Diagnosis, treatment, and prevention of adenovirus infection
- Flor M Munoz, MD, MSc
Flor M Munoz, MD, MSc
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Phyllis Flomenberg, MD
Phyllis Flomenberg, MD
- Associate Professor of Medicine
- Jefferson Medical College
- Section Editors
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
Adenoviruses are a family of DNA viruses that are an important cause of febrile illnesses in young children. They are most frequently associated with upper respiratory tract syndromes such as pharyngitis or coryza but can also cause pneumonia. Less commonly, adenoviruses cause gastrointestinal, ophthalmologic, genitourinary, neurologic, and disseminated disease. Most adenoviral diseases are self-limiting, although fatal infections can occur in immunocompromised hosts and occasionally in healthy children and adults.
The available diagnostic tests and strategies for treatment and prevention of adenovirus infection will be reviewed here. The virology, epidemiology, and clinical manifestations of adenovirus infection are discussed separately. (See "Epidemiology and clinical manifestations of adenovirus infection".)
Since adenoviruses are associated with a variety of clinical syndromes and nonspecific manifestations, diagnosis based upon clinical criteria alone is challenging. The diagnosis of adenovirus disease should be confirmed in outbreaks of infection and in individual patients with serious disease manifestations. Confirmation of adenovirus infection is important in order to decide on the use of antiviral agents, exclude other treatable infections, establish a prognosis, and initiate infection control measures when appropriate.
A number of different approaches are available for the specific diagnosis of adenovirus infection (table 1). Viral culture, adenovirus-specific viral antigen assays, and polymerase chain reaction (PCR) assays are used most frequently.
Viral culture — All adenovirus serotypes except types 40 and 41 cause a characteristic cytopathic effect (CPE) in human epithelial cell lines such as HeLa, A549, or HEp2 and in primary human embryonic kidney (HEK) cells. CPE generally occurs within 2 to 7 days with the common lower serotypes, but some others, especially subgroup D serotypes (which cause epidemic keratoconjunctivitis), can require up to 28 days.
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- DIAGNOSTIC TESTS
- Viral culture
- Viral antigen assay
- Polymerase chain reactions
- Histopathologic studies
- Serotyping and genotyping
- Restriction endonuclease analysis
- DIAGNOSTIC TESTS OF CHOICE FOR DIFFERENT ADENOVIRUS SYNDROMES
- Upper respiratory illness
- Epidemic keratoconjunctivitis
- Diarrhea in young children
- Infections in immunocompromised hosts
- Antiviral agents
- - Cidofovir
- - Lipid-ester derivatives of cidofovir
- - Other
- Infection control
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS