eMedicine Specialties > Infectious Diseases > Viral Infections

Adenoviruses: Follow-up

Author: Sandra G Gompf, MD, FACP, FIDSA, Section Chief, Associate Professor of Infectious Diseases and International Medicine, Infectious Diseases, James A Haley Veterans Hospital
Coauthor(s): Richard L Oehler, MD, FACP, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases and Tropical Medicine, Univ of South Florida College of Medicine; Assistant Epidemiologist, Division of Infectious Diseases, Tampa VA Medical Center
Contributor Information and Disclosures

Updated: Dec 3, 2007

Follow-up

Further Inpatient Care

  • Patients with meningoencephalitis or severe respiratory disease, including pneumonia, or those who are immunosuppressed require hospitalization.
  • Patients with severe keratitis who are suggested to have bacterial superinfection may require hospitalization.

Further Outpatient Care

  • Most disease is self-limited, and reassurance suffices; however, patients with keratoconjunctivitis or significant respiratory disease may need a follow-up evaluation within 2 weeks to monitor resolution. Immunosuppression often warrants hospitalization.
  • Consultation with an ophthalmologist may be indicated in the setting of corneal opacities. In addition, if hemorrhagic cystitis does not resolve within 5 days, consider noninfectious etiologies as the cause and refer the patient to a urologist or nephrologist, as appropriate.

Transfer

  • Hospitalized patients who are immunosuppressed and have suspected adenoviral disease may benefit from early transfer to centers experienced in the treatment of critically ill immunosuppressed patients because rapid decompensation may occur.

Deterrence/Prevention

  • Vaccination has been limited to military use because of the increased risk of clinically significant disease and potential for hospitalization. In 1971, the administration of live enteric-coated adenovirus vaccine (serotypes 4 and 7) was begun, with notable effectiveness. When given orally, these serotypes induce effective humoral immunity without producing disease. Approximately 80% of current isolates remain serotypes 4 and 7. However, serotypes 3 and 21 also appear to cause significant disease and may be appropriate targets of future immunization. Further, breakthrough infection may occur with nonvaccine strains in persons who have been immunized, and vaccination programs may promote emergence of new epidemic strains. Surveillance and modification of vaccine strains may become necessary over time.25,6
  • Genotyping of serotype 4 strains during outbreaks has demonstrated stable populations that vary geographically by training site. This suggests that epidemics arise from an endemic environmental source rather than from new recruits, and prevention programs may further require effective environmental control.6,26
  • Because of economic factors, vaccine production was ceased in 1996, and rates of ARD in the military rose significantly. A large outbreak of ARD (serotype 4; >1000 cases) between May and December 1997 reinforced the need for immunization. Women traditionally had not been offered vaccination because of the lack of documented epidemics in women-only training programs; this outbreak illustrated the risk of significant ARD in female recruits entering sex-integrated basic combat-training programs. The ranks of women in the military continue to climb, and vaccination strategies will need to incorporate the evolving epidemiology.27
  • Effective isolation procedures, handwashing, and sterilization of instruments can prevent nosocomial infection.
    • Hospitalized patients with adenoviral conjunctivitis require contact precautions. Adenoviral pneumonia requires both droplet and contact precautions.
    • Health care workers with any adenoviral syndrome should be relieved of patient care duties and sent home until symptoms resolve. Health care workers should be educated to report to the employee health office if they develop symptoms that suggest conjunctivitis.
    • Strict handwashing protocols should be emphasized, particularly in ophthalmologic care settings.
    • Elimination of environmental reservoirs and fomites includes proper disinfection of tonometry and ophthalmologic instruments according to local infection control and manufacturer guidelines. Proper use and monitoring of open, multiple-use ophthalmic solutions (and timely discarding of these) according to local infection control and manufacturer guidelines is essential.
  • Adequate chlorination of swimming pools may prevent waterborne outbreaks.

