Gastroenteritis associated with enteric type adenovirus in hospitalized infants

Rapid presumptive recognition of diarrhea-associated adenoviruses

The quantity of adenoviruses in a diarrhea stool provided a strong presumptive indication of the presence or absence of an adenovirus from subgenus F or G (proposed species 40 or 41). These adenoviruses were found in the stools of 91% of 56 acutely ill diarrhea patients with one or more than one adenovirus particle per min of direct electron microscopic viewing, as compared with 40% of 20 acutely ill diarrhea patients with less than one detected adenovirus particle per min of viewing.

Silver staining of DNA restriction fragments for the rapid identification of adenovirus isolates: application during nosocomial outbreaks

The ultrasensitive photochemical silver stain for nucleic acids, described by Beidler et al. (1982), has been applied to the detection of adenovirus restriction fragments as a relatively rapid technique for the identification of virus isolates. In this study, restriction enzyme cleavage analysis was used to characterize adenovirus isolates from what appeared to be two nosocomial outbreaks. The first outbreak was thus shown to include two clusters of patients, and involved two serotypes Ad7c and Ad40. The second outbreak was unrelated and involved Ad35. Although restriction analysis does not replace serum neutralization as a routine method for typing adenoviruses, it is a much more rapid means of discriminating between different patient isolates, providing a current rather than retrospective analysis of a nosocomial outbreak. During the first outbreak, restriction analysis identified two distinct adenovirus serotypes from one patient--Ad7c from a nasopharyngeal aspirate and Ad41 from a stool specimen. Restriction analysis is also valuable for the sub-typing of virus isolates. In this study, the Ad40 and Ad41 isolates were shown to be variants of the respective prototype strains.

Importance of enteric adenoviruses 40 and 41 in acute gastroenteritis in infants and young children

In a prospective 1-year study of acute infantile gastroenteritis, adenoviruses were detected in the stools or by seroconversions, or both, in 56 of 416 (13.5%) ill children. By use of DNA restriction enzyme analysis, enzyme immunoassay, and culture techniques, 33 of 56 (59%) adenovirus specimens were identified as enteric adenoviruses 40 and 41 (Ad40 and Ad41). They were found as the sole recognizable cause of diarrhea in 30 of 416 (7.2%) ill children and in 0 of 200 controls. Three additional ill children had enteric adenoviruses as a part of a dual infection. Evidence for established adenoviruses (Ad1 through Ad39) in gastroenteritis was found in 15 of 416 (3.6%) ill children but also in 3 of 200 (1.5%) controls. Eight adenovirus specimens remained untyped. Seroconversions were demonstrated in 17 of 18 (94%) paired serum samples from patients shedding enteric adenoviruses. The predominant symptom of infections with enteric adenoviruses was diarrhea, with a mean duration of 8.6 days (Ad40) and 12.2 days (Ad41). One-third of the children with Ad41 infections had prolonged symptoms (greater than or equal to 14 days). The frequency of respiratory symptoms was low (21%). The established adenoviruses presented a different clinical picture, characterized by diarrhea of shorter duration, higher fever, and significantly increased occurrence of respiratory symptoms (79%). In conclusion, enteric adenoviruses appear to be an important cause of acute infantile gastroenteritis, second only to rotaviruses in this study.

Diagnosis of fastidious enteric adenoviruses 40 and 41 in stool specimens

Thirty-five stool specimens, collected over a 14-week period from pediatric gastroenteritis patients and shown to contain adenovirus by electron microscopy, were inoculated onto 293 and HeLa cells. Virus isolates were characterized by serum neutralization and restriction endonuclease cleavage analysis of viral DNA from infected cells. Adenovirus was isolated upon primary inoculation of 293 cells from all 35 specimens shown to contain adenovirus by electron microscopy. Fastidious adenoviruses 40 and 41 (Ad40 and Ad41) were found in 17 (49%) of the stool specimens, and 4 of these specimens contained a conventional species (Ad1, Ad1, Ad18, Ad31) as well as Ad40. This was first manifest by the observation that four of the isolates which initially grew only in 293 cells acquired the capacity to grow in HeLa cells upon subsequent passage. In each case, the conventional species was undetectable by DNA analysis in the original inoculum but was selected in 293 cells and became the only one detectable by the second passage. Four other specimens, containing Ad1 or Ad31 alone, failed to grow initially in HeLa cells but did grow in 293 cells. The results of this study demonstrate therefore that (i) 293 cells are more sensitive than HeLa cells for the isolation of conventional as well as fastidious enteric adenovirus species and (ii) identification of viruses from patient specimens should involve minimal passage of the virus in cell culture, as a single passage can result in misdiagnosis of the virus associated with the infection.

