Influencia de la seropositividad contra adenovirus-36 sobre riesgo de obesidad y resistencia a la insulina en población infanto-juvenil de la Región de la Araucanía / Influence of adenovirus 36 seropositivity on the risk of obesity and insulin resistance in a population of children and adolescents from the Región de la Araucanía

La infección previa por el adenovirus-36 (Ad-36) se ha asociado con el proceso adipogénico y el control glicémico en modelos experimentales de cultivos celulares y animales. En humanos, la presencia de anticuerpos contra Ad-36 ha mostrado aumentar el riesgo de obesidad y, paradójicamente, mejorar el control glicémico en diferentes poblaciones. Se evaluó la influencia de la seropositividad contra Ad-36 sobre riesgo de obesidad, el perfil lipídico y glicémico en una población de niños en edad escolar. Métodos: Doscientos ocho individuos de entre 9 y 13 años se agruparon según estado nutricional como normopeso (IMC z-score de -1 a +1), con sobrepeso (IMC z-score de +1 a +2) y con obesidad (IMC z-score > +3). Se evaluaron medidas antropométricas, desarrollo puberal según Tanner y parámetros bioquímicos (perfil lipídico, glucemia e insulina) y la seropositividad contra Ad-36. Se determinó la resistencia a la insulina (RI) según criterio para la población infantil chilena. La seropositividad contra Ad-36 se determinó mediante ELISA. Resultados: Hubo una alta prevalencia de sobrepeso/obesidad en la población de estudio. La seropositividad contra Ad-36 fue del 5,4% en el grupo total, pero no se observó una asociación con el estado nutricional. No se encontró correlación entre la seropositividad contra Ad-36 y los parámetros del perfil lipídico. La insulina y la HOMA-RI fueron significativamente más bajas en el grupo Ad-36 (+) (p<0,001), no habiendo sido reportados casos de RI en el grupo Ad-36 (+) en nuestra población. Conclusiones: Nuestros resultados sugieren que la infección previa por el adenovirus-36 afecta la secreción de insulina y la resistencia a la insulina, como se ha descrito anteriormente, sin embargo, no se observa correlación con el desarrollo de la obesidad infantil en la población pediátrica del sur de Chile.

Previous infection with Adenovirus-36 (Ad-36) has been associated with adipogenic process and glycemic control in experimental models of cell culture and animals. In humans, the presence of antibodies against Ad-36 has been shown to increase the risk of obesity and, paradoxically, improve glycemic control in different populations. The influence of Ad-36 seropositivity on obesity risk, lipid and glycemic profile was evaluated in a population of school-age children. Methods: Two hundred eight individuals aged 9 to 13 years were grouped according to their nutritional status as normal weight (BMI z-score from -1 to +1), overweight (BMI z-score from +1 to +2) or obese (BMI z-score from -1 to +1). z-score > +3). Anthropometric measurements, pubertal development according to Tanner stage, biochemical parameters (lipid profile, glycemia and insulin) and seropositivity against Ad-36 were evaluated. Insulin resistance (IR) was determined according to criteria for the Chilean child population. Seropositivity against Ad-36 was determined by ELISA. Results: There was a high prevalence of overweight/obesity in the study population. Seropositivity against Ad-36 was 5.4% in the total group, but no association with nutritional status was observed. No correlation was found between Ad-36 seropositivity and lipid profile parameters. Insulin and HOMA-RI were significantly lower in the Ad-36 (+) group (p<0.001), and no cases of RI were reported in the Ad-36 (+) group in our population. Conclusions: Our results suggest that previous adenovirus-36 infection affects insulin secretion and insulin resistance, as previously described, however, no correlation is observed with the development of childhood obesity in the pediatric population. from southern Chile.

Infección grave diseminada por adenovirus en receptores de trasplante hepático / Severe adenovirus infections in hepatic transplant recipients / Infecção grave por adenovírus disseminado em receptores de transplante de fígado

Resumen: Los adenovirus humanos continúan siendo un desafío en la práctica clínica, se trata de virus de tipo ADN, con amplia distribución en la población, causa frecuente de enfermedad autolimitada en niños. Sin embargo, en pacientes inmunosuprimidos, principalmente trasplantados de células hematopoyéticas y de órganos sólidos, puede llegar a ser causa de enfermedad diseminada severa, con elevada morbimortalidad. Compartimos el primer reporte nacional de enfermedad por adenovirus diseminado, en el que se presentan dos casos clínicos de pacientes trasplantados hepáticos, que desarrollan enfermedad diseminada grave por adenovirus. Se realiza una revisión de la literatura sobre el tema.

Abstract: Human adenoviruses still constitute a challenge in the clinical practice. These are DNA viruses that are widely disseminated among the population and often cause self-limiting diseases in children. However, it may result in a severe diseminated disease with high morbi-mortality rates in immunocompromised patients, in particular transplant recipients of hematopoietic cells and solid organs. The study shares the first national report for disseminated adenovirus disease, presenting two clinical cases of hepatic transplant recipients who developed severe disseminated adenovirus disease. And conducting a literature review on the topic.

Resumo: Os adenovírus humanos continuam sendo um desafio na prática clínica; são vírus do tipo DNA, com ampla distribuição na população, causa frequente de doença autolimitada em crianças. Entretanto, em pacientes imunossuprimidos, principalmente receptores de transplante de células hematopoiéticas e órgãos sólidos, pode se tornar causa de doença disseminada grave, com alta morbimortalidade. Este é o primeiro relato nacional de doença de adenovírus disseminado, no qual são apresentados dois casos clínicos de pacientes transplantados de fígado que desenvolvem doença de adenovírus disseminada grave. Realizou-se também revisão da literatura sobre o assunto.

