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Adenovirus Infection

Adenovirus infection encompasses an array of clinical syndromes that can be caused by adenoviruses, ranging from benign and self-limiting upper respiratory illness to life-threatening conjunctival infection in neonates, hemorrhagic cystitis and severe disseminated infection of various tissues. Microbiological testing is pivotal in order to make the diagnosis, primarily through methods that are able to detect viral deoxyribonucleic acid (DNA) in patient samples.


Presentation

Adenoviruses, belonging to the group of double-stranded positive (+) sense DNA viruses, are a large group of pathogens responsible for numerous types of human disease [1] [2]. They are divided into six subgroups (A, B, C, D, E, and F) and more than 60 different serotypes have been described in the literature [1] [2] [3]. Common modes of transmission include the fecal-oral, direct contact with infected secretions, and respiratory spread, suggesting that the virus is able to cause local outbreaks [3] [4]. As the pediatric population is the age group where adenovirus infections are most prevalent, kindergartens, summer or college camps and schools are the main sites of outbreaks [5]. In addition, hospital-based (nosocomial) and severe, sometimes even life-threatening outbreaks have known to occur [3]. Adenovirus infection is seen across all ages and gender, although immunocompromised hosts seem to be at an increased risk compared to the immunocompetent [1]. The clinical presentation of adenovirus infection depends on the organ or tissue affected. Keratoconjunctivitis ( the principal form of the disease that causes outbreaks) manifests with fever, vomiting, diarrhea, muscle pain and malaise, usually after an incubation period of 1-14 days, whereas rhinitis, fever, and cervical lymphadenopathy are typical for pharyngoconjunctival fever (PCF) [5]. Other notable infections caused by adenovirus are those of the respiratory tract (both lower and upper), gastroenteritis, central nervous system infection (CNS), and hemorrhagic cystitis [1]. Neonatal adenovirus infection, despite being rare, is a frequently fatal disease characterized by severe forms of conjunctivitis (as a result of viral transmission from the mother), cyanosis, respiratory failure, fever and a rash in neonates [6].

