What is Adenoviral enteritis?
According to the available observations, gastroenteritis can cause intestinal adenoviruses belonging to serotypes 40 and 41, which are included in group F. Due to the lack of research done today, it is difficult to determine the proportion of adenoviral gastroenteritis in the overall structure of viral gastroenteritis. If in the late 80s they were assigned the second place after rotavirus infection in the structure of gastroenteritis in children, then in the 90s the dominant role of caliciviruses was established. In studies conducted in Europe, Asia, and North and South America, it was shown that intestinal adenoviruses can cause from 2 to 22% of cases of gastroenteritis in children under 2 years of age.
Causes of Adenoviral Enteritis
Pathogen is a group of DNA-containing viruses from the Adenoviridae family, of which 37 serological types have been isolated from humans. These serotypes have a common soluble complement-binding antigen, but differ in the structure of DNA, the molecular weight of the internal polypeptides, the antigenic specificity of capsid proteins, the structure of hemagglutitins, according to their biological properties, including oncogenicity. On this basis, they are divided into 7 subgroups, which received the letter name from A to G.
Adenoviruses are resistant to environmental factors, remain active for 7 days at a temperature of 36-37 ° C, 14 days at 22-23 ° C, 70 days at 4 ° C; resistant to ether, inactivated by heating to a temperature of 56 ° C for 30 minutes, under the action of a 5% phenol solution, a 1% solution of chloramine, a 3% solution of hydrogen peroxide – within 15-30 minutes.
Pathogenesis during adenoviral enteritis
Despite the ability of intestinal adenoviruses to epidemic spread, the seasonality of the disease, however, has not been proven. As a rule, intestinal adenoviruses cause disease in children under 2 years of age, with the highest risk of becoming ill in children under one year. Viruses can have nosocomial spread, causing outbreaks in hospitals. Among the adult population, the development of gastroenteritis is not described, although it is quite possible that, in contact with sick children, adults become infected and suffer subclinical forms of infection.
The mechanism of transmission is not well understood. It is believed that the main route of transmission of the virus – contact.
Symptoms of Adenoviral Enteritis
The incubation period is from 8 to 10 days.
Unlike other viral gastroenteritis, intestinal adenoviruses cause a longer illness (from 5 to 12 days, and sometimes up to 14 days).
The principal difference between intestinal adenoviruses and respiratory ones is that patients do not develop typical clinical signs such as nasopharyngitis and keratoconjunctivitis, although viremia is also registered in these patients.
The disease is characterized by moderately severe intoxication, low temperature, persisting for several days. In cases where the disease lasts up to 2 weeks, patients are more likely to have a fever of the wrong type, which is sometimes wavy.
Dyspeptic manifestations in the form of vomiting and diarrhea are moderate and persist for 1-3 days or more. Patients are significantly more likely than other viral gastroenteritis, abdominal pain, which is caused by an increase in mesenteric lymph nodes. Cases have been described where fever and abdominal pain were almost the only manifestations of adenoviral gastroenteritis.
In some cases, patients simultaneously with signs of gastroenteritis may show changes in the respiratory tract, however, the mechanisms and nature of the emerging pathology has not been studied enough.
The disease passes on its own almost without complications.
Diagnosis of Adenoviral Enteritis
Laboratory diagnosis is based on the detection of a specific antigen of the virus in the feces using ELISA. Rarely isolated virus in cell culture. To determine the serotype, the reaction of neutralization of the cytopathic effect with the corresponding antiserum is used. For retrospective diagnosis, RTGAs test paired sera taken on days 1–5 and 15–20. Also used RAC.
Treatment of Adenoviral Enteritis
Treatment of patients with adenoviral gastroenteritis is based on the principles of pathogenetic therapy. The choice of the most optimal method of treating patients depends on timely diagnosis, and more specifically, laboratory verification of the viral genesis of the disease.
Of non-pharmacological treatment methods, an important place is given to diet therapy, which is determined by the pathophysiological mechanisms of the development of diarrhea syndrome. At the height of the clinical manifestations of the disease, milk and dairy products should be excluded from food, and the intake of carbohydrates, sugar, vegetables and fruits should be limited. As the clinical symptoms of the disease are stopped, the diet gradually expands. Given that in the acute period of the disease, fermentopathy is formed in patients, it is advisable to prescribe them to combined enzyme preparations, such as festal, panzinorm, mezim forte, and others. The therapy with adsorbing and astringent preparations, which, in particular, contributes to the clearance of feces and the reduction of the frequency of defecation, is also grounded, although this has little effect on the development of dehydration. These include polyphepan, smecta, bismuth preparations and others.
In the literature there are indications of a positive effect on the course of adenoviral gastroenteritis of various probiotics. The pathophysiological rationale for their use in patients with adenoviral gastroenteritis is the fact that the strains that are part of probiotics are directly involved in the processes of digestion, metabolism and detoxification. In addition, patients may have dysbiotic changes in the intestines.
Since the main manifestation of adenoviral gastroenteritis, which determines the severity of the course of the disease, is dehydration, the relief of dehydration is the basis of pathogenetic therapy. The principles of rehydration therapy today are developed quite well and are universal. Depending on the degree of dehydration, rehydration is carried out by oral or intravenous route.
Oral rehydration therapy is carried out in patients with no pronounced systemic manifestations of dehydration. It is carried out by glucose electrolyte solutions (cytoglucosolane, rehydron and others), which are taken fractionally, 1–1.5 liters per hour.
Intravenous therapy is prescribed to patients in the event of marked systemic manifestations or in the presence of indomitable vomiting, which impedes oral rehydration. This therapy is carried out with balanced polyionic crystalloid solutions, such as Trisol, Kvartasol, Chlosol and others. The volume of injected solutions and the rate of their introduction are determined by the degree of dehydration. In cases where patients with intoxication dominate the symptoms of dehydration, the introduction of colloidal solutions (hemodesis, reopolyglucin and others) is allowed.
Prevention of Adenoviral Enteritis
Prevention is to prevent the action of those factors that can cause adenoviral gastroenteritis.