopathy with biphasic seizures and late reduced diffusion is a subtype of acute encephalopathy described in a cohort of Japanese children. Few cases have been reported in countries other than Japan. It is characterized clinically by biphasic seizures and late reduced subcortical diffusion on magnetic resonance imaging (MRI). We report the case of a 3-year-old Korean girl with acute encephalopathy with biphasic seizures and late reduced diffusion who presented with status epilepticus associated with fever and pneumonia. Human adenovirus was detected from a respiratory specimen using multiplex real-time reverse transcriptase polymerase chain reaction. After 5 days, she developed a second cluster of seizures followed by altered consciousness, aphasia, stereotypic movement, and developmental regression. Her brain MRI showed symmetrical and extensive restricted diffusion in the subcortical white matter, which finally resulted in global brain atrophy, consistent with acute encephalopathy with biphasic seizures and late reduced diffusion. Here, we report a case of acute encephalopathy with biphasic seizures and late reduced diffusion associated with preceding adenoviral pneumonia.

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

Cited by 15 publications

References 26 publications

Adenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention

Adenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention

17-Month-Old Girl With Severe, Prolonged Lethargy and Somnolence

Acute Encephalopathy With Biphasic Seizures and Late Reduced Diffusion Associated With Adenoviral Pneumonia

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