Updated: 3/11/2019

Adenovirus

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Snapshot
  • A 4-year-old boy presents to the pediatrician with fever and bilateral conjunctivitis. This was preceded by a 5-day history of a non-productive cough, rhinorrhea, and sore throat. There is no history of sick contacts, but the child attends daycare 3 times a week. Physical exam revealed an ill-looking child with bilateral conjunctival injection, scanty greenish discharge, and cervical lymphadenopathy.  The mucosa of the oropharynx is hyperemic. Complete blood count shows a leukocyte count of 8500/mm3. Throat swab and blood cultures proved negative for bacteria and a swab of the posterior pharynx was sent for viral PCR.
Introduction
  • Classification
    • linear, non-enveloped, double-stranded DNA virus
  • Epidemiology
    • worldwide distribution
      • most individuals have serologic evidence by 10 years of age
    • demographics
      • young children  
    • risk factors
      • daycare centers and households with young children
      • closed or crowded settings
        • e.g., public swimming pools, military barracks, medical facilities
  • Pathogenesis
    • transmission
      • aerosol droplets
      • fecal-oral
      • contact via contaminated fomites
    • reservoir
      • ubiquitous and can survive for long periods on environmental surfaces
  • Associated conditions
    • pharyngitis coryza
    • pneumonia
    • infectious conjunctivitis
  • Prevention
    • vaccinations
      • live, oral, enteric-coated vaccines
      • military recruits 17-50 years of age
    • infection control procedures
      • contact and droplet precaution
      • chlorination of swimming pools
  • Prognosis
    • depends on clinical presentation  
Presentation
  • Symptoms
    • febrile pharyngitis
      • fever
      • coryza
      • painful pharyngitis
      • most common cause of tonsillitis in young children
    • pneumonia
      • more severe in infants and older children
    • pharyngoconjunctivitis
      • conjunctival injection
      • pharyngitis and cervical adenitis
      • outbreaks in swimming pools or lakes
    • acute hemorrhagic cystitis  
      • bloody urine
      • self-limiting
  • Physical exam
    • febrile pharyngitis:
      • tonsillitis +/- exudative 
      • cervical adenopathy
    • pharyngoconjunctivitis
      • fever
      • cervical adenitis
Studies
  • Labs
    • viral culture
    • viral antigen assays
    • PCR assays
      • quick way to identify adenoviral pathogen
    • serology
  • Histology
    • histopathology via biopsy
    • basophilic inclusions
  • Making the diagnosis
    • based on clinical presentation and laboratory studies
    • most cases are clinically diagnosed
Differential
  • Rhinovirus
    • distinguishing factor
      • does not usually present with conjunctivitis
  • GAS pharyngitis
    • distinguishing factor
      • Centor criteria - no cough
  • Influenza
    • distinguishing factor
      • presents with minimal coryza and acute onset
Treatment
  • Mostly self-limited and treatment is supportive
  • Medical
    • cidofovir
      • immunocompromised patients or severe disease
      • dose-limiting nephrotoxicity
Complications
  • Bronchiectasis and bronchiolitis obliterans
  • Disseminated adenovirus infection

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