Complications

  • Meningoencephalitis rarely occurs, usually in association with pneumonia. No pathognomonic features distinguish adenovirus aseptic meningitis or meningoencephalitis from other causes.
  • Immunosuppression in the host permits more severe manifestations. Pediatric liver transplantation, AIDS, and hematopoietic stem cell transplantation have been associated with protean adenovirus infections.

Prognosis

  • Overall, prognosis is good, except in cases of immunosuppressed patients with severe disease.

Patient Education

  • Frequent handwashing and avoidance of towel and pillow sharing among household contacts of patients with conjunctivitis is helpful.
  • Hygienic measures in children are difficult to enforce, but they should be taught regardless.
  • Patients should be advised of the contagiousness and possible long-term ocular sequelae of ophthalmologic disease.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize severe keratitis with bacterial superinfection requiring hospitalization (ie, possible loss of vision or loss of eye)
  • Failure to recognize central nervous system or pulmonary disease that requires supportive care in the hospital
  • Failure to carefully monitor progression in immunosuppressed patients
 


More on Adenoviruses

Overview: Adenoviruses
Differential Diagnoses & Workup: Adenoviruses
Treatment & Medication: Adenoviruses
Follow-up: Adenoviruses
Multimedia: Adenoviruses
References
[ CLOSE WINDOW ]

References

  1. Havenga MJ, Lemckert AA, Ophorst OJ, et al. Exploiting the natural diversity in adenovirus tropism for therapy and prevention of disease. J Virol. May 2002;76(9):4612-20. [Medline].

  2. Ritter T, Lehmann M, Volk H. Improvements in gene therapy: averting the immune response to adenoviral vectors. BioDrugs. 2002;16(1):3-10. [Medline].

  3. Vora GJ, Lin B, Gratwick K et al. Co-infections of adenovirus species in previously vaccinated patients. Emerg Infect Dis. June 2006;12:921-30. [Medline].

  4. Shah KV. SV40 and human cancer: a review of recent data. Int J Cancer. Jan 15 2007;120(2):215-23. [Medline].

  5. Martini F, Corallini A, Balatti V, Sabbioni S, Pancaldi C, Tognon M. Simian virus 40 in humans. Infect Agent Cancer. 2007;2:13. [Medline].

  6. Kajon AE, Moseley JM, Metzgar D, Huong HS, Wadleigh A, Ryan MA. Molecular epidemiology of adenovirus type 4 infections in US military recruits in the postvaccination era (1997-2003). J Infect Dis. Jul 1 2007;196(1):67-75. [Medline].

  7. Russell KL, Hawksworth AW, Ryan MA et al. Vaccine-preventable adenoviral respiratory illness in US military recruits,1999-2004. Vaccine. April 2006;15:2835-42. [Medline].

  8. CDC. Acute Respiratory Disease Associated with Adenovirus Serotype 14 --- Four States, 2006--2007. MMWR Weekly [serial online]. November 16, 2007;56:Available from: CDC. Accessed November 27, 2007. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5645a1.htm.

  9. Wirsing von König CH, Rott H, Bogaerts H, Schmitt HJ. A serologic study of organisms possibly associated with pertussis-like coughing. Pediatr Infect Dis J. Jul 1998;17(7):645-9. [Medline].

  10. Versteegh FG, Mooi-Kokenberg EA, Schellekens JF, Roord JJ. Bordetella pertussis and mixed infections. Minerva Pediatr. Apr 2006;58(2):131-7. [Medline].

  11. Bruno B, Zager RA, Boeckh MJ, et al. Adenovirus nephritis in hematopoietic stem-cell transplantation. Transplantation. Apr 15 2004;77(7):1049-57. [Medline].

  12. Jalal H, Bibby DF, Tang JW, Bennett J, Kyriakou C, Peggs K. First reported outbreak of diarrhea due to adenovirus infection in a hematology unit for adults. J Clin Microbiol. Jun 2005;43(6):2575-80. [Medline].

  13. Hedderwick SA, Greenson JK, McGaughy VR, Clark NM. Adenovirus cholecystitis in a patient with AIDS. Clin Infect Dis. Apr 1998;26(4):997-9. [Medline].

