Healthcare Infection Prevention-Case reports: Fatal adenovirus infections

An elusive diagnosis in both cases

The Centers for Disease Control and Prevention case reports of fatal adenovirus infections in two young military recruits are summarized below:1

Case 1. A healthy 21-year-old man arrived at Navy basic training in Great Lakes, IL, May 19, 2000. His medical history was negative for underlying illnesses. On June 20-23, he presented to the medical clinic with upper respiratory symptoms. His clinical evaluations did not suggest severe illness, and two bacterial throat cultures were negative. On June 23, he was prescribed a five-day course of azithromycin for suspected bronchitis. On June 24, he was found unconscious in the barracks. He was transported to a local hospital where he had tonic clonic seizures and respiratory failure that required a ventilator.

A chest radiograph revealed a right upper lobe infiltrate, and computer tomography of the head was positive for sinusitis.

Examination of cerebrospinal fluid revealed elevated protein levels, but no identifiable pathogens. Blood cultures were negative. He was treated with broad-spectrum antibacterial agents (i.e., vancomycin, ceftriaxone, and metronidazole) and antivirals (i.e., acyclovir and foscarnet). He did not regain consciousness, and he died July 3 from complications of encephalitis.

Molecular testing by polymerase chain reaction (PCR) assay of lung and brain tissue was positive for adenovirus DNA. In addition, analysis of premorbid and postmortem serum specimens showed a greater than fourfold rise in neutralizing antibody titers to both adenovirus types 4 and 7.

Case 2. A healthy 18-year-old man arrived at Navy basic training in Great Lakes, IL, Aug. 1. On Aug. 17, 29; and Sept. 17, he presented to the medical clinic with upper respiratory symptoms. Examinations disclosed no severe illness. He was given acetaminophen and decongestants.

On Sept. 18, he presented to the medical clinic with severe dyspnea, weakness, and a petechial rash on the legs. A chest radiograph identified multilobar infiltrates, and he was admitted to a local hospital where his condition rapidly deteriorated. He was given intravenous ceftriaxone and erythromycin and respiratory and hemodynamic support.

He died nine hours after admission with a clinical diagnosis of acute respiratory distress syndrome.

An autopsy revealed diffuse hemorrhagic pneumonia and diffuse alveolar injury. Cultures and special stains of autopsy materials failed to identify specific pathogens. PCR testing of lung tissue was positive for adenovirus DNA.

Reference

1. Centers for Disease Control and Prevention. Two fatal cases of adenovirus-related illness in previously healthy young adults -- Illinois, 2000. MMWR 2001; 50(26);553-555.


Dining in the UK? Don’t be the 10 billionth served

Assessing transmission risk of new variant CJD

The current risk of acquiring new variant Creutzfeldt-Jakob (nvCJD) disease from eating beef and beef products produced from cattle in the United Kingdom is about one case per 10 billion servings, the Centers for Disease Control and Prevention estimates.1

The uniformly fatal nvCJD infection has been strongly linked to consuming meat contaminated with bovine spongiform encephalopathy (BSE) - widely known as "mad cow" disease. This new variant CJD is not to be confused with traditional or "sporadic" Creutzfeldt-Jakob disease, a neurological disorder that has occurred throughout the world and the United States for years at a rate of about one case per million people.

No cases of BSE in cattle or nvCJD in humans have appeared in the United States. However, nvCJD has a long incubation period, and experts fear England will see thousands of cases over the coming years linked to beef consumed before the mad cow threat was known.

To reduce the possible risk of acquiring nvCJD from food, travelers to Europe may wish to avoid beef and beef products altogether, the CDC notes.

Selecting solid pieces of muscle meat rather than ground beef products - which are more likely to be exposed to other animal tissues - is advised. Milk and milk products from cows are not believed to pose any risk for transmitting the disease, according to the CDC.

Reference

1. Centers for Disease Control and Prevention. Web site: http://www.cdc.gov/ncidod/hip/INFECT/CJD.htm.