Adenovirus Infections

Adenovirus Infections

 

Definition

Adenoviruses are DNA viruses (small infectious agents) that cause upper respiratory tract infections, conjunctivitis, and other infections in humans.

Description

Adenoviruses were discovered in 1953. About 47 different types have been identified since then, and about half of them are believed to cause human diseases. Infants and children are most commonly affected by adenoviruses. Adenovirus infections can occur throughout the year, but seem to be most common from fall to spring.
Adenoviruses are responsible for 3-5% of acute respiratory infections in children and 2% of respiratory illnesses in civilian adults. They are more apt to cause infection among military recruits and other young people who live in institutional environments. Outbreaks among children are frequently reported at boarding schools and summer camps. Another example includes an increased outbreak of gastroenteritis among cruise passengers in 2002.

Acquired immunity

Most children have been infected by at least one adenovirus by the time they reach school age. Most adults have acquired immunity to multiple adenovirus types due to infections they had as children.
In one mode of adenovirus infection (called lytic infection because it destroys large numbers of cells), adenoviruses kill healthy cells and replicate up to one million new viruses per cell killed (of which 1-5% are infectious). People with this kind of infection feel sick. In chronic or latent infection, a much smaller number of viruses are released and healthy cells can multiply more rapidly than they are destroyed. People who have this kind of infection don't seem to be sick. This is probably why many adults have immunity to adenoviruses without realizing they have been infected.

Childhood infections

In children, adenoviruses most often cause acute upper respiratory infections with fever and runny nose. Adenovirus types 1, 2, 3, 5, and 6 are responsible for most of these infections. Occasionally more serious lower respiratory diseases, such as pneumonia, may occur.
Adenoviruses also cause acute pharyngoconjunctival fever in children. This disease is most often caused by types 3 and 7. Symptoms, which appear suddenly and usually disappear in less than a week, include:
  • inflammation of the lining of the eyelid (conjunctivitis)
  • fever
  • sore throat (pharyngitis)
  • runny nose
  • inflammation of lymph glands in the neck (cervical adenitis)
Adenoviruses also cause acute diarrhea in young children, characterized by fever and watery stools. This condition is caused by adenovirus types 40 and 41 and can last as long as two weeks.
As much as 51% of all hemorrhagic cystitis (inflammation of the bladder and of the tubes that carry urine to the bladder from the kidneys) in American and Japanese children can be attributed to adenovirus infection. A child who has hemorrhagic cystitis has bloody urine for about three days, and invisible traces of blood can be found in the urine a few days longer. The child will feel the urge to urinate frequently—but find it difficult to do so—for about the same length of time.

Adult infections

In adults, the most frequently reported adenovirus infection is acute respiratory disease (ARD, caused by types 4 and 7) in military recruits. Influenza-like symptoms including fever, sore throat, runny nose, and cough are almost always present; weakness, chills, headache, and swollen lymph glands in the neck also may occur. The symptoms typically last three to five days.
Epidemic keratoconjunctivitis (EKC, caused by adenovirus types 8, 19, and 37) was first seen in shipyard workers whose eyes had been slightly injured by chips of rust or paint. This inflammation of tissues lining the eyelid and covering the front of the eyeball also can be caused by using contaminated contact lens solutions or by drying the hands or face with a towel used by someone who has this infection.

Key terms

Conjunctivitis — Inflammation of the conjunctiva, the mucous membrane lining the inner surfaces of the eyelid and the front of the eyeball.
Virus — A small infectious agent consisting of a core of genetic material (DNA or RNA) surrounded by a shell of protein.
The inflamed, sticky eyelids characteristic of conjunctivitis develop 4-24 days after exposure and last between one and four weeks. Only 5-8% of patients with epidemic keratoconjunctivitis experience respiratory symptoms. One or both eyes may be affected. As symptoms of conjunctivitis subside, eye pain and watering and blurred vision develop. These symptoms of keratitis may last for several months, and about 10% of these infections spread to at least one other member of the patient's household.
Other illnesses associated with adenovirus include:
  • encephalitis (inflammation of the brain) and other infections of the central nervous system (CNS)
  • gastroenteritis (inflammation of the stomach and intestines)
  • acute mesenteric lymphadenitis (inflammation of lymph glands in the abdomen)
  • chronic interstitial fibrosis (abnormal growth of connective tissue between cells)
  • intussusception (a type of intestinal obstruction)
  • pneumonia that doesn't respond to antibiotic therapy
  • whooping cough syndrome when Bordetella pertussis (the bacterium that causes classic whooping cough) is not found

