Journal Article

Adenovirus Type 21—Associated Acute Flaccid Paralysis during an Outbreak of Hand-Foot-and-Mouth Disease in Sarawak, Malaysia

Mong How Ooi, See Chang Wong, Daniela Clear, David Perera, Shekhar Krishnan, Teresa Preston, Phaik Hooi Tio, Hugh J. Willison, Brian Tedman, Rachel Kneen, Mary Jane Cardosa and Tom Solomon

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 36, issue 5, pages 550-559
Published in print March 2003 | ISSN: 1058-4838
Published online March 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/367648
Adenovirus Type 21—Associated Acute Flaccid Paralysis during an Outbreak of Hand-Foot-and-Mouth Disease in Sarawak, Malaysia

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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.

Journal Article.  5194 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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