Adenovirus Infections

Key Features

• At least 57 types, which produce a variety of clinical syndromes

• Usually self-limited except in immunosuppressed persons

Clinical Findings

• Common cold

• Nonstreptococcal exudative pharyngitis

• Lower respiratory tract infections

• Epidemic keratoconjunctivitis

• Hemorrhagic cystitis

• Acute gastroenteritis

• Disseminated disease in transplant recipients

Diagnosis

• Can be cultured from appropriate specimens when definitive diagnosis is desired

• Quantitative real-time rapid-cycle PCR useful in distinguishing disease from colonization, especially in hematopoietic stem cell transplant patients

• Multiplex nucleic acid amplification assays can test for multiple respiratory viruses simultaneously with increased sensitivity

• Appears as a multifocal consolidation or ground-glass opacity without airway inflammatory findings on chest CT imaging

Treatment

• Disease usually self-limited

• Immunocompromised patients often treated with ribavirin or cidofovir, with occasional success

  • Cidofovir is attendant with significant renal toxicity and reduction in doses of immunosuppressive agents is often required

• Brincidofovir, a nucleoside analog

  • Appears to be useful in patients infected after stem cell transplantation

  • Only available through compassionate use policies

• Epidemic adenoviral conjunctivitis is often difficult to control and requires

  • Meticulous attention to hand hygiene

  • Use of disposable gloves

  • Sterilization of equipment (isopropyl alcohol is insufficient, recommendations of manufacturers are preferred)

  • Cohorting of cases

  • Furloughing of employees

  • A combination of povidone-iodine 1.0% eyedrops and dexamethasone 0.1% eyedrops four times a day can reduce symptoms and expedite recovery

• Intravenous immunoglobulin (IVIG) is used in immunocompromised persons but data are still limited