key: cord-0009105-r27reds5
authors: Muzzi, A.; Rocchi, G.; Lumbroso, B.; Tosato, G.; Barbieri, F.
title: Acute hæmorrhagic conjunctivitis during an epidemic outbreak of adenovirus-type-4 infection
date: 1975-10-25
journal: Lancet
DOI: 10.1016/s0140-6736(75)80061-4
sha: 5e530942f430d7bbc8e3686fa4b6755d14988763
doc_id: 9105
cord_uid: r27reds5

nan

SIR,-Dr Phillips and Dr Pain (Sept. 6, p. 455) have drawn attention to the fact that in the calculation of urinary osmolality (Aug. 9, p. 245, table II) we have forgotten the anions. This we regret very much. If this correction is made then the supposed urinary osmolality in beer drinkers would be approximately 40 mosmol at diureses of about 5 litres.

Dr Phillips and Dr Pain remark that in 2 patients we found urinary osmolality of 69 and 79 mosmo!. However, these urine collections began on the first or second dayjafter admission and thus the patients had already been eating normal. food.

They also suggest that our low serum-sodium values could be misleading because ofhyperlipidremia. This was excluded in 2 of our patients. Furthermore, it must be a very heavy hyperlipidremia to cause "pseudohyponatnemia" to the extent that we found.

Dr Phillips and Dr Pain think that inappropriate secretion of antidiuretic hormone is not excluded. To this, we can say that in 2 of our patients we measured plasma-volume and found it slightly reduced.

We wish to thank Professor Demanet (Sept. 6, p. 455) and Dr Banks and Dr Lecky (Sept. 20, p. 559) for their comments.

CORONAVIRUS AND GASTROENTERITIS IN FOALS SIR,-In an editorial 1 you suggested that coronavirus was involved in human gastroenteritis. We later reported that calf-diarrhcea coronavirus serologically cross-reacted with antibodies in human sera.' The existence of an enteric coronavirus in man is supported by electron microscopic observation of such particles in frecal specimens from an outbreak of human gastroenteritis. 3 We should like to expand the list of species in which coronavirus may cause gastroenteritis. Feecal specimens from three foals that died or were killed in the acute stage of disease were examined by electron microscopy. All three foals were found to contain typical coronavirus particles.

The three specimens originated from an endemic area in the U.S. where 40 or more cases of foal diarrhoea have recently been reported. The disease is characterised by profuse watery diarrheea, fever, extensive lymphatic involvement, and a high rate of mortality despite treatment.

We have also tested 65 equine sera for serum-neutralising antibody against calf-diarrheea coronavirus. Titres ranged from nil to greater than 181. We believe these serological data support our electron microscopic observation of virus particles from foals, suggesting the existence of an enteric coronavirus for the horse in addition to man, swine, and calves (calf-diarrhoea agent). ation. The patients, of different classes and nationalities, were unanimous in welcoming the pamphlet and difficulties or omissions which they raised were taken into account in the next revision. Working-class women certainly understood it and did not appear to find any undue problems.

With regard to the assumptions about the behaviour of friends and relatives, gynaecologists and obstetricians, in the course of clinical work, are repeatedly made aware of the fact that patients do receive inaccurate and misleading information in this way. However, confirmation was provided by patients who, after reading it spontaneously and specifically, welcomed the pamphlet, among other reasons, because it avoided this particular problem. We should add that we found that the pamphlets were borrowed and read by other patients in the ward and many of those admitted for hysterectomy under other firms complained that they had not received copies. We have accumulated considerable information from our interviews which we intend to publish and our study continues. LATE NEOPLASIA AFTER POLIOMYELITIS SIR,-We report here two cases of spinal-cord tumours 30 years after childhood poliomyelitis. A 34-year-old woman at the age of 4 had had poliomyelitis affecting the lower limbs. Thirty years later she had a retroperitoneal neurogenic (Schwarm cell) sarcoma excised. She died shortly thereafter; necropsy was not performed. In the second patient, a 52-year-old woman, poliomyelitis occurred at age 4 with subsequent partial paralysis of the lower lim~s. At the age of 30 she experienced sudden onset of paraplegia, and at operation a meningioma at DI0 level was removed. The motor paralysis remained but sensation and sphincter control returned to normal.

No published reports have been found relating poliomyelitis to tumours. In studies showing the late progression of poliomyelitis, Mulder et al.! and Andersen et. al. 2 showed an association between poliomyelitis and late onset of neurological and functional changes (amyotrophiclateral-sclerosis-like picture). Kayser-Gotchalin 3 reported late muscle atrophy many years after poliomyelitis. Many publications refer to the late picture as "A.L.S." rather than poliomyelitis. It is difficult to conceive of tumours causing a poliomyelitis-like picture thirty years before their detection, although spinal-cord tumours have been reported after aseptic meningitis. 4 • Hopkins and Shield 5 described immunological aspects of poliomyelitis. In children with bronchial asthma, a picture of poliomyelitis has appeared after an acute attack of asthma; the neurological picture here could b~due to a hypersensitivity to drugs, for no pathogen was Isolated. Pietsch and Morris • found an association between HL-A (especially HL-A 3 and 7) and poliomyelitis: "this association might represent an association between HL-A and immune response gene determining an immune response to the virus or a product of viral infection of the central nervous system." Such an association was found in multiple sclerosis, and perhaps the retiology is similar. The possibility of an immune response to poliovirus, with a neoplastic reaction many years after infection, must be considered.

Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel.

infection in the metropolitan area of Rome (see figure) appear to characterise this adenovirus-type-4 epidemic. The outbreak lasted for three months, only adult cases were found to be affected, and the epidemiological survey failed to demonstrate the usual sources of adenoviral contagion (i.e., iatrogenic transmission, commu~i:y living and/or work, swimming-pools, &c.) as the origm of the cases studied. The results obtained in the A.H.C. cases studied are summarised in the accompanying table. These data prove that A.H.C. can be caused not only by an enterovirus 4 but occasionally by an adenovirus.

. The relevant incidence of conjunctival hsemorrhagic manifestation as well as the widespread diffusion of the

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