Lynch David T, Lott Lisa, Cebe Katherine, McDonald J Matthew, Abplanalp Allison, Tully Charla, Trujillo-Lopez Elizabeth, Danaher Patrick J
Department of Pathology, San Antonio Military Medical Center, 3851 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
Center for Advanced Molecular Detection, 2460 Pepperrell Street, JBSA Lackland, TX 78236.
Mil Med. 2017 May;182(5):e1765-e1768. doi: 10.7205/MILMED-D-16-00308.
Acute appendicitis (AA) is one of the most common causes of a surgical abdomen worldwide, occurring most frequently in those age 10 to 29 years. Adenovirus (ADV) is a rare but reported cause of AA in children and a well-recognized cause of intussusception in infants and young children. Annually, about 36,000 basic military trainees (BMTs) undergo initial training at Joint Base San Antonio Lackland, Texas. Before reintroduction of the ADV 4/7 vaccine in November 2011, one-third of BMTs developed an adenoviral upper respiratory tract infection (URI) during the 8.5 weeks of training. We hypothesized that ADV may be a common cause of AA in the BMT population given their young age and high incidence of adenoviral URIs. The objective of this study was to determine the frequency with which ADV, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and enterovirus were associated with AA in a population of young adults.
This study was a retrospective review of patient charts and existing pathological tissue specimens of all BMTs who underwent appendectomy at the Wilford Hall Medical Center from January 1, 2003, to August 31, 2011. Pathological tissue samples from 112 BMTs were assayed by quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC) for viral targets.
ADV DNA was detected in 16 of 112 samples (14%) via qPCR: ADV 4 in 13 cases, ADV B14 in 1 case, and nontypable ADV in 2 cases. IHC was positive in only the ADV B14 case (0.9%). All cases were negative for CMV, EBV, and enterovirus.
By using qPCR, this study demonstrated an association between ADV and AA higher than has been previously reported: ADV was detected in 14% of AA cases in this series versus in only 0.23% of AA cases in previous studies (p < 0.01). There was no evidence of CMV, EBV, or enterovirus association with AA in this study. Comparison of qPCR to IHC shows that histologic analysis may overlook evidence of ADV in appendiceal tissue: qPCR is significantly more sensitive than light microscopy and IHC for detecting ADV in this setting. Because ADV 4 was detected in 81% of those with positive qPCR, the recently licensed live oral ADV vaccine might be useful for primary prevention against AA. Prospective studies evaluating young adults presenting with AA for evidence of infection with ADV are needed to determine if a causal relationship exists.
急性阑尾炎（AA）是全球外科急腹症最常见的病因之一，最常发生于10至29岁人群。腺病毒（ADV）是儿童AA的一种罕见但有报道的病因，也是婴幼儿肠套叠的一个公认病因。每年，约36000名基础军事训练学员（BMT）在得克萨斯州圣安东尼奥-拉克兰联合基地接受初始训练。在2011年11月重新引入ADV 4/7疫苗之前，三分之一的BMT在8.5周的训练期间发生腺病毒上呼吸道感染（URI）。鉴于BMT年龄小且腺病毒URI发病率高，我们推测ADV可能是BMT人群中AA的常见病因。本研究的目的是确定在年轻成人人群中，ADV、巨细胞病毒（CMV）、爱泼斯坦-巴尔病毒（EBV）和肠道病毒与AA相关的频率。
本研究是对2003年1月1日至2011年8月31日在威尔福德·霍尔医疗中心接受阑尾切除术的所有BMT的患者病历和现有病理组织标本进行的回顾性研究。对112名BMT的病理组织样本进行定量聚合酶链反应（qPCR）和免疫组织化学（IHC）检测病毒靶点。
通过qPCR在112个样本中的16个（14%）检测到ADV DNA：13例为ADV 4，1例为ADV B14，2例为不可分型ADV。仅ADV B14病例的IHC呈阳性（0.9%）。所有病例的CMV、EBV和肠道病毒均为阴性。
通过使用qPCR，本研究显示ADV与AA之间的关联高于先前报道：本系列中14%的AA病例检测到ADV，而先前研究中AA病例仅0.23%检测到ADV（p<0.01）。本研究中没有证据表明CMV、EBV或肠道病毒与AA有关联。qPCR与IHC的比较表明，组织学分析可能会忽略阑尾组织中ADV的证据：在这种情况下，qPCR检测ADV比光学显微镜和IHC明显更敏感。由于qPCR阳性者中81%检测到ADV 4，最近获批的口服活ADV疫苗可能有助于AA的一级预防。需要进行前瞻性研究，评估出现AA的年轻成人是否有ADV感染的证据，以确定是否存在因果关系。
