Adenovirus type 21-associated acute flaccid paralysis during an outbreak of hand-foot-and-mouth disease in Sarawak, Malaysia
Adenovirus type 21-associated acute flaccid paralysis during an outbreak of hand-foot-and-mouth disease in Sarawak, Malaysia
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DOI：
10.1086/367648
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发表时间：
2003-03-01
影响因子：
11.8
通讯作者：
Solomon, T
中科院分区：
文献类型：
--
作者：
Ooi, MH;Wong, SC;Solomon, T
我们报告了1997年马来西亚沙捞越市肠道病毒71型（EV71）相关手足口病（HFMD）流行期间8例腺病毒相关急性弛缓性麻痹（AFP）患儿的病毒学和临床特征。中和试验和系统发育分析显示腺病毒21型（Ad21），尽管DNA限制性内切酶表明该病毒与原型Ad21不同。4名儿童上肢单轻瘫，2名下肢单轻瘫（其中1名在磁共振成像上观察到脊髓前部变化），2名为弛缓性轻瘫。在随访中，4名儿童已完全康复，3名儿童有残留的弛缓性无力和消瘦。神经生理学检查显示运动和感觉神经轴突和脱髓鞘特征的混合物，伴有去神经支配。这些结果表明，Ad21可能通过前角细胞损伤或臂丛或腰骶丛神经病变引起AFP。在EV71相关的手足口病爆发期间发生这些不寻常的腺病毒感染表明这两种病毒之间可能发生了相互作用。
We report the virological and clinical features of 8 children who presented with adenovirus-associated acute flaccid paralysis (AFP) during an epidemic of enterovirus type 71 (EV71)-associated hand-foot-and-mouth disease (HFMD) in Sarawak, Malaysia, in 1997. Neutralization tests and phylogenetic analysis revealed adenovirus type 21 (Ad21), although DNA restriction digests suggested that this virus was different from the prototype Ad21. Four children had upper-limb monoparesis, 2 had lower-limb monoparesis (one of whom had changes in the anterior spinal cord noted on magnetic resonance imaging), and 2 had flaccid paraparesis. At follow-up, 4 children were noted to have made full recoveries and 3 had residual flaccid weakness and wasting. Neurophysiological investigation revealed a mixture of axonal and demyelinating features in motor and sensory nerves, with denervation. These findings suggest that Ad21 might cause AFP by anterior horn cell damage or neuropathy of the brachial or lumbosacral plexus. The occurrence of these unusual adenovirus infections during an outbreak of EV71-associated HFMD suggests that an interaction between the 2 viruses may have occurred.