Gravedad de infecciones respiratorias agudas bajas por adenovirus en los años 2015 y 2016 en el hospital de niños Roberto del Rio / Severity of acute lower respiratory infections due to adenovirus in the years 2015 and 2016 at the Roberto del Rio children's hospital

OBJETIVO. Comparar la gravedad de las infecciones respiratorias agudas bajas (IRAb) producidas por Adenovirus (ADV) entre los años 2015 y 2016, en el Hospital de Niños Roberto del Río. MÉTODOS. Se identificó a pacientes hospitalizados por IRAb por ADV, y se registró edad, sexo, días de hospitalización, ingreso a unidad de paciente crítico (UPC), necesidad de ventilación mecánica (VM), entre otros. Se comparó la evolución de los pacientes, y se analizó la relación entre gravedad y presencia de infecciones asociadas a atención de salud (IAAS). RESULTADOS. Se identificó 158 pacientes hospitalizados por IRAb por ADV. La relación hombre: mujer fue 6:4, con una edad promedio de 17.4 meses. La media de días de hospitalización fue de 9.88 el 2015 y 16.06 el 2016 (p=0.01). El promedio de días de oxigenoterapia fue de 5.86 el 2015 y 8.76 el 2016. Un 22.8% (n:36) de los pacientes ingresó a UPC, y el 20.25% (n:32) requirió VM. Un 41.8% de los casos (n:66) correspondió a IAAS. 3 pacientes fallecieron. CONCLUSIONES. Durante el 2016 hubo hospitalizaciones más prolongadas en comparación al 2015, sin diferencias estadísticamente significativas en relación a requerimientos de oxigenoterapia, VM y fallecimiento. La prolongación de la hospitalización se podría asociar a mayor presencia de IAAS.

OBJETIVE. To compare the severity of lower respiratory infections produced by Adenovirus between 2015 and 2016 at the Hospital de Niños Roberto del Río. METHODS. We identified patients hospitalized for lower respiratory tract infection for ADV and we recorded age, sex, days of hospitalization, admission to Intensive Care Unit (ICU), need for mechanical ventilation (MV), among others. The evolution of the patients between the two years were compared. The relationship between severity and the presence of nosocomial infections was also analyzed. RESULTS. We identified 158 hospitalized patients for ADV. The male:female ratio was 6:4, with an average age of 17.4 months. The mean of hospitalization days was 9.88 days in 2015 and 16.06 days in 2016 (p = 0.01). The average number of oxygen therapy days was 5.86 in 2015 and 8.76 in 2016. The 22.8% (n: 36) of cases required admission in the ICU, and 20.25% (n: 32) required MV. The 41.8% (n: 66) of cases corresponded to nosocomial infections. 3 patients died. CONCLUSIONS. During 2016, there were longer hospitalizations for adenovirus infections compared to 2015, without significant differences in relation to oxygen therapy, MV requirements and death. The prolongation of the hospitalization could be associated by the greater presence of nosocomial infections.

Interpretación de biomarcadores en pacientes pediátricos con infección por Adenovirus / Interpretation of biomarkers in pediatric patients with Adenovirus infection

RESUMEN Objetivo: Evaluar el uso de los biomarcadores proteína C reactiva (PCR) y procalcitonina (PCT) para la valoración de severidad clínica en pacientes pediá-tricos diagnosticados con infección por adenovirus. Método: Se estudiaron 100 pacientes mayores de 28 días y menores a 15 años con diagnóstico confir-mado de infección por adenovirus, en el Hospital Vozandes Quito, Hospital Metropolitano y Hospital de los Valles en el periodo enero 2010 a mayo 2019, se recolectó información demográfica y clínica de forma retrospectiva. las características clínicas y biomarcadores se compararon de acuerdo a la severidad de la patología respiratoria presentada, cuya clasificación por requerimientos terapéuticos la definió como leve, moderada y grave. Resultados: El 89% de los pacientes presentó severidad clínica leve, el 11% moderada y ninguno fue clasificado como severa. El 35% de los pacientes presentaron coinfección con al menos un virus adicional, estos presentaron severidad clínica moderada en el 63,3%. Los valores promedio de PCR fueron 61,3 ± 54,06 mg/L y PCT 0,65 ± 0,8ng/mL. Entre los pacientes con severidad clínica leve y moderada vemos que PCR y PCT fueron superiores en pacientes con severidad clínica leve 66,07±55,09 mg/L vs 22,71±19,60 mg/L, p=0,003 y 0,70±0,83 ng/mL vs 0,23±0,26 ng/mL, p=0.005 respectivamente. Al momento de predecir la severidad clínica de los pacientes pediátricos diagnosticados con adenovirus el área bajo la curva encontrada en estos dos parámetros fue 0,241 y 0,224 para PCT y PCR respectivamente, con valores de sensibilidad y especificidad bajo el 50%. Conclusión: Los biomarcadores PCT y PCR presentan limitada utilidad al momento de predecir la severidad clínica de los pacientes pediátricos diagnosticados con infección por adenovirus.

