Adenoviruses

Key Features

• Multiple syndromes, depending on the type of adenovirus

• Upper respiratory infections; most notable is severe pharyngitis with tonsillitis and cervical adenopathy

• Conjunctivitis

• Pneumonia

• Enteric adenoviruses cause mild diarrheal illnesses

• Definitive diagnosis by antigen detection, polymerase chain reaction (PCR), or culture

Clinical Findings

• Pharyngitis

  • Most common adenoviral disease

  • Fever and adenopathy are common

  • Tonsillitis may be exudative

  • Rhinitis and an influenza-like systemic illness may be present

  • Laryngotracheitis or bronchitis may accompany pharyngitis

• Pharyngoconjunctival fever

  • Conjunctivitis may occur alone and be prolonged

  • Most often associated with preauricular adenopathy, fever, pharyngitis, and cervical adenopathy

  • Foreign body sensation in the eye and other symptoms last less than a week

  • Lower respiratory symptoms are uncommon

• Epidemic keratoconjunctivitis

  • Severe conjunctivitis with punctate keratitis and occasionally visual impairment

  • A foreign body sensation, photophobia, and swelling of conjunctiva and eyelids are characteristic

  • Preauricular adenopathy and subconjunctival hemorrhage are common

• Pneumonia

  • May occur at all ages; it is especially common in children younger than age 3

  • Symptoms persist for 2–4 weeks

  • Can be necrotizing and cause permanent lung damage, such as bronchiectasis and bronchiolitis obliterans

  • A pertussis-like syndrome with typical cough and lymphocytosis can occur with lower respiratory tract infection

  • A new variant of adenovirus serotype 14 can cause unusually severe, sometimes fatal pneumonia in children and adults

• Rash

  • A diffuse morbilliform (rarely petechial) rash resembling measles, rubella, or roseola may be present

  • Koplik spots are absent

• Diarrhea

  • Enteric adenoviruses (types 40 and 41) cause 3–5% of cases of short-lived diarrhea in afebrile children, especially in those younger than 4 years old

• Mesenteric lymphadenitis

  • Fever and abdominal pain may mimic appendicitis

  • Pharyngitis is often associated

  • Adenovirus-induced adenopathy may be a factor in appendicitis and intussusception

• Other syndromes

  • Immunosuppressed patients, including neonates, may develop severe or fatal pulmonary or gastrointestinal infections or multisystem disease

  • Hemorrhagic cystitis can be a serious problem in immunocompromised children

  • Other rare complications that can occur in the immunocompetent child include

    • Encephalitis

    • Hepatitis

    • Myocarditis

  • Adenoviruses have been implicated in the syndrome of idiopathic myocardiopathy

Diagnosis

• Conventional culture of conjunctival, respiratory, or stool specimens can be done but several days to weeks are required

• Viral culture using the rapid culture technique with immunodiagnostic reagents detects adenovirus in 48 hours; however, this method is less sensitive than culture methods

• PCR is an important, relatively rapid and sensitive diagnostic method for adenovirus infections

• Enzyme-linked immunosorbent assay (ELISA) tests rapidly detect enteric adenoviruses in diarrheal specimens

• Chest radiographs show bilateral peribronchial and patchy ground-glass interstitial infiltrates in the lower lobes in patients with pneumonia

Treatment

• No specific treatment

• Intravenous immunoglobulin (IVIG) may be tried in immunocompromised patients with severe pneumonia