Cloning and physical mapping of enteric adenoviruses (candidate types 40 and 41)

We have studied the DNAs of fastidious enteric adenoviruses recovered from the stools of infants with gastroenteritis. By endonuclease analysis, the strains examined represent candidate adenovirus types 40 and 41, which are thought to comprise new adenovirus subgroups F and G. Cloning of DNA from representative enteric adenovirus isolates, together with hybridization and subcleavage analysis, permitted the mapping of restriction enzyme cleavage sites. Although the restriction profiles are different for the two strains, they appear to have several cleavage sites in common. Cross hybridization studies show considerable homology between the subgroup F and G strains but much less homology to adenovirus 2. In addition, regions on both ends of enteric adenovirus genomes (map units, 2.9 to 11.3 and 75 to 100) possess little or no homology to adenovirus 2. Restriction enzyme digests reveal submolar fragments that map to the terminal regions of the genome. Electron micrographic studies of denatured and renatured DNA strands suggest that the submolar fragments may derive from cleavage of defective molecules. Inverted terminal repeat sequences were shown to comprise 0 to 3.2% of the length of complete (greater than or equal to 22 megadaltons) enteric adenovirus DNA molecules but 4 to 69% of incomplete-length (less than 22-megadalton) molecules.

Enzyme immunoassays in which biotinillated beta-lactamase is used for the detection of microbial antigens

The performance characteristics of enzyme immunoassays are determined to a great extent by the enzyme-substrate system utilized for the immunoassay. Beta-lactamases (penicillin amido-beta-lactamhydrolase EC 3.5.2.6) offer a number of advantages which might make them useful in immunoassay systems. We linked beta-lactamase from Bacillus cereus with biotin and used the biotinillated enzyme to devise immunoassay systems for the detection of a number of microbial antigens. An assay system in which antibodies to the polyribitol phosphate antigen of Haemophilus influenzae type b were used was capable of detecting between 0.4 and 1.6 ng of that antigen. Similarly, an assay in which antibodies to the common antigens of adenoviruses and biotin-linked beta-lactamase were used was capable of detecting between 1 and 10 50% tissue culture infective doses of a strain of enteric-type adenovirus. When applied to the detection of rotavirus, a similar system in which biotinillated beta-lactamase was used was capable of detecting small amounts of antigen in a standard rotavirus preparation. This assay could also detect virus in 36 of 37 stool specimens from children with rotavirus gastroenteritis. The positive specimens could easily be distinguished from negative ones by the naked eye, and a permanent record of the qualitative results could be obtained by the use of a standard office photocopying machine. Beta-lactamases have promise for use in practical enzyme immunoassay systems, especially in situations in which expensive colorimetric instrumentation is not available.

Improved enzyme immunoassays for the detection of antigens in fecal specimens. Investigation and correction of interfering factors

Solid phase enzyme immunoassays (EIA) are widely used for the detection of infectious agents in body fluids such as stool specimens. However, we found that stool specimens contained substances which desorb from 50% to 68% of the immunoreactant from solid phase surfaces. This desorbing activity decreased the sensitivity of EIA systems for toxin A of C. difficile, rotavirus and adenovirus. The desorbing activity in stool specimens was partially heat labile at 56 degrees C for 30 min, was present in stool fractions corresponding to an estimated molecular weight of 25,000 and was shown to degrade solid phase protein. In addition, the desorbing activity was partially reversed by specific and nonspecific protease inhibitors. Thus, the desorption may reflect the enzymatic activity of stool proteases. The desorption was markedly reduced by diluting specimens in 50% fetal calf serum or an acid-protein buffer such as 0.25 M citrate buffer, pH 4.7, containing 5% bovine serum albumin. These diluents were shown to improve the recovery of toxin A of C. difficile, rotavirus and adenovirus in EIA systems for these antigens.