ABSTRACT Objective: To evaluate the use of C-reactive protein (CRP) and procalcitonin (PCT) biomarkers for the assessment of clinical severity in pediatric patients diag-nosed with adenovirus infection. Method: 100 patients older than 28 days and younger than 15 years with a confirmed diagnosis of adenovirus infection were studied at the Hospital Vozandes Quito, Hospital Metropolitano and Hospital de los Valles in the period January 2010 to May 2019, demographic information was collected and retrospectively. the clinical characteristics and biomarkers were compared according to the severity of the respiratory pathology presented, whose classification by therapeutic requirements defined it as mild, moderate and severe. Results: 89% of the patients presented mild clinical severity, 11% moderate and none were classified as severe. 35% of the patients presented coinfection with at least one additional virus, these presented moderate clinical severity in 63.3%. Mean CRP values were 61.3 ± 54.06 mg / L and PCT 0.65 ± 0.8ng / mL. Among patients with mild and moderate clinical severity, we see that CRP and PCT were higher in patients with mild clinical severity 66.07 ± 55.09 mg / L vs 22.71 ± 19.60 mg / L, p = 0.003 and 0, 70 ± 0.83 ng / mL vs 0.23 ± 0.26 ng / mL, p = 0.005 respectively. When predicting the clinical severity of pediatric patients diagnosed with adenovirus, the area under the curve found in these two parameters was 0.241 and 0.224 for PCT and CRP, respectively, with sensitivity and specificity values below 50%. Conclusion: PCT and CRP biomarkers have limited usefulness when predicting the clinical severity of pediatric patients diagnosed with adenovirus infection

Estudio clínico-epidemiológico de las infecciones respiratorias agudas bajas causadas por adenovirus en niños hospitalizados. Diecinueve años de vigilancia epidemiológica activa / Clinical and epidemiological study of acute lower respiratory tract infections caused by adenovirus in hospitalized children. Nineteen years of active epidemiological surveillance

Introducción. La infección respiratoria aguda baja por adenovirus es una importante causa de morbimortalidad en niños. Objetivos: Describir el patrón clínico-epidemiológico y los factores asociados en niños hospitalizados.Métodos. Estudio transversal en niños ingresados por infección respiratoria aguda baja al Hospital de Niños Ricardo Gutiérrez, Buenos Aires, en 2000-2018. El diagnóstico viral se realizó mediante inmunofluorescencia indirecta en secreciones nasofaríngeas. Se compararon características clínico-epidemiológicas de infección por adenovirus con otros virus respiratorios (virus sincicial respiratorio, influenza y parainfluenza). Se utilizó regresión logística múltiple para identificar predictores independientes de infección.Resultados. De 16018 pacientes con infección respiratoria aguda baja, 13545 fueron testeados para virus respiratorios y 6047 (el 45 %) fueron positivos. Adenovirus fue el agente menos frecuente [el 4,4 % (265) de los casos]; presentó una tendencia en descenso durante todo el período estudiado (pico en 2003) y circuló durante todo el año (pico en julio). El 63,8 % eran varones; mediana de edad: 11 meses (rango intercuartílico: 6-20). La presentación clínica más frecuente fue neumonía (el 63 %). El 50 % tenía internaciones previas por causa respiratoria; el 15,6 % eran reingresos; el 58,3 % tenía comorbilidades. El 19,2 % requirió asistencia ventilatoria; el 44 %registró complicaciones. La letalidad fue del 7,7 %. La infección por adenovirus se asoció a edad ≥ 12 meses, sexo masculino, presentación clínica de neumonía, internaciones previas por causas respiratorias y reinternaciones.Conclusiones. Los adenovirus fueron detectados con menor frecuencia que los otros virus respiratorios, aunque presentaron un importante perfil de morbimortalidad

Introduction. Acute lower respiratory tract infection (ALRTI) caused by adenovirus is a major cause of morbidity and mortality in children.Objectives. To describe the clinical and epidemiological pattern and associated factors in hospitalized children.Methods. Cross-sectional study in children admitted due to ALRTI to Hospital de Niños "Ricardo Gutiérrez," in the Autonomous City of Buenos Aires, between 2000 and 2018. Viral diagnosis was done by indirect immunofluorescence in nasopharyngeal secretions. The clinical and epidemiological characteristics of adenovirus infection were compared to other respiratory viruses (respiratory syncytial virus, influenza, and parainfluenza). A multiple logistic regression was done to identify independent predictors of infection.Results. Out of 16 018 patients with ALRTI, 13 545 were tested for respiratory viruses; 6047 (45 %) had a positive result. Adenovirus was the least common agent (4.4 % [265] of cases); it tended towards a reduction over the study period (peak in 2003) and circulated throughout the year (peak in July). In total, 63.8 % of patients were males; median age: 11 months (interquartile range: 6-20). The most common clinical presentation was pneumonia (63 %). Prior admissions due to respiratory conditions were seen in 50 %; 15.6 %were readmissions; 58.3 % had comorbidities. Ventilatory support was required by 19.2 %and complications were recorded in 44 %. The fatality rate was 7.7 %. Adenovirus infection was associated with age ≥ 12 months, male sex, clinical presentation of pneumonia, prior admissions due to respiratory conditions, and readmissions.Conclusions. Adenoviruses were less common than other respiratory viruses, although their morbidity and mortality were important

Fatal nosocomial hemorrhagic enterocolitis probably caused by adenovirus: report of one case / Enterocolitis hemorrágica fatal nosocomial probablemente causada por adenovirus: informe de un caso

ABSTRACT Adenovirus (ADV) is a recognized cause of severe disease among immunocompromised patients. We report a previously healthy 39-year-old female, admitted with influenza pneumonia and evolving with lung hemorrhage and acute renal failure requiring mechanical ventilation and hemodialysis. She received high corticosteroid doses due to an initial suspicion of alveolar hemorrhage. Lymphopenia already present before steroid use (567/μL), was maintained during the whole hospital stay (mean 782/μL). From the second week of admission she presented a high-volume diarrhea (mean 2.5 L/day) associated to intermittent bloody stools. An ulcerative enterocolitis was confirmed by CT images and colonoscopy. ADV was detected in a colonic tissue sample by real time PCR but not by a commercial filmarray test. Cidofovir-probenecid and racecadotril therapy were indicated without changing the clinical course of diarrhea and the patient finally died.