Fever
  • The elder brother developed a high fever and was diagnosed with HAdV infection with an immunochromatographic kit for HAdV (IC-kit). He was transferred to our institute after persistent fever for 7 days.[ncbi.nlm.nih.gov]
  • […] typical for pharyngoconjunctival fever (PCF).[symptoma.com]
  • Abstract Three children in Bangladesh who presented with diarrhoea, cough, dyspnoea, fever, and signs of malnutrition and died in the hospital were shown at post-mortem examination to have both adenovirus infection of the intestine (by immunofluorescence[ncbi.nlm.nih.gov]
  • Pharyngoconjunctival fever is a specific presentation of adenovirus infection, manifested as: high fever that lasts 4–5 days pharyngitis (sore throat) conjunctivitis (inflamed eyes, usually without pus formation like pink eye) enlargement of the lymph[en.wikipedia.org]
  • Bring down a fever . Ask your doctor if you can give your child acetaminophen ( Tylenol ) or ibuprofen ( Motrin ) to relieve aches and fever.[webmd.com]
Lymphadenopathy
  • Keratoconjunctivitis ( the principal form of the disease that causes outbreaks) manifests with fever, vomiting, diarrhea, muscle pain and malaise, usually after an incubation period of 1-14 days, whereas rhinitis, fever, and cervical lymphadenopathy are[symptoma.com]
  • HAdV infection also shows KD-like symptoms such as conjunctival injection, red cracked lips, and cervical lymphadenopathy. However, skin erythema and swollen red palms and soles followed by desquamation are distinctive features of KD.[ped-rheum.biomedcentral.com]
  • Figure 4: Lymphadenopathy. A large pre-auricular node can be palpated and visible on examination by studying the shadowing and elevation of the skin.[eyerounds.org]
  • Children may have fever and lymphadenopathy. Malaise and headache are reported. Inflammation may persist for weeks, and residual scarring and visual impairment may occur.[emedicine.medscape.com]
Malaise
  • Keratoconjunctivitis ( the principal form of the disease that causes outbreaks) manifests with fever, vomiting, diarrhea, muscle pain and malaise, usually after an incubation period of 1-14 days, whereas rhinitis, fever, and cervical lymphadenopathy are[symptoma.com]
  • […] a specific presentation of adenovirus infection, manifested as: high fever that lasts 4–5 days pharyngitis (sore throat) conjunctivitis (inflamed eyes, usually without pus formation like pink eye) enlargement of the lymph nodes of the neck headache, malaise[en.wikipedia.org]
  • […] involvement) Physical Exam Fever Tonsillar erythema/exudate Cervical lymphadenopathy Otitis media Conjunctivitis Differential Diagnosis Characteristics of adenovirus infections: Acute respiratory illness Mostly in children Incubation period: 2 to 5 days Malaise[unboundmedicine.com]
  • Malaise and headache are reported. Inflammation may persist for weeks, and residual scarring and visual impairment may occur.[emedicine.medscape.com]
Cough
  • Abstract Three children in Bangladesh who presented with diarrhoea, cough, dyspnoea, fever, and signs of malnutrition and died in the hospital were shown at post-mortem examination to have both adenovirus infection of the intestine (by immunofluorescence[ncbi.nlm.nih.gov]
  • Fever Dehydration Cough with expectoration.[epainassist.com]
  • Continued Symptoms Each type of adenovirus can affect you differently: Bronchitis : Cough , runny nose , fever, chills Colds and other respiratory infections : Stuffy and runny nose, cough, sore throat , and swollen glands Crou p: Barking cough, trouble[webmd.com]
  • Adenovirus can cause a cough that sounds like whooping cough (pertussis) . Gastroenteritis is an infection of the stomach and intestines. Symptoms include diarrhea, vomiting, belly pain, and fever.[kidshealth.org]
Common Cold
  • Adenoviruses are a group of viruses that cause respiratory (breathing) illnesses, such as a common cold , conjunctivitis (an infection in the eye), croup , bronchitis , bronchiolitis (inflammation of the lower airways) and pneumonia .[childrenshospital.org]
  • They most commonly cause upper respiratory tract infections, including the common cold , sore throats, tonsillitis , ear infections, and conjunctivitis .[drgreene.com]
  • Adenoviruses can cause a wide range of illnesses such as Common cold Sore throat Bronchitis (a condition that occurs when the airways in the lungs become filled with mucus and may spasm, which causes a person to cough and have shortness of breath) Pneumonia[cdc.gov]
  • In the upper respiratory tract there is frequent involvement of the regional lymph nodes , bearing considerable resemblance to the common cold . Lower respiratory infection occasionally results in pneumonia .[britannica.com]
Throat Irritation
  • Adenovirus 14 infections usually begin with cold symptoms such as: a cough , runny nose, and mild fever and possibly throat irritation.[medicinenet.com]
Dry Cough
  • cough Fever lasting 2 to 4 days Illness subsiding in 10 to 14 days DDx: rhinovirus, influenza, parainfluenza, RSV Viral pneumonia Sudden onset of high fever, rapid infection of upper and lower respiratory tracts, skin rash, diarrhea Occurs mostly in[unboundmedicine.com]
Severe Clinical Course
  • RESULTS: Ad-7 was associated with the most severe clinical course and resultant long-term pulmonary sequelae, followed by milder clinical course and lower frequency of sequelae in Ad-3 cases, and even milder outcomes in children infected with Ad-5.[ncbi.nlm.nih.gov]
Diarrhea
  • Enteric viral infectious should be considered in solid organ transplant recipients with chronic diarrhea.[ncbi.nlm.nih.gov]
  • Abstract Intractable diarrhea in a 40-year-old woman with terminal acquired immunodeficiency syndrome resulted from adenovirus infection of the duodenal mucosa.[ncbi.nlm.nih.gov]
  • The main clinical symptom presented by infected patients was diarrhea, and Graft-versus-host disease (GVHD) was the main intercurrence. An association was observed between HAdV-positivity and diarrhea and also between HAdV-positivity and GVHD.[ncbi.nlm.nih.gov]
  • We report an infant with acute lymphoblastic leukemia who developed disseminated adenovirus infection while lymphopenic during maintenance chemotherapy 6 months following a bout of adenoviral diarrhea.[ncbi.nlm.nih.gov]
  • You can buy medicines at the drugstore that can help stop or slow diarrhea. Do not use these medicines without talking to your provider if you have bloody diarrhea, a fever, or if the diarrhea is severe. Do not give these medicines to children.[mountsinai.org]
Exudative Pharyngitis
  • Health Hazard: PATHOGENICITY: Varies in clinical manifestation and severity; symptoms include fever, rhinitis, pharyngitis, tonsillitis, cough and conjunctivitis; common cause of nonstreptococcal exudative pharyngitis among children under 3 years; more[viracore.ucsf.edu]
Myopathy
  • Viral-induced myopathy should be suspected in patients who present with rhabdomyolysis.[ncbi.nlm.nih.gov]
Visual Hallucination
  • The most frequently cited CNS symptoms were seizure (64%), altered state of consciousness (13%), visual hallucination (9.3%) and lethargy (7.5%).[ncbi.nlm.nih.gov]
Headache
  • Conjunctival redness and edema Photophobia and blurry vision Swelling of eyelids Foreign body sensation within eye Symptoms of Meningitis and Encephalitis High Fever Stiff neck Headache Seizures Confusion and Sleepiness Nausea and Vomiting Skin Rash[epainassist.com]
  • , fever, stomach cramps Swelling of the brain and spinal cord ( meningitis and encephalitis ): Headache , fever, stiff neck, nausea , and vomiting (this is rare) Urinary tract infections: Burning and pain while urinating, frequent need to go, blood in[webmd.com]
  • […] throat pharyngitis runny nose rhonchi & rales nasal congestion swollen lymph nodes dry, harsh cough sounds like pertussis cough If adenovirus causes an infection in your gastrointestinal tract, then inflammation and symptoms might involve: fever vomiting headache[healthblurbs.com]
  • While each child may experience symptoms differently, the most common include: Respiratory infections runny nose sore throat fever severe cough swollen lymph nodes headache feeling of uneasiness non-productive "croupy" cough Intestinal tract infections[childrenshospital.org]
  • […] fever is a specific presentation of adenovirus infection, manifested as: high fever that lasts 4–5 days pharyngitis (sore throat) conjunctivitis (inflamed eyes, usually without pus formation like pink eye) enlargement of the lymph nodes of the neck headache[en.wikipedia.org]