Outbreak of infantile gastroenteritis due to type 40 adenovirus

Genetic and antigenic characterisation was performed on a strain of adenovirus (EAd) isolated from an outbreak of gastroenteritis which occurred in an orphanage in the City of Sapporo, in the room housing the eldest children, who ranged in age from 14 to 22 months. 7 of the 11 children housed in that room had diarrhoea between July 11 and July 22, 1982. All 7 shed adenoviruses detectable by electron microscopy in their stools. Immune electron microscopy showed that all patients as well as the healthy contacts sharing the room underwent seroconversion to EAd. There was no homology, or very slight homology, between DNA of EAd and those of adenoviruses belonging to subgroups A to E. Antigenically EAd was closely related to type 40 adenovirus, so far the sole member of the newly identified subgroup F. This outbreak of gastroenteritis is the first in which the causative agent has been identified as being a member of subgroup F adenoviruses.

Comparison of a monoclonal antibody with a polyclonal serum in an enzyme-linked immunosorbent assay for detecting adenovirus

To develop and evaluate an enzyme-linked immunosorbent assay (ELISA) for detecting adenovirus antigens in which a group-specific monoclonal antibody to the adenovirus hexon is used, we studied two different ELISA test systems. The test system which was the most sensitive and specific was then compared in parallel tests with a similarly constructed ELISA in which a mouse polyclonal serum was used. Both the ELISA with the monoclonal antibody and that with the polyclonal serum detected purified hexon and 15 different adenovirus types with similar sensitivities. The two assays also showed no reaction with 23 heterologous viruses. Both tests detected adenovirus in stool and respiratory tract specimens tested for adenovirus by standard tissue culture techniques with similar sensitivities and specificities, but neither was sufficiently sensitive for routine testing of these types of clinical specimens. However, the ELISA with the monoclonal antibody proved to be a good test for the noncultivatable adenoviruses, detecting 12 of 12 stool samples that were positive by electron microscopy. The monoclonal antibody proved to be as sensitive and specific as the polyclonal serum and has the advantage that it can be produced in unlimited quantities and needs to be characterized only once.

An outbreak of rotavirus-associated neonatal necrotizing enterocolitis

An outbreak of necrotizing enterocolitis and hemorrhagic gastroenteritis occurred in two nurseries during 25 days in August 1982. Eleven of the 40 patients in these nurseries during that time developed disease (attack rate 27.5%). In seven of the 10 patients with gastrointestinal disease, stool samples tested for human rotavirus were positive by ELISA, whereas in 20 unaffected infants, no stools tested demonstrated HRV (P = 0.0001). Eleven staff members had serologic evidence of recent HRV infection. Comparison of risk factors traditionally associated with the development of NEC between the affected and unaffected infants revealed no significant differences. Rotavirus infection was the only finding that was highly correlated with this epidemic.

Pediatric viral gastroenteritis during eight years of study

During the period January 1974 through July 1982, fecal samples from 1,537 pediatric inpatients with gastroenteritis were tested for enteric viruses by electron microscopic and rotavirus enzyme-linked immunosorbent assay techniques. Rotaviruses were detected in 34.5% of these patients, enteric adenoviruses were detected in 4.7%, approximately 27-nm viruses were detected in 1.6%, and at least one of these agents was found in 40.1% of the study subjects. Three infections were by an apparently new agent which morphologically is a rotavirus, but which failed to react in the rotavirus enzyme-linked immunosorbent assay. During the first 8 calendar years of study, rotaviruses were detected in 39.0% of 577 patients in the even-numbered years and 30.3% of 702 patients in the odd-numbered years. Adenoviruses were found in all calendar months. Rotaviruses were found in inpatients in November through July, whereas approximately 27-nm viruses were found in October through June. The percentage of patients who had a demonstrated viral infection rose steadily from 7.4% in September to 72.0% in January and then steadily declined to 2.9% in August. Viral infection was especially common in study subjects who were 7 through 24 months of age; 61% of such children had one or more enteric viruses. Rotavirus-infected patients tended to be younger during the months of greatest rotavirus activity than at the beginning and end of the rotavirus season, presumably because of a greater exposure to virus at the height of the rotavirus outbreak.