Adenovirus (ADV) es una causa reconocida de enfermedades graves en pacientes inmunocomprometidos. Informamos el caso de una mujer de 39 años, previamente sana, que ingresó por neumonía grave por influenza, evolucionando con hemorragia pulmonar y falla renal aguda, requiriendo ventilación mecánica y hemodiálisis. Recibió altas dosis de corticoides por la sospecha inicial de una hemorragia alveolar. Tuvo linfopenia durante toda su estadía (promedio 782/μL), la que ya estaba presente antes del uso de los corticoides (567/μL). Desde la segunda semana de hospitalización, presentó una diarrea de alto volumen (promedio 2,5 L/día) asociada a la presencia de sangre en deposiciones en forma intermitente. Se confirmó una enterocolitis ulcerativa por tomografía computada y colonoscopía. Se detectó ADV en muestras de biopsia colónica por PCR en tiempo real pero no por un test de PCR múltiples automatizado comercial. Fue tratada con cidofovir-probenecid y racecadrotrilo sin impacto clínico y la paciente finalmente falleció.

Detection of bluetongue virus in Brazilian cervids in São Paulo state / Detecção de vírus da língua azul em cervídeos brasileiros no estado de São Paulo

Viral hemorrhagic diseases in cervids occur worldwide and include epizootic hemorrhagic disease (EHD), bluetongue (BT), and adenoviral hemorrhagic disease (AHD). Since gross lesions in all three hemorrhagic diseases are identical (hemorrhagic enteropathy, pulmonary edema, systemic petechial and suffusion hemorrhages), it is necessary to use accurate techniques for a definitive etiologic diagnosis. Archival material (paraffin blocks) at the Department of Veterinary Pathology of FCAV - Unesp was reviewed for lesions of hemorrhagic disease and 42 captive and free-living Brazilian deer were selected to include in this study. Paraffin-embedded tissues were evaluated using immunohistochemistry and tested negative for adenovirus. Using real time RT-PCR, EHD virus was not detected in paraffin-embedded tissues in any of the cases evaluated. The same technique was used for detection of BT virus and seven positive animals (16,66%) were confirmed after agarose 4% gel electrophoresis and gene sequencing. The main macroscopic changes observed in the positive animals were hemorrhagic intestinal contents, reddish mucous membrane of the gastrointestinal tract, ulcers on tongue and petechiae in various organs. Microscopic changes observed were lymphocytic inflammatory infiltrate in liver, kidney and lungs, hemorrhage, and congestion in various organs. All positive cases were from captive animals, three females (two young and one adult), and four young males. This study demonstrates that the bluetongue virus is involved in hemorrhagic disease outbreaks of deer in Brazil.(AU)

Doenças hemorrágicas virais em cervídeos ocorrem no mundo todo e incluem a doença epizoótica hemorrágica (DEH), língua azul (LA), e doença hemorrágica por adenovírus (DHA). Uma vez que as lesões nas três doenças hemorrágicas são idênticas (enteropatia hemorrágica, edema pulmonar, petéquias sistêmicas e sufusões hemorrágicas), é necessário utilizar técnicas precisas para um diagnóstico etiológico definitivo. Material de arquivo (blocos de parafina) do Departamento de Patologia Veterinária da FCAV - Unesp foi revisado para lesões de doenças hemorrágicas e 42 cervídeos brasileiros de cativeiro e de vida livre foram selecionados e incluídos neste estudo. Tecidos embebidos em parafina foram avaliados usando imunohistoquímica e foram negativos para adenovírus. Usando o RT-PCR em tempo real, o vírus da DEH não foi detectado nos tecidos de nenhum dos casos avaliados. A mesma técnica foi utilizada para detecção do vírus da LA e sete animais positivos (16,66%) foram confirmados após eletroforese em gel de agarose a 4% e sequenciamento genético. As principais alterações macroscópicas observadas nos animais positivos foram conteúdo intestinal hemorrágico, mucosa do trato gastrointestinal avermelhada, úlceras na língua e petéquias em vários órgãos. As alterações microscópicas observadas foram infiltrado inflamatório linfocítico em fígado, rins e pulmões, e hemorragia e congestão em vários órgãos. Todos os casos positivos foram de animais de cativeiro, três fêmeas (dois jovens e um adulto), e quatro jovens do sexo masculino. Este estudo demonstra que o vírus da lingual azul está envolvido nos surtos de doença hemorrágica em veados no Brasil.(AU)

Development of a prototype immunochromatographic test for rapid diagnosis of respiratory adenovirus infection

Abstract Human adenoviruses comprise an important group of etiologic agents that are responsible for various diseases in adults and children, such as respiratory, ocular, gastroenteric, and urinary infections. In immunocompromised and organ-transplanted individuals, these agents can cause generalized infections. Rapid diagnostic methods for detecting these infectious agents are not widely available.The aim of this work was to produce monoclonal and polyclonal anti-adenovirus antibodies to be used in a rapid diagnostic test for respiratory infections.Adenovirus hexons were satisfactorily purified by ultracentrifugation and chromatography. After virus purification, anti-hexon monoclonal antibodies were produced and characterized, following classical methods. Antibodies were specific for adenoviruses 2, 3, 5, and 41. The proposed immunochromatographic test was standardized using colloidal gold.The standardization of the rapid test was sufficient to detect adenovirus antigens (in nasopharyngeal lavage samples) with sensitivity of 100% and specificity of 85% when compared to direct immunofluorescence.The immunochromatographic assay prototype was sufficiently sensitive to detect B (3), C (2 and 5), and F (41) adenovirus samples. Although based on preliminary data, the test demonstrated the same performance as direct immunofluorescence, but with the advantage of being a point-of-care test. Further studies are still needed to confirm its effectiveness in clinical practice.

