Background: Adenovirus is a common pediatric pathogen responsible for a wide variety of infections. Although a bacterial super infection in viral diseases is a well-documented phenomenon, secondary bacteremia following an adenovirus infection has not been previously described.
Methods: The clinical and microbiological data of all children who tested positive for adenovirus and were hospitalized in our center between October 2006 and April 2013, were retrospectively reviewed. Inclusion criteria included: 1) clinical manifestations compatible with an adenovirus infection on admission; 2) a positive result for adenovirus found in the stool, pharynx or eye on admission; 3) a positive blood culture with pathogenic bacteria ≥ 2 days after adenovirus disease onset.
Results: During the 8 year study period, 429 children were hospitalized in our center with an adenovirus infection. Bacteremia was diagnosed in 7 (1.6%) children, most (6/7) were previously healthy. Three children presented with bacteremia already on admission, while in 4 patients there was a clinical deterioration which led to blood culture obtaining and diagnosis of a secondary bacteremia. In 5 children with adenoviral gastroenteritis the bacteria isolated from the blood were all enteric bacteria. Similarly, in the two patients with respiratory symptoms, the isolated bacteria were known colonizers of the respiratory tract. All seven children fully recovered without complications.
Conclusions: Secondary bacteremia is a rare complication of adenovirus infection in children. However, pediatricians should be aware that in cases of a severe or deteriorating clinical condition in children with adenoviral infection, obtaining a blood culture and initiating empiric antibiotic treatment may be prudent.
