Göran Sterner

On the occurrence of adenoviruses in Sweden.

I n the course of a study of some 800 stool specimens obtained in Stockholm during the epidemic of poliomyelitis in 1953 (21) five strains of adenoviruses were encountered. Similar agents were recovered from the stools of three patients with the diagnosis o€ mesenteric lymphadenitis. I n one of these cases the virus was also isolated from a mesenteric lymph node. The results of a detailed study of these first Swedish strains of adenoviruses have been reported previously (13). It was thus found that all strains shared complement fixing antigens with each other as well as with the agent RI-67 isolated by Hilleman & Werner (10) and with the Sutherland strain isolated by Neva & Enders (17). By neutralization tests on the other hand, the strains were separated into three groups. Other studies in the laboratory of Huebner (1 1) have established that these types of viruses can be classified together with agents isolated by them from various sources. The first report on such viruses thus seems to be that of Rowe and coworkers (19) on agents recovered from human adenoids. Various names for this virus group have been used by different authors, including APC (adenoidal-pharyngeal-conjunctival, (1 1) ), R I (respiratory illness, (10) ), and ARD (acute respiratory disease, ( 7 ) ) viruses. Recently the term Adenoviruses was agreed upon (5). Seventeen serologically distinct types of adenoviruses have so far been reported (18). By epidemiological, clinical and laboratory studies some types have, more or less definitely, been etiologically correlated to syndromes of human disease, such as various types of respiratory illnesses (10, 2, 7 , 3, 4) and kerato-conjunctivitis (12). The present paper is a report on the various strains of adenoviruses isolated in Sweden since 1953. Extensive data mll be given only in those cases where type 7 virus was isolated. The outbreaks of type 3 adenovirus

Respiratory Syncytial Virus An Outbreak of Acute Respiratory Illnesses in a Home for Infants

A report is given of an outbreak of acute respiratory illness in a home for infants in Stockholm. Respiratory syncytial (RX) virus was recovered from nasopharyngeal and/or throat swabs from 13 out of 15 infants (1–13 months old). Complement fixation (CF) tests against RS antigen showed at least 4‐fold rises of antibody titre in 7 out of 15 paired sera, including sera from two infants, from whom no virus was isolated. There was no rise in CF antibody titre against adenovirus, influenza A and B, parainfluenza 1, 2 and 3, mumps or herpes simplex antigens. RS virus was recovered 2 days before the onset of illness as well as 9 days afterwards. The incubation period was estimated to be from 3 to 5 days.

Acute Respiratory Illness and Gastroenteritis in Association with Adenovirus Type 7 Infections1

Summary During an epidemic in Stockholm in the autumn of 1959 adenovirus type 7 was isolated from 99 hospitalized children. There was serological evidence of acute gdenovirus infection in 75 cases. The virus strains could not be referred to types 7 or 7A according to the scheme of Rowe et al., since no definite differences between the prototypes for these strains could be demonstrated by cross-neutralization tests. In addition to the symptoms of acute respiratory illness observed previously in such infections, many of the patients exhibited symptoms of gastroenteritis, for which no other cause could be established.

INCREASING METABOLIC ACIDOSIS FOLLOWING FRUCTOSE INFUSION IN TWO CHILDREN

Two children with metabolic acidosis received fructose infusion in accordance with the standard treatment at the time. During the infusion, both pH and bicarbonate decreased in spite of the administration of large doses of bicarbonate. When the fructose infusion was reduced or withdrawn, pH and bicarbonate increased. However, the extreme acidosis (pH 6.6) during fructose infusion in one of the children had probably caused irreversible cell injuries which might have been the main reason for the death in this patient. The other child survived probably because the fructose infusion was interrupted in time. We accordingly recommend that fructose infusions should not be given to patients in whom there is a risk of acidosis and tissue hypoxia.