Causes and symptoms

Specific adenovirus infections can be traced to particular sources and produce distinctive symptoms. In general, however, adenovirus infection is caused by:
  • inhaling airborne viruses
  • getting the virus in the eyes by swimming in contaminated water, using contaminated eye solutions or instruments, wiping the eyes with contaminated towels, or rubbing the eyes with contaminated fingers.
  • not washing the hands after using the bathroom, and then touching the mouth or eyes
Symptoms common to most types of adenovirus infections include:
  • cough
  • fever
  • runny nose
  • sore throat
  • watery eyes

Diagnosis

Although symptoms may suggest the presence of adenovirus, distinguishing these infections from other viruses can be difficult. A definitive diagnosis is based on culture or detection of the virus in eye secretions, sputum, urine, or stool.
The extent of infection can be estimated from the results of blood tests that measure increases in the quantity of antibodies the immune system produces to fight it. Antibody levels begin to rise about a week after infection occurs and remain elevated for about a year.

Treatment

Treatment of adenovirus infections is usually supportive and aimed at relieving symptoms of the illness. Bed rest may be recommended along with medications to reduce fever and/or pain. (Aspirin should not be given to children because of concerns about Reye's syndrome.) Eye infections may benefit from topical corticosteroids to relieve symptoms and shorten the course of the disease. Hospitalization is usually required for severe pneumonia in infants and for EKC (to prevent blindness). No effective antiviral drugs have been developed.

Prognosis

Adenovirus infections are rarely fatal. Most patients recover fully.

Prevention

Practicing good personal hygiene and avoiding people with infectious illnesses can reduce the risk of developing adenovirus infection. Proper hand-washing can prevent the spread of the virus by oral-fecal transmission. Sterilization of instruments and solutions used in the eye can prevent the spread of EKC, as can adequate chlorination of swimming pools.
A vaccine for pertussis has been developed and is in use in combination with diphtheria and tetanus vaccines for infants. It is shown to have nearly 90% efficacy. A vaccine containing live adenovirus types 4 and 7 is used to control disease in military recruits, but it is not recommended or available for civilian use. A recent resurgence of the adenovirus was found in a military population as soon as the vaccination program was halted. Vaccines prepared from purified subunits of adenovirus are under investigation.

Resources

Periodicals

Evans, Jeff. "Viral Gastroenteritis On Board." Internal Medicine News (January 15, 2003): 44.
"Guard Against Pertussis." Contemporary Pediatrics (February 2003): 87.
Kolavic-Gray, Shellie A., et al. "Large Epidemic of Adenovirus Type 4 Infection Among Military Trainees: Epidemiological, Clinical, and Laboratory Studies." Clinical Infectious Diseases (October 1, 2002): 808-811.
References in periodicals archive ?
Adenovirus infections now account for 90 percent of all viral infections treated by military hospitals, Gray said.
The epidemiologic association and similar hospitalization and fatality rates for confirmed and suspected cases support our conclusion that most suspected cases likely had adenovirus infections.
Rapid and sensitive diagnosis of human adenovirus infections by a generic polymerase chain reaction.
Severe and fatal pneumonia in infants and young children associated with adenovirus infections.
An epidemic of adenovirus infections among military recruits.
Eight year prospective study of adenovirus infections in hospitalized children.
We retrospectively reviewed demographic and clinical information of adenovirus infections reported in Singapore during January 2011-July 2013 in 3 populations: 1) pediatric inpatients at KK Women's and Children's Hospital (formerly known as Kandang Kerbau Hospital) and National University Hospital, which are the only government hospitals in Singapore that have pediatric departments; 2) military personnel; and 3) outpatients reported to the nationwide ILI surveillance network housed in the National Public Health Laboratories (NPHL).
CMX001 as Therapy for Severe Adenovirus Infections in Immunocompromised Pediatric Patients: Single Experience in 5 Patients," which will also be presented by Dr.
Adenovirus infections are frequently observed in individuals with immune deficiency, T or B cell dysfunction and hypogammaglobulinemia.
Avian gastric yeast and adenovirus infections may have been facilitated by reovirus-associated immunosuppression or may have been coincidental, because those 2 infectious agents were also found in budgerigars that died from other causes.
David Gilbert, who was making rounds in the intensive care unit at Providence Portland Medical Center and thought it was odd that 4 of 13 patients had adenovirus infections, which are typically mild and self-limited.