Workup

Despite the nonspecific signs and symptoms of an adenovirus infection, the physician must perform a thorough physical examination and obtain a detailed patient history. Patients (or parents of the infected children) should be asked about similar symptoms in people with whom they were in contact (schools, kindergartens, camps, other crowded areas), as it may provide valuable clues toward the diagnosis. To confirm adenovirus infection, a comprehensive microbiological investigation is necessary. It must be pointed out that detection of adenoviruses readily occurs in asymptomatic individuals, and thus the term adenovirus infection does not always imply to a disease state [3]. In the presence of symptoms, however, the identification of this virus is highly suggestive that it is responsible for their onset. Direct methods in the form of isolation of virus in cultures or antigen/viral DNA detection from patient samples are recommended diagnostic tests, but since up to 3 weeks are necessary for viral cultures to yield conclusive results, the focus of diagnostics is turned to the latter method [1] [3]. Polymerase chain reaction (PCR) is the gold standard for both screening and diagnostic purposes [1] [3]. Based on the clinical and microbiological criteria, an adenovirus infection may be probable (absence of histologic criteria in the presence of typical symptoms) or proven (both microbiological and corresponding clinical confirmation), which can be further divided into local (when the virus is isolated from local specimens and not peripheral blood) or systemic (detection of virus in peripheral blood along with clinical manifestation) [2].

Hepatic Necrosis
  • Herein we report three patients with AIDS and fatally disseminated adenovirus infection with hepatic necrosis.[ncbi.nlm.nih.gov]
  • Abstract This is an unusual case of fatal hepatic necrosis caused by disseminated type 5 adenovirus in a renal transplant recipient. This adult patient may have been colonized at the time of transplantation with a kidney from a pediatric donor.[ncbi.nlm.nih.gov]

Treatment

  • The optimal surveillance and treatment strategies are under discussion.[ncbi.nlm.nih.gov]
  • Three died on treatment. CONCLUSIONS: Disseminated adenovirus infection is uncommon in adult transplant patients and uncertainties remain surrounding effective treatment.[ncbi.nlm.nih.gov]
  • Despite prompt treatment with cidofovir, his respiratory function continued to deteriorate over the next two weeks and he was moved to intensive care. Intravenous immunoglobulin and ribavirin were subsequently added to his treatment.[ncbi.nlm.nih.gov]
  • Early identification and treatment are necessary to improve patient outcomes and prevent the spread of infection to other neonates.[ncbi.nlm.nih.gov]
  • There is uncertainty regarding monitoring and treatment of this virus. Although not supported by randomized clinical trials, cidofovir is used for the treatment of adenovirus disease not responding to reduction of immunosuppression.[ncbi.nlm.nih.gov]

Prognosis

  • There are several reports of adenovirus infections in adult solid organ transplant recipients and the prognosis is usually poor, with mortality rates of 40% to 60%.[ncbi.nlm.nih.gov]
  • The main objective of this study was to prospectively monitor ASCT recipients for HAdV occurrence in a reference center in Brazil, and also to correlate viral positivity, viral load, molecular variant, clinical symptoms, and patients' prognosis.[ncbi.nlm.nih.gov]
  • The prognosis declines as the severity of disease increases.[medicinenet.com]
  • ADENOVIRUSES have been isolated from symptomless infants and children as well as from patients with mild febrile inflammatory processes involving the conjunctivas, upper respiratory tract, lungs and intestine. 1 In general, the prognosis at all ages is[nejm.org]