Adenovirus 36 y su potencial contribución en el desarrollo de obesidad / The potential contribution of adenovirus 36 to the development of obesity

The evidence of the last 20 years shows a link between viral infections and obesity in animals and humans. There are five adenovirus which have been associated with development of obesity in animals. SMAM-1 virus was the first studied in humans associated with obesity. There is compelling evidence that Ad-36 virus could contribute to the development of obesity in humans and it is related with body mass index (BMI). This manuscript reviews the association between Ad-36 and the other four virus infections with obesity. An electronic search of articles in the databases PubMed and Scielo, with use of key words: obesity, infection, adipose tissue, Ad-36, 3T3-L1 was performed. The search was restricted "human" and "animals". The importance of the relationship between virus infections and obesity has increased over the past two decades. Ad-36 shows more compelling evidence in humans. There are reports involving this virus in the enhancement of adipogenesis, adipocyte differentiation, a lower secretion of leptin and an increased insulin sensitivity. Future work should focus in larger cohort studies to confirm this association, which explains the global obesity epidemic from a new perspective.

Infección por adenovirus en el Hospital de niños Roberto del Río 2016 / Adenovirus infection at the Roberto del Río children's Hospital 2016

En los meses de invierno, las enfermedades respiratorias representan la primera causa de hospitalización en hospitales pediátricos. La mayoría de estas enfermedades son causadas por virus, dentro de los cuales se encuentra el adenovirus (AdV), el cual puede generar infecciones diseminadas graves, secuelantes e incluso letales y se caracteriza por tener una rápida transmisión entre pacientes, generando brotes intrahospitalarios. Se identificó a 54 pacientes hospitalizados con infección por adenovirus en el periodo de marzo-julio del 2016 con una edad promedio de 18,3 meses, de los cuales 23 casos fueron infecciones asociadas a la atención de salud (IIAS) y 2 tuvieron desenlace fatal. Los casos de IIAS, se asociaron a una mayor tasa de hospitalización prolongada (p= <0.01), ingreso a UPC (p= <0.01) y uso de ventilación mecánica (p= <0.01). No se encontró asociación entre la presencia de antecedentes mórbidos con el desarrollo de IIAS. Las IIAS por adenovirus se asocia a una hospitalización prolongada, ingreso de unidades de alta complejidad y necesidad de uso de ventilación mecánica. Dado que el adenovirus se transmite a través de contactos directo, aerosoles y fómites, las medidas básicas de precaución de contacto y de aislamiento permiten reducir los contagios nosocomiales, recayendo la responsabilidad en todo el equipo de salud a cargo.

Respiratorio deseases are frequent in winter times. being the main cause of hospital admissions. Viral infecciones are the main etiology, and adenovirus infección clould lead to severe disease, with cross infections. We identified 54 patients admitted to the Roberto del Río Childrens hospital in 2016, with a mean age of 18,3 months old; 23 cases where nosocomial infection, and 2 were fatal. Hospital acquired adenovirus infection were associated to long hospital stay (p= <0.01), intensive care admission (p= <0.01) and ventilatory support (p= <0.01). We did not find previous illness conditions. Adenovirus hospital acquired infection is associated with longer hospital stay and dead. Adenovirus is transmitted with direct contact, aerosols and fomites, therefore basic contact precautions are important.

A non-enteric adenovirus A12 gastroenteritis outbreak in Rio de Janeiro, Brazil

A gastroenteritis outbreak that occurred in 2013 in a low-income community in Rio de Janeiro was investigated for the presence of enteric viruses, including species A rotavirus (RVA), norovirus (NoV), astrovirus (HAstV), bocavirus (HBoV), aichivirus (AiV), and adenovirus (HAdV). Five of nine stool samples (83%) from patients were positive for HAdV, and no other enteric viruses were detected. Polymerase chain reaction products were sequenced and subjected to phylogenetic analysis, which revealed four strains and one strain of non-enteric HAdV-A12 and HAdV-F41, respectively. The HAdV-A12 nucleotide sequences shared 100% nucleotide similarity. Viral load was assessed using a TaqMan real-time PCR assay. Stool samples that were positive for HAdV-A12 had high viral loads (mean 1.9 X 107 DNA copies/g stool). All four patients with HAdV-A12 were < 25 months of age and had symptoms of fever and diarrhoea. Evaluation of enteric virus outbreaks allows the characterisation of novel or unique diarrhoea-associated viruses in regions where RVA vaccination is routinely performed.

The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil

OBJECTIVES: Viral conjunctivitis is a common, highly contagious disease that is often caused by an adenovirus. The aim of this study was to evaluate the prevalence of adenoviral conjunctivitis by analyzing data from a prospective clinical study of 122 consecutively enrolled patients who were treated at the Clinical Hospital of the State University of Campinas (UNICAMP) after a clinical diagnosis of infectious conjunctivitis between November 2011 and June 2012. METHODS: Polymerase chain reaction was used to evaluate all cases of clinically diagnosed infectious conjunctivitis and based on the laboratory findings, the prevalence of adenoviral infections was determined. The incidence of subepithelial corneal infiltrates was also investigated. RESULTS: Of the 122 patients with acute infectious conjunctivitis included, 72 had positive polymerase chain reaction results for adenoviruses and 17 patients developed subepithelial corneal infiltrates (13.93%). CONCLUSIONS: The polymerase chain reaction revealed that the prevalence of adenoviral conjunctivitis was 59% in all patients who presented with a clinical diagnosis of infectious conjunctivitis from November 2011 to June 2012. The prevalence of adenoviral conjunctivitis in the study population was similar to its prevalence in other regions of the world.