  14. Ison MG. Adenovirus infections in transplant recipients. Clin Infect Dis. Aug 1 2006;43(3):331-9. [Medline].

  15. Pehler-Harrington K, Khanna M, Waters CR, Henrickson KJ. Rapid detection and identification of human adenovirus species by adenoplex, a multiplex PCR-enzyme hybridization assay. J Clin Microbiol. Sep 2004;42(9):4072-6. [Medline].

  16. Walls T, Hawrami K, Shingadia D, et al. Polymerase chain reaction in the management of disseminated adenovirus infection after stem cell transplantation. Pediatr Infect Dis J. Dec 2004;23(12):1167-9. [Medline].

  17. Seidemann K, Heim A, Pfister ED, et al. Monitoring of adenovirus infection in pediatric transplant recipients by quantitative PCR: report of six cases and review of the literature. Am J Transplant. Dec 2004;4(12):2102-8. [Medline].

  18. Watkins SJ, Mesyanzhinov VV, Kurochkina LP, Hawkins RE. The 'adenobody' approach to viral targeting: specific and enhanced adenoviral gene delivery. Gene Ther. Oct 1997;4(10):1004-12. [Medline].

  19. Carter BA, Karpen SJ, Quiros-Tejeira RE, et al. Intravenous Cidofovir therapy for disseminated adenovirus in a pediatric liver transplant recipient. Transplantation. Oct 15 2002;74(7):1050-2. [Medline].

  20. Hayashi M, Lee C, de Magalhaes-Silverman M. Adenovirus infections in BMT patients successfully treated with cidofovir. Blood. 2000;96 (suppl 1):189a.

  21. Muller WJ, Levin MJ, Shin YK, Robinson C, Quinones R, Malcolm J. Clinical and in vitro evaluation of cidofovir for treatment of adenovirus infection in pediatric hematopoietic stem cell transplant recipients. Clin Infect Dis. Dec 15 2005;41(12):1812-6. [Medline].

  22. Yusuf U, Hale GA, Carr J, Gu Z, Benaim E, Woodard P. Cidofovir for the treatment of adenoviral infection in pediatric hematopoietic stem cell transplant patients. Transplantation. May 27 2006;81(10):1398-404. [Medline].

  23. Feuchtinger T, Lücke J, Hamprecht K, Richard C, Handgretinger R, Schumm M. Detection of adenovirus-specific T cells in children with adenovirus infection after allogeneic stem cell transplantation. Br J Haematol. Feb 2005;128(4):503-9. [Medline].

  24. Fanourgiakis P, Georgala A, Vekemans M, Triffet A, De Bruyn JM, Duchateau V. Intravesical instillation of cidofovir in the treatment of hemorrhagic cystitis caused by adenovirus type 11 in a bone marrow transplant recipient. Clin Infect Dis. Jan 1 2005;40(1):199-201. [Medline].

  25. Ryan MA, Gray GC, Smith B, et al. Large epidemic of respiratory illness due to adenovirus types 7 and 3 in healthy young adults. Clin Infect Dis. Mar 1 2002;34(5):577-82. [Medline].

  26. Vora GJ, Lin B, Gratwick K et al. o-infections of adenovirus species in previously vaccinated patients. Emerg Infect Dis. June 2006;12:921-30. [Medline].

  27. Barraza EM, Ludwig SL, Gaydos JC et al. Reemergence of adenovirus type 4 acute respiratory disease in military trainees:report of an outbreak during a lapse in vaccination. J Infect Dis. June 1999;179:1531-3. [Medline].

  28. Baltzer AW, Whalen JD, Wooley P, et al. Gene therapy for osteoporosis: evaluation in a murine ovariectomy model. Gene Ther. Dec 2001;8(23):1770-6. [Medline].

  29. Blasiole DA, Metzgar D, Daum LT, et al. Molecular analysis of adenovirus isolates from vaccinated and unvaccinated young adults. J Clin Microbiol. Apr 2004;42(4):1686-93. [Medline].

