Adenovirus
Double-stranded, non-enveloped DNA viruses. Has a 5-9 day incubation period. Can lay dormant in lymphatic tissue and shed even after the individual has recovered.
52 human subtypes exist and are grouped based on hemagglutination. Epidemics can occur where there is increased contact between individuals.
Cellular Targets
Transmitted through direct contact with aerosol droplets, blood, contaminated water, or fecal-oral contamination. Mediated by the mucosal inflammatory response in the conjunctiva, GI tract, or respiratory tract.
Clinical Features
The majority of cases present with mild symptoms, and half of cases are asymptomatic. Immunocompromised individuals and military recruits (as they live in close quarters) can have severe manifestations of the disease.
Common symptoms
General flu-like: Fever, sore throat, headache, earache, conjunctivitis.
Respiratory: Cough, coryza (rhinitis)
Gastrointestinal & genitourinary: Vomiting, diarrhea, abdominal pain, dysuria, hematuria
Physical exam
Fever, tonsillar erythema with or without exudate, cervical lymphadenopathy, and otitis media.
Key syndromes
- Upper respiratory tract infections: Pharyngitis, bronchiolitis, and croup
- Lower respiratory tract infections: Can develop into severe pneumonia
- Adenovirus-associated hemorrhagic cystitis: dysuria, frequent urination, hematuria (pink urine)
- Adenovirus-associated gastroenteritis: Mesenteric adenitis (abdominal lymph node inflammation), intussusception (telescoping intestines)
Ocular disease
- Acute follicular conjunctivitis: Conjunctivitis with watery discharge and preauricular lymphadenopathy
- Keratoconjunctivitis: Unilateral ocular redness. Can be caused by contaminated instruments or ophthalmic solution
- Pharyngoconjunctival fever: Triad of fever, pharyngitis, and conjunctivitis. Associated with unchlorinated pools and lakes.
Diagnosis
Indirect: Antibody detection
Direct: PCR and Direct Hybridization Assay (most common)
Management
Most cases are self-limited and require only supportive therapy. Could consider Cidofovir or Ribavirin for immunocompromised folks.