Prevalência de conjuntivite adenoviral em clínica oftalmológica no município de Viçosa (MG) / Prevalence of adenoviral conjunctivitis at the ophthalmologic clinic on municipality of Viçosa/MG

Objetivo: Avaliar a prevalência de Adenovírus como agente etiológico da conjuntivite, em clínica médica oftalmológica especializada, em Viçosa, Minas Gerais, Brasil. Métodos: Amostras da secreção conjuntival de 91 pacientes clinicamente diagnosticados com conjuntivite foram submetidos à reação em cadeia da polimerase (PCR), utilizando primers degenerados para a região codificadora do gene da proteína estrutural II. Posteriormente as amostras positivas foram submetidas a sequenciamento e genotipagem. Resultados: A análise dos resultados de PCR revelou prevalência de 36,3% de Adenovírus. Não havendo distinção entre os sexos e com maior prevalência na faixa etária de 26 a 65 anos com 60,60% dos casos positivos. O sequenciamento dos casos positivos por Adenovírus revelaram a presença dos sorotipos 3, 4, 7, 8 e 34 circulante na região. Conclusão: No município de Viçosa, dois em cada cinco casos de conjuntivite são de etiologia adenoviral.

Objective: The aim of this study was to evaluate the prevalence of Adenovirus as a etiologic agent of conjunctivitis on a ophthalmic clinic in Viçosa, Minas Gerais, Brazil. Methods: Samples of conjunctival secretion from 91 patients clinically diagnosed with conjunctivitis were subjected to polymerase chain reaction (PCR) using degenerate primers targeted to the gene encoding the structural protein II. Positive samples were subsequently subjected to sequencing and genotyping. Results: PCR results showed 36.3% prevalence of Adenovirus. No differences between the sexes and was found to be higher in the age group 26-65 years with 60.60% of the positive cases. Sequencing of positive cases showed the presence of Adenovirus serotypes 3, 4, 7, 8, and 34 circulating in the region. Conclusion: In Viçosa two in five cases of conjunctivitis has Adenovirus as etiologic agent.

Adenoviruses of canine and human origins in stool samples from free-living pampas foxes (Lycalopex gymnocercus) and crab-eating foxes (Cerdocyon thous) in São Francisco de Paula, Rio dos Sinos basin / Adenovírus de origens canina e humana em fezes de graxains (Lycalopex gymnocercus) e cachorros-do-mato (Cerdocyon thous) de vida livre em São Francisco de Paula, bacia do Rio dos Sinos

The spread of enteric viruses of domestic animals and human beings to wild species can be facilitated by the resistance of these viruses on the environment and their ability to be transmitted by water and contaminated food. The health status of the populations of pampas foxes (Lycalopex gymnocercus) and crab-eating foxes (Cerdocyon thous) is largely unknown and the landscapes occupied by these animals in southern Brazil have been threatened by human occupation and expansion of agriculture. In this work, the search of genomes of human and canine adenoviruses in feces from these wild carnivores was used to track the dissemination of domestic animals and human pathogens to the free-living populations in a wildlife reserve located in southern Brazil. This was performed by virus-specific differential real-time polymerase chain reactions (qPCR) on stool specimens, avoiding capture and additional stress to the animals. Genus-specific conventional reverse-transcriptase PCR (RT-PCR) was complementarily performed aiming the detection of enteroviruses (EV) and rotaviruses (RV) on these same samples. HAdV genomes were found on 14 out of the 17 (82.35%) stool samples analysed, whereas CAV was found co-infecting 5 of these samples. RV genomes were detected on 7 of the 17 samples (41.18%) and all samples were negative for EV. The results point to the dispersion of HAdV and RV at a high rate to these species of South American wild carnivores, which can be an effect of growing anthropisation of the habitat of these animals.

A disseminação de vírus entéricos de animais domésticos e seres humanos para espécies selvagens pode ser facilitada pela resistência desses vírus no ambiente e sua capacidade de ser transmitida por água e alimentos contaminados. O estado de saúde das populações de Graxains-do-campo (Lycalopex gymnocercus) e Cachorros-do-mato (Cerdocyon thous) é em grande parte desconhecida e as paisagens ocupadas por estes animais no sul do Brasil têm sido ameaçadas pela ocupação humana e a expansão da agricultura. Neste trabalho, utilizou-se a pesquisa de genomas de adenovírus humanos (HAdV ) e caninos (CAV-1 e -2) em amostras fezes desses carnívoros selvagens com vistas a diagnosticar a disseminação de patógenos de animais domésticos e seres humanos às populações de vida livre em uma reserva de vida selvagem, localizado no sul do Brasil. Foram realizadas reações em cadeia da polimerase diferenciais e em tempo real (qPCR) de adenovírus específicos em amostras de fezes, evitando a captura e estresse adicional para os animais. PCRs gênero-específicas convencionais com transcrição reversa prévia (RT-PCR) foram ainda realizadas visando a detecção de enterovírus (EV) e rotavírus (RV) nestas mesmas amostras. Genomas de HAdV foram encontrados em 14 a 17 amostras de fezes (82.35%) analisados, Considerando que o CAV foi encontrado coinfectando 5 destas amostras. Genomas de RV foram detectados em 7 das 17 amostras (41.18%) e todas as amostras foram negativas para EV. Os resultados apontam para a dispersão de HAdV e RV em uma taxa elevada para estas espécies de carnívoros selvagens sul-americanas, que podem ser um efeito da crescente antropização do habitat desses animais.

