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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
        • bloody urine
        • self-limiting
      • bloody urine
      • self-limiting
    • 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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