Journal of Clinical Virology - Volume 82 - Supplement 1 - September 2016

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Abstracts / Journal of Clinical Virology 82S (2016) S1–S142 S65
Abstract no: 293
Presentation at ESCV 2016: Poster 88
Investigation of the role of gastroenteritis
causing viruses in the asymptomatic neonatal
digestive tract
F.J. Hamilton ∗, L. Lynch , J. Quinn , R. Langley ,
C. Smith , K. Templeton
1 Department of Medical Microbiology, Royal
Infirmary of Edinburgh Edinburgh, UK
2 Department of Neonatal Medicine, Royal Infirmary
of Edinburgh, Edinburgh, UK
Background: Viral gastroenteritis is a significant cause of mor-
bidity and indeed mortality across the world. The World Health
Organization (WHO) estimates that every year there are 1.7 billion
cases of diarrhoeal disease, with the suggestion is that neonates
and children under 5 years old are particularly prone. However lit-
tle is known about the role of viruses in asymptomatic infants. This
study sets out to identify whether certain viruses associated with
diarrhoeal disease are present in asymptomatic neonates.
Methods: Faecal samples from 245 symptomatic neonates, 80
symptomatic 0–5 year olds, and 113 asymptomatic neonates were
collected from patients attending the Royal Infirmary of Edinburgh
and analysed for the presence of Enterovirus, Parechovirus, Astro-
virus, Sapovirus, Norovirus, Rotavirus, Adenovirus and Human
Bocavirus by Real Time PCR. Ethical approval was obtained to col-
lect faecal samples from asymptomatic neonates. All samples were
analysed with no patient identifiable data. Results were entered
into a database and analysed. A comparison of these groups was
then performed.
Results: 19.2% and 27.5% of symptomatic neonates and 0–5 year
olds, respectively, tested positive for at least one of the viruses.
Enterovirus was the most common of the viruses, whereas pare-
chovirus, astrovirus, and sapovirus were rarely found. No strong
gender bias, nor age-bias was identified. Enterovirus was found in
18.6% of asymptomatic neonates. Furthermore, this study showed
the presence of Adenovirus DNA in 27% of asymptomatic children,
which was higher than the prevalence of 11% seen amongst symp-
tomatic children. No Norovirus, Rotavirus or Human Bocavirus
infections were detected in the asymptomatic cohort, but were
detected in 2.8%, 4% and 4.62% of symptomatic patients respec-
tively. Moreover, levels of viruses detected in patients older than
3 months of age were statistically higher than in their younger
counterparts (p = 0.001).
Conclusions: This study concludes that Adenovirus is the
most prevalent virus in the asymptomatic neonate population.
Enterovirus is the most prevalent virus found in both symptomatic
and asymptomatic populations of children within NHS Lothian of
less than five years of age. Due to the appearance of enterovirus in
both groups it cannot conclusively be linked with a disease-causing
phenotype, and highlights that these viruses may form part of the
natural microbiome in young children.
Abstract no: 315
Presentation at ESCV 2016: Poster 89
A paediatrics case with unusual presentation of
adenovirus enteritis in immunocompetent host
N. El Sakka ∗, G. Mahdi , P. Brown
1 Consultant Medical Microbiology and Virology,
Aberdeen Royal Infirmary, Aberdeen, UK
2 Consultant Paediatrics, Aberdeen Royal Infirmary,
Aberdeen, UK
3 Consultant Pathology, Aberdeen Royal Infirmary,
Aberdeen, UK
Adenovirus is the second most common cause of gastroenteri-
tis in children in the UK after rotavirus. Infection is usually mild
and self-limiting in the immunocompetent host. Complications are
uncommon, and the management is mainly supportive therapy.
We present a case of 7 years old boy, otherwise fit and healthy,
presentedwith on going problemswith pale stools, nausea, abdom-
inal pain and lethargy. The course of his symptoms was protracted
and affected his nutritional status. In addition, he had a history
of multiple food intolerances and dysphagia. He had been kept on
gluten-free diet for many years, which improved his diarrhoea.
He was investigated for possible coeliac disease, and was rein-
troduced to gluten for 3 months to allow for an accurate biopsy
results, but has found recurrence of diarrhoea and worsening of
symptoms once gluten was reintroduced. Upper GI endoscopy was
performed and mucosal biopsies were taken to rule out coeliac
disease. Examination of the biopsies from the duodenal lining
was not in keeping with coeliac disease. There was however, evi-
dence of what is commonly seen with current infections. Electron
microscopy was performed on formalin-fixed, paraffin-embedded
duodenal biopsies. Intra-nuclear inclusions of viral particles were
seen. Particles were hexagonal in shape with an average diameter
of 68 nm and arranged in regular array formations. PCR analysis
was performed on 4 curls from the duodenal biopsy material, and
the 4 samples were all positive to adenovirus DNA. In addition,
each of the 4 biopsies was PCR negative to astrovirus, rotavirus,
sapovirus, enterovirus, parechovirus, norovirus, cytomegalovirus
and Epstein-Barr virus.
The current case represents an unusual and protracted course
of adenovirus enteritis in immunocompetent host. Adenovirus
infection in this child was associated with prolonged course, mal-
nutrition and lactose intolerance. It is not clear in this patient
whether adenovirus infection is the direct cause of his symptoms,
or it is an associating factor to another undiagnosed clinical con-
dition. Secondary lactose intolerance has been reported as a rare
complication of acute gastroenteritis in children, however little is
known in literature about the mechanism, rates and correlation
with cases of adenovirus enteritis. Further investigation in this field
is required in order to shed more light on the possible mechanisms,
and prevent missed opportunities of clinical diagnosis.