Identificación de virus respiratorios en pacientes pediátricos / Identification of respiratory viruses in pediatric patients

Los virus son la principal causa de infecciones respiratorias agudas. Para la detección de los virus respiratorios se emplea la Inmunofluorescencia directa (IFD). Objetivos: Describir los resultados de las IFD positivas según edad de los pacientes y estacionalidad y determinar el porcentaje de positividad. Material y métodos: Estudio descriptivo retrospectivo. Se incluyeron todas las IFD realizadas en pacientes <15 años en el Hospital de Niños de Viña del Mar entre enero 2012 y noviembre 2013. Resultados: Se realizaron 32015 IFD en 9012 pacientes en ambos años. El virus más frecuente es el Virus Respiratorio Sincicial (VRS) (51 por ciento 2012, 63 porciento 2013), obteniendo un mayor número de casos en pacientes menores de 1año. El Adenovirus (ADV) ocupa el segundo lugar con una incidencia uniforme a lo largo del año. Se observó una disminución de los casos de Influenza A y B desde el año 2012 al 2013. El porcentaje de positividad global de los exámenes es muy bajo (4,25 por ciento 2012 y 3,19 por ciento 2013). El VRS alcanza la mayor positividad en invierno (31,8 por ciento 2012 y24,7 por ciento 2013) y llega al 0 por ciento durante el verano. Conclusiones: Nuestros resultados se asemejan a la epidemiología nacional principalmente en la distribución de los virus según edad y estacionalidad. El virus más frecuentemente encontrado es el VRS. Hubo menos casos de Influenza A durante el 2013 en comparación con los resultados en el país. Existe una solicitud aumentada de exámenes lo que lleva a un porcentaje de positividad muy bajo...

The main cause of acute respiratory infections is viral. The direct immunofluorescence (IF) is used in the detection of respiratory viruses. Objectives: To describe the results of positive IF in relationship to the patient´s age and seasonality and to determine the percentage of positive results. Material and Methods: A descriptive retrospective study that includes all IF performed in patients <15 years old in a private clinic in the V region from January 2012 to November 2013. Results: 32015 IF were conducted in 9012 patients during both years. The Respiratory Syncytial Virus (RSV) is the most common virus (51 percent 2012, 63 percent 2013), obtaining a larger number of cases in patients under the age of 1. The second most common virus is Adenovirus (ADV) with a uniform incidence during the year. A decrease in cases of Influenza A and B was observed from 2012 to 2013. The percent positivity of the tests is very low (4.25 percent and 3.19 percent 2012 2013). The RSV positive testing is higher during the winter (31.8 percent and 24.7 percent 2012 2013) and 0 percent during the summer. Conclusions: Our results are similar to the ones obtained by the national epidemiology in terms of age and season relationship. The RSV is the most common virus. There were fewer cases of influenza A in 2013 compared with results in the country. Due to high demand in IF testing, a very low percentage of positive results is observed...

Prevalencia de virus respiratorios en pacientes menores de 2 años internados por infecciones respiratorias bajas en el Hospital de Emergencias Pediátricas durante el año 2011 / Prevalence of respiratory viruses in patients younger than 2 years interned by lower respiratory infections at the Hospital of Pediatric Emergency during the year 2011

Objetivos: Determinar la prevalencia de Virus en Infecciones Respiratorias Bajas en los pacientes internados en el Hospital de Emergencias Pediátricas. Material y métodos: Se realizó un estudio descriptivo, retrospectivo transversal. Se revisaron 274 historias clínicas de pacientes menores de 2 años que ingresaron al Servicio de Hospitalización Pediátrica del Hospital de Emergencias Pediátricas con diagnóstico de Infección Respiratoria Baja y a los que se les realizó algún Tipo de prueba para identificar Virus Respiratorios. Resultados: El 56.6 por ciento de los pacientes fueron del sexo masculino, y el 43.4 por ciento fueron del sexo femenino. Hubo una mayor frecuencia de virus sincicial respiratorio en el 18.6 por ciento de los casos seguido de adenovirus (14.2 por ciento), virus parainfluenza 3 (12 por ciento). El 94.2 por ciento de los casos se detecto con inmunofluorescencia indirecta. El 40.9 por ciento de los pacientes tenían edades entre los 6 a 12 meses. Hubo una mayor frecuencia de internamiento en el mes de Agosto en el 17.2 por ciento de los casos. El diagnóstico de ingreso de mayor frecuencia fue el de síndrome de obstrucción bronquial aguda con un 42 por ciento. El 51.8 por ciento de los casos tuvo una estancia de 4 a 7 días. El hallazgo radiológico de mayor frecuencia fue atrapamiento de aire con un 38.7 por ciento de los casos. El 7.3 por ciento de los pacientes ingresaron a fa UCI. El 41.2 por ciento de los pacientes recibieron tratamiento antibiótico. El 65 por ciento de los pacientes recibieron tratamiento con beta dos agonistas. El 53.6 por ciento recibieron tratamiento con corticoides. El 5.1 por ciento padecían de enfermedad cardiaca. El 4 por ciento tenían el antecedente de prematuridad. El 4.4 por ciento tenían el antecedente de enfermedad pulmonar crónica. La complicación más frecuente fue la atelectasia con un 7.3 por ciento de los casos. Conclusiones: La prevalencia de Virus en Infecciones Respiratorias Bajas en los pacientes...

Profilaxis de infección por virus respiratorios en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos / Prophylaxis against respiratory viral disease in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantation

Respiratory viruses have been identified as a cause of morbidity and mortality in patients undergoing SOT and HSCT, specially in children. The most frequent are respiratory syncytial virus (RSV), influenza (FLU), parainfluenza (PI) and adenovirus (ADV). These infections are associated with progression to severe lower respiratory tract infections in up to 60% of the cases. It is advised to apply universal protection recommendations for respiratory viruses (A2) and some specific measures for FLU and AD. FLU: Annual anti-influenza vaccination (from 4-6 months post-transplantation in SOT, 6 months in HSCT (A2)); post- exposure prophylaxis in FLU (oseltamivir for 10 days (B2)). In lung transplantion, the prophylaxis should last as long as the risk period (B2). ADV: There is no vaccine nor valid chemoprophylaxis strategy to prevent ADV disease. In some specific HSCT recipients, weekly PCR monitoring is recommended until day+100 (A3).

