Adenovirus Workup

Updated: May 15, 2018
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
  • Print
Workup

Laboratory Studies

Culture

Adenovirus is stable in routine viral transport medium, including specimens of nasopharyngeal, rectal, and corneal secretions; urine; and unfixed biopsy tissue. Detection is enhanced if specimens are collected early in the clinical course and promptly shipped cold or frozen to the appropriate laboratory. Many adenovirus serotypes can be isolated in cell culture lines commonly used in diagnostic virology laboratories; a few, such as types 40 and 41, fail to grow. Primary human embryonic kidney cells support growth of many fastidious adenovirus serotypes, but their additional cost may be prohibitive in some settings. Other cell lines may not support the growth of ocular strains well, may be less sensitive, or may not be maintainable to support slower-growing strains.

Serology

Seroreactivity to adenovirus is common. By age 4 years, approximately half of all children have positive adenovirus titers. As a result, serology is less useful in the acute clinical setting. If a serologic diagnosis is pursued, serum should be obtained as early as possible in the clinical course, followed by a second titer 2-4 weeks later. A 4-fold rise in acute titers to convalescent titers is diagnostic.

Antigen tests

Indirect immunofluorescence assays may be used for direct examination of tissue specimens.

Polymerase chain reaction

Polymerase chain reaction (PCR) is being used with high specificity on various specimens (eg, respiratory, tissue, urine, blood) to identify adenovirus. [5, 21]

Serotyping

Serotyping is generally in the domain of epidemiology and research and is not typically used in clinical practice. However, as specific syndromes are associated with specific serotypes, tests can be performed in a reference laboratory.

Certain serotypes of enteric adenovirus have been seen in stool specimens using electron microscopy, but they have been difficult to isolate in routine tissue culture. These types have been referred to as noncultivatable enteric adenoviruses. Adenovirus has been identified using electron microscopy and immunohistochemistry techniques. The isolation of enteric adenovirus infection in recipients of small bowel transplants in whom allograft damage is a risk may warrant stool cultures or biopsy.

Transmission electron micrograph of adenovirus. Im Transmission electron micrograph of adenovirus. Image courtesy of the US Centers for Disease Control and Prevention.

Syndrome-specific testing

The following laboratory studies are suggested in the given syndromes, both to diagnose adenoviral infections and to evaluate for other diagnoses in the differential diagnoses of each syndrome.

Acute respiratory disease

Nasopharyngeal swab for culture of respiratory viruses (eg, influenza virus, adenovirus, respiratory syncytial virus, rhinovirus) is suggested.

Consider Monospot assay for Epstein-Barr virus.

Consider rapid group A Streptococcus throat swab and culture.

Pharyngoconjunctival fever

Nasopharyngeal swab for culture of respiratory viruses (eg, influenza virus, adenovirus) is suggested.

Consider Monospot assay.

Consider rapid group A Streptococcus throat swab and culture.

Epidemic keratoconjunctivitis

Viral and bacterial swab cultures of conjunctival secretions and scrapings are suggested.

Acute hemorrhagic cystitis or nephritis

Urinalysis and cultures for bacterial and viral pathogens are suggested.

Gastroenteritis

Consider stool Wright stain; ova and parasites examination; culture for bacterial enteric pathogens; assays for norovirus, rotavirus, and Cyclospora; and Clostridium difficile toxin assay.

Next:

Imaging Studies

Pneumonia

Plain radiography or CT scanning demonstrates typically diffuse and reticulonodular infiltrates. High-resolution CT scanning may show "crazy-paving" patterns in immunocompromised patients. [22] Occasionally, findings are lobar.

Hepatitis

Liver ultrasonography may be helpful to exclude obstructive causes of transaminitis or hyperbilirubinemia.

Nephritis

Renal ultrasonography is helpful to exclude obstructive causes of renal insufficiency or renal swelling that may indicate infection.

Previous
Next:

Other Tests

Urine cytology

Urine cytology should be considered to exclude other causes if hemorrhagic cystitis does not resolve within 5 days.

Previous
Next:

Procedures

Biopsy

Biopsy may be considered in the setting of pneumonia, hepatitis, nephritis, enteritis, or other suspected end-organ involvement in immunocompromised patients, particularly in transplant recipients.

Previous
Next:

Histologic Findings

Pneumonia

Obliterative bronchiolitis is seen; viral intranuclear and intracytoplasmic inclusions with positive immunohistochemical staining specific for adenovirus are noted. The intranuclear inclusions during late infection are surrounded by a clear halo, which may obstruct visualization of the nuclear membrane, resulting in a smudged appearance. These "smudged" cells are classically seen in adenovirus infection.

Enteritis

Denudation of the gastrointestinal mucosa with edema may be seen. Also, acute and chronic inflammatory infiltrate involving the full thickness of the bowel wall may be noted. Viral intranuclear and intracytoplasmic inclusions with positive immunohistochemical staining specific for adenovirus are noted within infected cells.

Hepatitis

Viral intranuclear and intracytoplasmic inclusions with positive immunohistochemical staining specific for adenovirus are noted within infected cells.

Nephritis

Viral intranuclear and intracytoplasmic inclusions with positive immunohistochemical staining specific for adenovirus are noted within infected cells. Tubular epithelium is typically involved until late; extension may occur thereafter to the Bowman capsule and the glomerulus.

Previous