  30. Boeckh M, Nichols WG. 42nd Annual Meeting of the American Society of Hematology: Nonherpesvirus Infections in Transplant Recipients. Medscape-Hematology-Oncology Conference Summaries. 2000;Available at: http://www.medscape.com/px/urlinfo.

  31. Chakrabarti S, Collingham KE, Pillay D. Adenovirus infections in haematopoietic stem cell transplant recipients: is there a role for immunotherapy?. Blood. 2000;96 (suppl 1):191a.

  32. Elnifro EM, Cooper RJ, Dady I, Hany S, Mughal ZM, Klapper PE. Three nonfatal cases of neonatal adenovirus infection. J Clin Microbiol. Nov 2005;43(11):5814-5. [Medline].

  33. Emovon OE, Chavin J, Rogers K, Self S. Adenovirus in kidney transplantation: an emerging pathogen?. Transplantation. May 15 2004;77(9):1474-5. [Medline].

  34. Erdman D. EIN epi: Life-threatening adenovirus pneumonia. Emerging Infections Network (EIN) listserv. Available at http://127.0.0.1:4664/cache?event_id=15089&schema_id=1&q=adenovirus&s=VG3cyBjbnInL9-lHEXtU0ht5098. Accessed April 26, 2007.

  35. Gray GC, Callahan JD, Hawksworth AW, et al. Respiratory diseases among U.S. military personnel: countering emerging threats. Emerg Infect Dis. May-Jun 1999;5(3):379-85. [Medline].

  36. Gray GC, Goswami PR, Malasig MD, et al. Adult adenovirus infections: loss of orphaned vaccines precipitates military respiratory disease epidemics. Clinical Infectious Diseases. 2000;31:663-70. [Medline].

  37. Gris O, Güell JL, Wolley-Dod C, Adan A. Diffuse lamellar keratitis and corneal edema associated with viral keratoconjunctivitis 2 years after laser in situ keratomileusis. J Cataract Refract Surg. Jun 2004;30(6):1366-70. [Medline].

  38. Hendrix RM, Lindner JL, Benton FR, et al. Large, persistent epidemic of adenovirus type 4-associated acute respiratory disease in U.S. army trainees. Emerg Infect Dis. Nov-Dec 1999;5(6):798-801. [Medline].

  39. Hierholzer JC. Adenoviruses. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology. 6th ed. Washington, DC: ASM Press; 1995:947-55.

  40. Horwitz MS. Adenoviruses. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious Diseases. 2nd ed. Philadelphia, Pa: WB Saunders; 1998:. 2012-21.

  41. Horwitz MS. Adenoviruses. In: Fields BN, Knipe DM, Howley PM, Chanock RM, eds. Fields Virology. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1996:2149-71.

  42. Howard DS, Phillips II GL, Reece DE, et al. Adenovirus infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. Dec 1999;29(6):1494-501. [Medline].

  43. Jeon K, Kang CI, Yoon CH, Lee DJ, Kim CH, Chung YS. High isolation rate of adenovirus serotype 7 from South Korean military recruits with mild acute respiratory disease. Eur J Clin Microbiol Infect Dis. Jun 1 2007;[Medline].

  44. Kapoor N, Shah AJ, Hoffman J. Cidofovir for the treatment of adenoviral infections in pediatric hematopoietic stem cell transplant. Blood. 2000;96 (suppl 1):189a.

  45. Koneman EW, Allen SD, Janda WM, Schreckenberger PC. Adenoviruses. In: Color Atlas of Diagnostic Microbiology. 5th ed. Philadelphia, Pa: Lippincott-Raven; 1997:1203, 1216-17, 1260.

  46. Lankester AC, Heemskerk B, Claas EC, Schilham MW, Beersma MF, Bredius RG. Effect of ribavirin on the plasma viral DNA load in patients with disseminating adenovirus infection. Clin Infect Dis. Jun 1 2004;38(11):1521-5. [Medline].