Los virus respiratorios se han identificado como causa de morbi-mortalidad en pacientes sometidos a TOS y TPH, particularmente en pediatría. Los más frecuentes son virus respiratorio sincicial (VRS), influenza (FLU), parainfluenza (PI) y adenovirus (ADV). La fuente de contagio está en la comunidad y en el hospital afectando al paciente en cualquier período post-trasplante. Se describe progresión a infecciones graves del tracto respiratorio bajo hasta en 60 % de los casos. Se recomienda aplicar medidas de aislamiento de precaución universal para todos los virus respiratorios (A2) y se describen algunas medidas específicas para FLU y AlDV. Vacunación anti-influenza anual con vacuna inactivada (en TOS a partir de 4-6 meses post-trasplante (A2), en TPH a partir de 6 meses (A2)); profilaxis post exposición a virus FLU (oseltamivir durante 10 días (B2)). En trasplante de pulmón, la duración de la profilaxis se extenderá mientras dure el período de riesgo (B2). Con respecto a ADV, no se dispone de una vacuna adecuada y no existe a la fecha una estrategia validada de quimioprofilaxis para prevenir enfermedad por ADV; en casos específicos de TPH pediátrico, se recomienda vigilancia semanal con RPC en sangre periférica hasta el día +100 post-TPH (A3).

Uso de una prueba rápida de rotavirus en la prescripción de antibióticos en diarrea aguda pediátrica: un estudio observacional, aleatorizado y controlado / Use of rotavirus rapid test in the prescription of antibiotics in acute pediatric diarrhea: an observational study, randomized controlled

OBJETIVO: Evaluar el efecto de la disponibilidad de un método diagnóstico rápido y preciso de rotavirus sobre la frecuencia en el uso de antibióticos en niños menores de 5 años con diarrea aguda de menos de 5 días de duración del Hospital Nacional Arzobispo Loayza; Lima, Perú. MATERIALES Y MÉTODOS: se realizó un estudio observacional, prospectivo, aleatorizado, controlado, entre Julio 2008 y Enero 2009. Se asignó aleatoriamente 101 pacientes al Grupo A (con prueba de leucocitos fecales) y 100 al Grupo B (con prueba de leucocitos fecales y prueba rápida de rotavirus/adenovirus). Se evaluó en cada grupo la decisión clínica de administrar o no antibióticos. RESULTADOS: No existieron diferencias significativas en el tiempo de enfermedad, edad ni peso entre ambos grupos. Los casos de rotavirus tuvieron leucocitos fecales positivos en un 46.9%. El grado de positividad de los leucocitos fecales se asoció de manera directamente proporcional al uso de antibióticos (P<0.0001). El grupo positivo a rotavirus presentó un mayor riesgo de hospitalización que el grupo negativo a este agente (21.9% vs. 6.3%, P<0.0001). No se registraron muertes atribuibles a diarrea. CONCLUSIONES: La disponibilidad de un diagnóstico rápido y preciso de rotavirus en menores de 5 años con diarrea aguda, redujo significativamente el uso de antibióticos.

OBJECTIVE: To determine the impact of a rapid and accurate rotavirus test in the emergency ward on the reduction of antibiotic prescription in children under 5 years old with acute diarrhea at ôArzobispo Loayza National Hospitalõ, Lima, Peru. MATERIAL AND METHODS: We performed an observational prospective randomized controlled study, from July 2008 to January 2009. Stool samples from patients with diarrhea lasting less than 5 days were analyzed. Out of 201 cases, 101 were classified in Group A (with fecal leukocytes test performed) and 100 in Group B (with fecal leukocytes test and rotavirus/adenovirus test performed). We aimed to associate the signs and symptoms with the decision of prescribing antibiotics and with hospitalization risk. RESULTS: Both groups were comparable with regard to age, weight and illness duration. In patients with rotavirus infection, fecal leukocytes were positive in 46.9% of cases. Frequency of antibiotic use was directly associated with the number of fecal leukocytes (P<0.0001). There was a higher risk of admission in the group positive to rotavirus than in the group negative to this agent (21.9% vs. 6.3, P<0.0001). No diarrhea-attributable deaths were reported. CONCLUSION: The use of rotavirus test in the pediatric emergency room decreased antibiotic prescription in children with diarrhea.

Nuevos y viejos agentes asociados a diarrea en niños en Honduras / New and old agents of acute diarrhea In children In Honduras

INTRODUCCIÓN: La diarrea es la segunda causa de morbilidad y mortalidad en niños menores de 5 años en Honduras. El objetivo de este estudio fue determinar los agentes etiológicos virales, bacterianos y parasitarios en niños con diarrea no sanguino lenta de 2 barrios marginales de Comayagüela, Honduras. METODOLOGÍA: Estudio de casos y controles realizado del 1er de marzo al 31 de agosto 2004 en los centros de Salud de Las Crucitas y El Carrizal, en 151 niños de 6 meses a 5 años de edad con diarrea aguda que acudieron por demanda espontanea; con los correspondientes 151 controles apareados por edad, sexo y vecindario, una vez obtenido el consentimiento informado. Las muestras de heces se procesaron por virus, bacterias y parásitos utilizando métodos convencionales en el laboratorio. El análisis estadístico además de la prueba exacta de Fisher. RESULTADOS: Se encontró una asociación significativa entre los niños infectados por Cryptosporidium spp. y Adenovirus y los episodios de diarrea aguda, comparada con los no infectados por esos agentes patógenos (OR=9.31, 95%CI=1.24 - 69.97; OR = 5.47, 95%CI=1.51 – 19.80, respectivamente); los 8 pacientes infectados con Rotavirus tenían un cuadro diarreico agudo evidente (prueba exacta de Fisher p<0.01). CONCLUSIONES: Las infecciones por Adenovirus, Rotavirus y Cryptosporidium spp. se asociaron fuertemente con diarrea aguda no sanguinolenta en niños en Honduras...