ADENOVIRUSES

WHAT ARE
ADENOVIRUSES?
Adenoviruses are double-stranded, linear DNA viruses,
nonenveloped (naked) and icosahedral. They are
medium sized (90-100 nm) and at least 42 serotypes
affect humans which belong to 1 of 6 subgroups which
are responsible for 5-10% of upper respiratory
infections in children and in adults also
(gastrointestinal and urinary tracts)

Diagram 1 shows the transmission of the electron

micrograph of 2 adenovirus particles.
Diagram 2 shows the structure of the adenovirus.
1= penton capsomeres 2= hexon capsomeres 3= viral
genome (linear dsDNA)

REPLICATION
Adenoviruses possess a linear ds (double
stranded) DNA genome and are able to replicate in
the nucleus of mammalian cells using the hosts
replication machinery

Adenovirus infections most commonly cause

illness of the respiratory system; however,
depending on the infecting serotype, they may also
cause various other illnesses such as
gastroenteritis, conjunctivitis, cystitis and rash
illness. Symptoms of respiratory illness range from
the common cold to pneumonia, croup and
bronchitis. Patients with compromised immune
systems are especially susceptible to severe
complications of adenovirus infection. Acute
respiratory disease (ARD), first recognized in World
War II, can be caused by adenovirus infections
during stress and conditions of crowding.

CLINICAL
FINDINGS

Acute respiratory disease

pharyngitis, which may be exudative, is a finding. Conjunctivitis may occur
in this setting
Patients have pulmonary rhonchi and rales
Pharngoconjunctival feverFever; coryza; pharngitis, which may be exudative; follicular, bulbar and
plapebral conjunctivitis (typically mild granular appearance); and headache
are reported
Cervical lymphadenopathy is a finding.
The hallmark is preauricular lymphadenopathy (ie, Parinuad syndrome),
with small lymph nodes palpable just anterior to the rear.this finding is not
common; however, its presence in the setting of a viral conjunctivitis is very
suggestive of adenovirus infection

Epidemic keratoconjunctivitis
Severe follicular keratoconjunctivitis is reported.
Palpebral conjunctiva may be granular.
Palpebral edema is a finding.
Preauricular lymphadenopathy is not common but
is a pathognomonic finding with adenovirus
infection.
Hemorrhagic conjunctivitis may develop
Visual haziness or impairment resulting from
keratitis develops and may persist for months to
years.

Acute hemorrhagic cystitis/nephritis

No significant features are described in the setting of
hemorrhagic cystitis, other than evidence of blood in the
urine.
Nephritis is characterized by flank pain.
Patients with hemorrhagic cystitis are afebrile. Nephritis is
characterized by fever.
Gastroenteritis: if severe, the patient has signs of
dehydration.
Adenoviral infections in immunocompromised hosts:
features include dyspnea, dry cough, pulnonary rhonchi and
rales, grossly bloody urine, and diarrhea.

LABORATORY
DIAGNOSIS

Adenovirus is stable in routine viral transport medium,

including specimens if nasopharyngeal, rectal, and
corneal secretions; urine; and unfixed biopsy tissue.
Detection is enhanced if specimens are taken early in
the clinical course as promptly shipped cold or frozen
to the laboratory.
Many adenovirus serotypes can be isolated in cell
culture lines commonly used in diagnostic virology
laboratories; however, others fail to grow. Primary
human embryonic kidney cells support growth of many
fastidious adenovirus serotypes, but their additiona;
cost may be prohibitive in some settings

Indirect immunofluorescence assays may be

used for direct examination of tissue
specimens (ELISA)
Serology- the complement fixation (CF) test is
an easily applied method for detecting infection
by any member of the adenovirus group. A
greater rise in CF antibody titer between acute
phase and convalescent phase sera indicates
current infections with an adenovirus.

The following laboratory studies are suggested in the

given syndromes, both to diagnose adenoviral
infections and to evaluate for other diagnoses in the
differential of each syndrome.
Acute respiratory disease
-nasopharyngeal swab for culture of respiratory
viruses (eg, influenza virus, adenovirus) is suggested
-consider Monospot assay or respiratory syncytial
virus culture for Epstein-Barr virus and respiratory
syncytial virus
-consider rapid group A Streptococcus throat swab
and culture

Pharyngoconjuctival fever
-the same considerations as those for Acute respiratory
disease
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, rotavirus assay, and clostridium difficile toxin
assay.

EPIDEMIOLOGY
AND IMMUNITY
Adenoviruses exist in all parts of the world and are spread often
by the fecal-oral route but may also be transmitted by respiratory
droplets
In contrast to most respiratory agents, the adenoviruses induce
effective and long lasting immunity against re-infection.

TREATMENT
Ribavirin and cidofovir therapy have been used
with variable success in immunosuppressed
hosts.
Most infections are mild and require no therapy
or only symtomatic treatment. Bcause there is
no virus-specific therapy, serious adenovirus
illness can be managed only by treating the
symptoms and complications of the infection.
Deaths are exceedingly rare but have been
reported.

PREVENTION AND
CONTROL
Effective isolation procedures, handwashing and sterilization of
instruments can prevent nosocomial infection
Adequate chlorination of swimming pools may prevent
waterborne outbreaks.