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(1)

Case histroy 1

A child presented to OPD with complaints of

passage of loose stools for the past 2 days. The stools are not fowl smelling, and are watery in consistency with the presence of blood but no mucus

.

What can be the etiology

?

(2)

Case history 2

In a military recruits posted in the valley, 5 of the army men developed fever, sore throat, nasal congestion, cough and malaise. Four of these recovered and in 1 of them the illness progressed to pneumonia

.

What can be the etiology

.

(3)

Case History 3

chlidren developed fever , conjunctivitis and 3 pharyngitis 3 days after a summer camp

.

What can be the etiology

?

(4)

Case history 4

A 10 year old boy was brought to the casuality with the history of passage of blood in urine

.

Etiology again a question

?

(5)

ADENOVIRUS

(6)

ADENOVIRUS

DNA viruses first isolated from

adenoidal tissue in 1953

(7)

ADENOVIRUS

Family

Adenoviridae

Genus

Mastadenovirus Aviadenovirus

(8)

ADENOVIRUS - Structure

Non-enveloped DNA virus 70-90 nm in size

Linear ds DNA genome with core proteins

(9)

ADENOVIRUS - Ultra structure

Icosahedral capsid with 252 capsomeres (12 pentons at vertices and 240 hexons)

Each penton has a fibers with terminal knob projecting from it

(10)

Adenovirus- 3 D structure

(11)

ADENOVIRUS - Classification

Subgroups- 6 subgroups (A-F), based on

hemagglutination, DNA fragment analysis, Fibre length and oncogenic potential

Serotypes- 1-47 (human)

Common serotypes:- 1-8, 11, 21, 35, 37, 40

Enteric Adenoviruses belong to subgroup F

(12)

TRANSMISSION

Droplets

Fecal-oral route

Direct and through poorly chlorinated water Fomites

(13)

Time-course of infection

Incubation period- 2-14 days

Infective period continues for weeks

Intermittent and prolonged rectal shedding

Secondary attack rate within families up to 50%

(14)

EPIDEMIOLOGY

Endemic, epidemic and sporadic infections Many infections are sub-clinical

(15)

EPIDEMIOLOGY-contd.

’Tip of the iceberg phenomenon’

Classical disease presentation

Mild clinical disease

Asymptomatic infection but +infectivity

(16)

EPIDEMIOLOGY- Outbreaks

Military recruits,

swimming pool users, hospitals,

residential institutions, day care settings

(17)

CLINICAL SYNDROMES

Respiratory Eye

Genitourinary

Gastrointestinal

Others

(18)

Acute Respiratory Disease (LRI)

Fever

Tracheobronchitis Pneumonia

Children and adults

Epidemics in military recruits

Types 4 and 7 most frequently

(19)

Pharyngoconjunctival fever

Headache, fever, malaise

Conjunctivitis and Pharyngitis

Cervical adenopathy, rash and diarrhea also Main adenovirus types: 3, 4, 7, 14

Epidemics in summer months

Contaminated water in swimming pools, fomites

(20)

Adenoviral Infections of the eye

Epidemic Keratoconjunctivitis (EKC) Acute follicular conjunctivitis

Pharyngoconjunctival fever

(21)

Adenoviral conjunctivitis

Early conjunctivitis (top) and Bilateral conjunctivitis (lower)

(22)

ADENOVIRAL INFECTIONS- Genitourinary system

Acute hemorrhagic cystitis

• fever, dysuria, hematuria

• Types 11, 7, 4, 21, 1

• More common in boys

Others

• Orchitis, nephritis, cervicitis with ulcerated vesicular lesions, urethritis

• Types 2, 8, 19, 37

(23)

Other Infections due to Adenovirus

Myocarditis

Pericarditis

Meningitis

Rash

Arthritis

(24)

Adenovirus infections in Immunocompromised hosts

Disseminated, severe and often fatal infections

Due to new infection or reactivation of latent virus

Prolonged infections with prolonged viremia and viral shedding

Necrotizing pneumonia, hepatitis, rash, disseminated intravascular coagulation (DIC), CNS involvement

(25)

DIAGNOSIS OF ADENOVIRAL INFECTIONS

• Variety of clinical specimens depending on clinical syndrome-NP, conjunctival, stool, urine,

• tissue, etc.

• Transport in viral transport media

• Isolation from pharyngeal site correlates better with current clinical infection

(26)

ADENOVIRAL INCLUSION

BODIES

(27)

Methods for diagnosis

Culture in HeLa, Hep2 cell lines Shell vial cell culture

DFA ELISA

PCR, nucleic acid probes EM and Immune EM

(28)

ADENOVIRUS VACCINE

• Oral live attenuated vaccine

• Strains 4, 7

• Used in military recruits

• Manufacture of vaccine was halted in 1996

• Lapse in immunization was associated with

outbreaks in military recruits

(29)

Adenovirus

Used as VECTORS to transfer desired genetic material into cells

Viral genome is relatively easily manipulated in vitro

Efficient expression of inserted DNA in recipient cell

(30)

THANKS

(31)

Gastrointestinal Infections

Types 40, 41 Age <4 years

• Diarrhea lasts for 10-14 days

• Fever

• Also, intussusception, mesenteric adenitis, appendicitis

References

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