Etiology

  • CONCLUSIONS: Adenovirus detection should be included in the diagnostic testing to determine the infectious etiology of fever and/or respiratory symptoms in SLE patients. Copyright 2010. Published by Elsevier B.V.[ncbi.nlm.nih.gov]
  • Publication type, MeSH terms, Substances Publication type Case Reports MeSH terms Adenovirus Infections, Human/diagnosis Adenovirus Infections, Human/drug therapy* Adenovirus Infections, Human/etiology Adult Antiviral Agents/therapeutic use* Drug Therapy[ncbi.nlm.nih.gov]
  • Human adenoviruses comprise an important group of etiologic agents that are responsible for various diseases in adults and children, such as respiratory, ocular, gastroenteric, and urinary infections.[ncbi.nlm.nih.gov]
  • BACKGROUND: The etiology of Kawasaki disease (KD) remains unknown. However, many studies have suggested that specific genetic factors and/or some infectious agents underlie the onset of KD.[ncbi.nlm.nih.gov]
  • Salivirus/klassevirus was first identified as an etiologic agent of gastroenteritis and was never reported in respiratory infection cases.[ncbi.nlm.nih.gov]

Epidemiology

  • Bulletin Archive Contact Us Laurie Forlano, DO, MPH, State Epidemiologist Director, Office of Epidemiology 109 Governor Street, 6th Floor East Richmond, VA 23219 Phone: (804) 864-8141 Fax: (804) 864-8139 Contact Us by Email[vdh.virginia.gov]
  • Epidemiologic evidence suggests that viral acquisition from the mother, perhaps via the birth canal, is a major mode of transmission.[ncbi.nlm.nih.gov]
  • ‡Associate professor of epidemiology, University of Michigan School of Public Health.[nejm.org]
  • Article navigation Center for Emerging Infectious Diseases and Department of Epidemiology, University of Iowa College of Public Health, Iowa City Search for other works by this author on: Gregory C.[doi.org]
  • Abstract We present two premature infants with disseminated neonatal adenovirus infection, whose epidemiology, clinical course and outcome differ to a great extent.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • 31, 40, and 41 are mostly reported in infants; 2, 3, and 5 mostly in children It is not well understood why specific serotypes are associated with specific syndromes; however, differences in mode of transmission and viral tropism likely play a role Pathophysiology[pathologyoutlines.com]
  • Many adenovirus infections are subclinical or asymptomatic. 15–70% of conjunctivitis worldwide Etiology and Pathophysiology DNA virus 60 to 90 nm in size, 6 species (A through F) with 50 known serotypes Adenovirus can remain dormant in lymphoreticular[unboundmedicine.com]
  • Res. 7 : 39S . 12. ( 2000 ) Pathophysiology of the human adenovirus that induces adiposity in animals . FASEB J 14 : A732 (abs.). 13. ( 1998 ) Evidence for an association of an obesity virus with human obesity at three sites in the United States .[doi.org]

Prevention

  • Abstract This article outlines the evolution of a rescue team in responding to adenovirus prevention with a deployable field hospital.[ncbi.nlm.nih.gov]
  • Centers for Disease Control and Prevention--National Center for Infectious Diseases—Division of Viral and Rickettsial Diseases, Respiratory and Enteric Viruses Branch[en.wikipedia.org]
  • Hence, it seems that whether one serves as a public-health professional concerned about preventing adenovirus epidemics, a clinician concerned about protecting immunocompromised patients or preventing chronic disease, or a water-quality engineer, one[doi.org]
  • Intravenous immunoglobulin was administered to prevent exacerbation of the suspected incipient hemophagocytic syndrome.[ncbi.nlm.nih.gov]
  • Early identification and treatment are necessary to improve patient outcomes and prevent the spread of infection to other neonates.[ncbi.nlm.nih.gov]

References

Article

  1. Ison MG. Adenovirus infections in transplant recipients. Clin Infect Dis. 2006;43(3):331-339.
  2. Lion T. Adenovirus Infections in Immunocompetent and Immunocompromised Patients. Clin Microbiol Rev. 2014;27(3):441-462.
  3. Echavarría M. Adenoviruses in Immunocompromised Hosts. Clin Microbiol Rev. 2008;21(4):704-715.
  4. Lee J. Mixed Respiratory Viral Infections in Children with Adenoviral Infections. Infection & Chemotherapy. 2016;48(4):347-349.
  5. Ghebremedhin B. Human adenovirus: Viral pathogen with increasing importance. Eur J Microbiol Immunol (Bp). 2014;4(1):26-33.
  6. Elnifro EM, Cooper RJ, Dady I, Hany S, Mughal ZM, Klapper PE. Three Nonfatal Cases of Neonatal Adenovirus Infection. J Clin Microbiol. 2005;43(11):5814-5815.

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Last updated: 2018-06-22 02:34