  47. Ljungman P. Treatment of adenovirus infections in the immunocompromised host. Eur J Clin Microbiol Infect Dis. Aug 2004;23(8):583-8. [Medline].

  48. McNeill KM, Ridgely Benton F, Monteith SC, et al. Epidemic spread of adenovirus type 4-associated acute respiratory disease between U.S. Army installations. Emerg Infect Dis. Jul-Aug 2000;6(4):415-9. [Medline].

  49. Mosby. Ribavirin. In: Mosby's Drug Consult. 15th ed. St. Louis, Mo: Mosby; 2005.

  50. Musher DM. How contagious are common respiratory tract infections?. N Engl J Med. Mar 27 2003;348(13):1256-66. [Medline].

  51. Nagafuji K, Aoki K, Henzan H, et al. Cidofovir for treating adenoviral hemorrhagic cystitis in hematopoietic stem cell transplant recipients. Bone Marrow Transplant. Nov 2004;34(10):909-14. [Medline].

  52. Parizhskaya M, Walpusk J, Mazariegos G, Jaffe R. Enteric adenovirus infection in pediatric small bowel transplant recipients. Pediatr Dev Pathol. Mar-Apr 2001;4(2):122-8. [Medline].

  53. Ribaud P, Scieux C, Freymuth F, et al. Successful treatment of adenovirus disease with intravenous cidofovir in an unrelated stem-cell transplant recipient. Clin Infect Dis. Mar 1999;28(3):690-1. [Medline].

  54. Russell KL, Broderick MP, Franklin SE et al. Transmission dynamics and prospective environmental sampling of adenovirus in amilitary recruit setting. J Infect Dis. October 2006;194:877-85. [Medline].

  55. Sander DM. The Big Picture Book of Viruses: Adenoviridae. 1995;Available at: http://www.tulane.edu/~dmsander/Big_Virology/BVDNAadeno.html. [Full Text].

  56. Strair RK, Sheay W, Goodell L, et al. Adenovirus infection of primary malignant lymphoid cells. Leuk Lymphoma. Jan 2002;43(1):37-49. [Medline].

  57. Suparno C, Milligan DW, Moss PA, Mautner V. Adenovirus infections in stem cell transplant recipients: recent developments in understanding of pathogenesis, diagnosis and management. Leuk Lymphoma. May 2004;45(5):873-85. [Medline].

  58. Venard V, Carret A, Corsaro D, et al. Genotyping of adenoviruses isolated in an outbreak in a bone marrow transplant unit shows that diverse strains are involved. J Hosp Infect. Jan 2000;44(1):71-4. [Medline].

  59. Yazawa K, Fisher WE, Brunicardi FC. Current Progress in Suicide Gene Therapy for Cancer. World J Surg. Apr 15 2002;26(7):[Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

adenoviruses, acute respiratory disease, ARD, pharyngoconjunctival fever, epidemic keratoconjunctivitis, acute hemorrhagic cystitis, nephritis, gastroenteritis, adenoviral infection, immunocompromise, immunosuppression, transplantation, transplants, transplantation complications, transplant complication, gene therapy, adenovirus, Mastadenovirus, viral gene therapy, cystic fibrosis, osteoporosis, lytic infection

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Sandra G Gompf, MD, FACP, FIDSA, Section Chief, Associate Professor of Infectious Diseases and International Medicine, Infectious Diseases, James A Haley Veterans Hospital
Sandra G Gompf, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Richard L Oehler, MD, FACP, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases and Tropical Medicine, Univ of South Florida College of Medicine; Assistant Epidemiologist, Division of Infectious Diseases, Tampa VA Medical Center
Richard L Oehler, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

Medical Editor

David Hall Shepp, MD, Program Director, Fellowship in Infectious Diseases, Department of Medicine, North Shore University Hospital; Associate Professor, New York University School of Medicine
David Hall Shepp, MD is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard B Brown, MD, FACP, Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine
Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.