A syndrome of transient encephalopathy associated with adenovirus infection

Background and Objective. Adenovirus is a common pathogen in the pediatric population. Respiratory, gastrointestinal, or renal systems are often invol ved in adenovirus infections. Several neurologic syndromes have been attrib uted to adenovirus, such as adenovirus aseptic meningitis, myelitis, subacu te focal encephalitis, and Reye-like syndrome. The purpose of this study wa s to describe the clinical features and encephalography findings in 7 infan ts treated in our center for a syndrome of transient encephalopathy associa ted with adenovirus infection. Study Participants. Three females and 4 males ages 7 to 34 months seen in o ur department between July 1983 and February 1984 and September 1998 and Ma y 1999 presented with fever of at least 7 days' duration and a gradual decl ine in the state of alertness. Score on the Glasgow Coma Scale ranged from 9 to 12. Findings on lumbar puncture were normal. In all 7 patients, the en cephalogram showed moderate to severe background slowing compatible with en cephalopathy. All patients were catarrheal and had mild hepatomegaly with s light elevation of liver enzymes. Some had bronchopneumonia, diarrhea, and conjunctivitis either isolated or in combination. Methods and Results. Adenovirus was isolated by immunfluorescence technique in all patients-from the sputum in 3 patients, nasopharynx in 5, conjuncti va in 4, and rectal swab in 5. In 5 patients, serotyping was performed by a n antibody neutralization method. Adenovirus type 3 was ascertained from a nasal swab in 1 patient, sputum specimens in 3, throat swab in 3, and recta l cultures in 5. The clinical course was characterized by a progressive rec overy of alertness. After several days, there was a complete reversal of ne urologic findings. Conclusion. We suggest that this syndrome of transient encephalopathy is a distinct entity and should be considered as another of the several neurolog ic syndromes known to be associated with adenovirus infection.