Acute Respiratory Illness in Children: A Combined Bacteriological and Virological Study

In some studies of recent years materials of acute respiratory disease in children have been analyzed with respect to the incidences of several types of respiratory virus and antibodies against these agents [l, 2 , 3, 191. As a growing number of virus types able to cause respiratory disease have been found, increasing proportions of these materials have been shown to harbour and react immunologically against such agents. The incidence of potentially pathogenic bacteria has also been investigated in the same groups, but the frequencies found have generally not differed from those observed in so-called normal materials [l, 2,3,7]. The primary or secondary aetiological significance of bacteria thus has not been possible to evaluate with any degree of safety. Groups of children with oto-rhinological infections have been studied sero-bacteriologically by Tunevall [15] in an attempt to state the part played by bacteria in such conditions, but no virological examination of these groups was done. The same methods were applied by Philipson to materials of non-diphtheritic croup in a combined virological and bacteriological study [9, lo]. The present study aims a t elucidating, by means of serological methods, the incidence of acute bacterial infection in a group of children with respiratory infections previously analyzed virologically, chiefly for adenovirus infections.

Acute Respiratory Illness with Mycoplasma Pneumoniae An Outbreak in a Home for Children

An outbreak of acute respiratory illness, in a few cases combined with primary atypical pneumonia (P.A.P.), occurred in August‐October 1964 in a home for children in Stockholm. Seventeen out of 22 children (age 1–12 years) fell ill during the observation period, four of them twice.

ACUTE RESPIRATORY ILLNESS IN CHILDREN. A SEROLOGICAL STUDY WITH VIRAL AND BACTERIAL ANTIGENS.

I n a previous study in Stockholm of acute respiratory illness in children, a probable etiology (virus and/or bacteria) could bc demonstrated in one-third of the cases a t that time [18]. However, tests for infections with ~xwainfluenza and respiratory syncytial (RS) viruses Here not included. Information on such virus infections in Swedish children is hitherto lacking. Investigations from other countries have shown tha t these groups of viruses cause a great deal of acute respiratory tract diseases in childhood [2-4, 7 , 8) .

Antibodies Against Respiratory Viruses Among Healthy Children

In recent years many viruses have been adtled to t h e list of agents causing acute respiratory illnebs in man. In Sweden the occurrence of adenovirus infections among children has been studied since 1954 [15]. but data on the frequency of infections with more recently detected viruses such as the parainfluenza and the respiratory syncytial (Its) viruses not t o mention the rhino-coryza group have hitherto been scarce in our country. This paper concerns a survey of the incidence of complement fixing (CF) antibodies against parainfluenza viruses 1, 2 and 3 and respiratory syncytial virus as well as antibodies against the group antigens of influenza A and B and adenoviruses in healthy children. Mumps was also included since cross reactions between th is virus and the parainfluenza group have been reported [l, 9. 111.

Adenovirus neutralizing antibodies in Swedish children.

Adenoviruses have been divided into endemic and epidemic types. The former include types 1, 2 and 5 which have been isolated from children chiefly in the first years of life [2, 61. Among Swedish children hospitalized for acute respiratory illness a peak incidence of some 10 ”/o for these types of adenovirus was reached between 6 months and 1 year of age [la]. These infections were scattered throughout the year. Types 3 and 7, on the other hand, have mainly been discovered in epidemic outbreaks of acute respiratory illness, often associated with gastroenteritis [l, 5, 7 , 8, 111. On such occasions infections were common in higher age groups. Against this background, it was considered to be of interest to survey the occurrence of neutralizing antibodies to types 1, 2 , 3, 5 and 7 in sera from Swedish children free from signs of infectious tlisease.

The Occurrence of Adenovirus in Hospitalized Swedish Children1

In an earlier study the occurrence of adenoviruses in Sweden during 1953-1957 was reported [13]. Adenovirus type 3 was recovered in 1955 during an outbreak of respiratory illnesses in association with gastroenteritis [la]. Since that time epidemics of similar diseases caused by adenovirus type 7 have occurred in Sweden [ll, 201. Among the childrcn with respiratory illness a few infections with adenovirus types 1, 2 or 5 were found [13, 19, 201. These patients were generally younger than 3 years of age. Because of the few and scattered cases i t was not possible to draw any aetiological conclusions. In the present study we have intended to gain further information on the spread of adenoviruses among children. For this purpose stool specimens of children admitted to the Children’s Hospital in Malmo, Sweden during the course of one year were tested in tissue culture of HeLa cells. Other cytopathic agents than adenovirns isolated during the study have naturally been included.