title: Adenovirus type 21-associated acute flaccid paralysis during an outbreak of hand-foot-and-mouth disease in Sarawak, Malaysia.
abstract: 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.
authors.affiliation: Department of Paediatrics, Sibu Hospital, Sibu, Malaysia.
authors.forename: Mong How
authors.initials: MH
authors.lastname: Ooi
authors.forename: See Chang
authors.initials: SC
authors.lastname: Wong
authors.forename: Daniela
authors.initials: D
authors.lastname: Clear
authors.forename: David
authors.initials: D
authors.lastname: Perera
authors.forename: Shekhar
authors.initials: S
authors.lastname: Krishnan
authors.forename: Teresa
authors.initials: T
authors.lastname: Preston
authors.forename: Phaik Hooi
authors.initials: PH
authors.lastname: Tio
authors.forename: Hugh J
authors.initials: HJ
authors.lastname: Willison
authors.forename: Brian
authors.initials: B
authors.lastname: Tedman
authors.forename: Rachel
authors.initials: R
authors.lastname: Kneen
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Cardosa
authors.forename: Tom
authors.initials: T
authors.lastname: Solomon
mesh_terms: D000208:Acute Disease; D000256:Adenoviridae / Q000145:classification / Q000276:immunology / Q000302:isolation & purification*; D000257:Adenoviridae Infections / Q000150:complications* / Q000276:immunology / Q000821:virology; D004196:Disease Outbreaks; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D010264:Paraplegia / Q000150:complications / Q000276:immunology / Q000821:virology*