Adenovirus Infections

KEY FEATURES

• At least 88 serotypes, which produce a variety of clinical syndromes

• Usually self-limited or clinically inapparent except in immunosuppressed persons

CLINICAL FINDINGS

• Common cold

• Nonstreptococcal exudative pharyngitis

• Lower respiratory tract infections

• Pharyngoconjunctival fever

• Epidemic keratoconjunctivitis

• Hemorrhagic cystitis

• Sexually transmitted genitourinary ulcers and urethritis

• Acute gastroenteritis, mesenteric adenitis, acute appendicitis, rhabdomyolysis, and intussusception

• Rarely associated with encephalitis, meningitis, cerebellitis, acute respiratory distress syndrome, acute flaccid myelitis, and pericarditis

• Disseminated disease in transplant recipients

DIAGNOSIS

• Viral culture is considered the standard

• Quantitative real-time rapid-cycle polymerase chain reaction (PCR) useful in distinguishing disease from colonization, especially in patients who have received hematopoietic stem cell transplants

• 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

• Treatment is symptomatic

• 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

  • Lipid-conjugated prodrug of cidofovir

  • Has better oral bioavailability, is better tolerated, and achieves higher intracellular concentrations of active drug than cidofovir

  • Only available through compassionate use policies

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

• Topical steroids or tacrolimus may be used to treat adenoviral keratoconjunctivitis

• 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

• Vaccines are not available for general use