Adenoviruses

Objectives

After completing this article, readers should be able to:

1. Describe clinical manifestations of adenovirus infection.

2. Explain how adenovirus is transmitted and how this risk can be reduced.

3. Delineate who should be tested for adenovirus infection and the laboratory tests available.

4. Describe treatment options for immunocompromised patients who have adenovirus infection.

Case Report

A 4-year-old previously well boy presents with fever, bilateral conjunctivitis, and a rash. Five days ago, while at child care, he began to complain of a sore throat. He developed a nonproductive, nonparoxysmal cough and clear rhinorrhea. Throughout the illness, he was anorexic and “not himself” according to his mother. On physical examination, he appears quiet and unwell and has a fever. His temperature is 104°F (40°C), heart rate is 120 beats/min, respiratory rate is 24 breaths/min, and blood pressure is 114/86 mm Hg. There is bilateral mild, nonpitting periorbital edema; mild conjunctival injection; and some greenish discharge from the eyes. One soft, tender, enlarged 1.5-cm diameter cervical node can be palpated. A 2/6 vibratory systolic ejection murmur is audible at the left sternal border. A blanching pink maculopapular rash is visible on the face, limbs, trunk, and lateral borders of the feet.

The clinical impression suggests a viral illness, but because Kawasaki disease is part of the differential diagnosis, some investigations are performed. The white blood cell count is 8.5×10³/mcL (8.5×10⁹/L), hemoglobin is 10.2 mg/dL (102 g/L), and platelet count is 251×10³/mcL (251×10⁹/L). A few atypical and reactive lymphocytes are seen on the peripheral smear. Bacterial cultures of the throat and blood are negative.

Defervescence occurs on day 7 of the illness; the other symptoms resolve over the ensuing 3 days. A culture of the posterior pharynx taken on admission grows adenovirus.

Introduction

In 1953, Rowe and associates described an infectious agent …