Adenovirus

  • Diagnosis
  • Background
  • Lab Tests
  • References
  • Related Topics

Indications for Testing

  • Severe pneumonia in
    • Immunocompromised patient
    • Military recruit
    • Young child

Laboratory Testing

  • CDC diagnosis recommendations for adenovirus
  • Immunocompetent patients
    • Most cases are diagnosed based on clinical presentation alone
    • Antigen/DNA testing
      • DFA – respiratory specimens or nasopharyngeal swabs
      • RT PCR (qualitative) – highly sensitive; nasopharyngeal swabs
        • Standard of care for diagnosing adenovirus in tissue specimen
      • EIA – most useful in fecal samples for types 40, 41in gastroenteric disease
    • Serologic testing relies on demonstration of antibodies to group-specific antigens
      • Typically used in epidemiological studies
      • Often requires acute and convalescent sera
  • Immunocompromised patients
    • PCR
      • Standard screening tool for immunocompromised patients suspected of have adeno infection
      • Peripheral blood viremia appears to be the only site indicative of disseminated infection
    • Viral culture
      • Gold standard
      • Use of blood samples – not recommended due to lack of sensitivity
      • Slow growth makes early diagnosis difficult
      • Not recommended for most patients

Histology

  • Immunohistochemistry – adenovirus stain

Differential Diagnosis

Adenoviruses usually cause mild, self-limiting respiratory illnesses, primarily in children. In immunocompromised patients, it may cause severe, fatal disease.

Epidemiology

  • Prevalence
    • Causes 5-7% of respiratory infections in children
    • Year-round infection
    • Rarely fatal, but 50% of infants and young children have prolonged, intermittent disease
  • Age – usually <10 years (primary infection)
  • Transmission
    • Respiratory droplet transfer
    • Fecal-oral route
    • Neonatal transmission following vaginal delivery (rare)
    • Nosocomial transmission reported (infected fomite transmission)

Organism

Risk Factors

  • Military service (recruit)
  • Immunocompromised status
  • Malnutrition in children <2 years
  • Transplant patients
    • Highest risk in allogeneic hematopoietic transplants with T-cell depletion, ATG treatment, or in the presence of graft versus host (grades III, IV)
    • Autologous transplants – much lower risk

Clinical Presentation

  • Immunocompetent patients
    • Most infections are mild, self-limited respiratory illness
    • Bronchiolitis, pneumonia
    • Gastroenteritis
    • Hemorrhagic cystitis
    • Epidemic keratoconjunctivitis
    • Fatal adenovirus infections can occur in infants and immunocompromised adults
    • Complications – hepatitis, acute colitis, cystitis, meningitis, encephalitis, myocarditis
  • Immunocompromised patients
    • Posttransplantation – solid organ
      • Usually 2-3 months after transplant
      • First symptoms – fever, enteritis, elevated transaminases, and pancytopenia
      • More severe disease in pediatric population
      • Often first manifests in organ of transplantation
    • Posttransplantation – hematopoietic stem cell (HSCT)
      • Ranges from mild gastroenteritis, respiratory disease to severe disease (multi-organ failure)
      • Disseminated disease is frequently fatal
    • HIV/AIDS
      • Most commonly subgroup B & D
      • Chronic diarrhea
      • Occasionally associated with fatal illness
Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Respiratory Viruses DFA with Reflex to Viral Culture, Respiratory 0060281
Method: Direct Fluorescent Antibody Stain/Cell Culture

Respiratory Viruses Rapid Culture 2001504
Method: Cell Culture/Immunofluorescence

Limitations 

Other viruses such as HSV, CMV, or human metapneumovirus not routinely detected in this culture

Limited sensitivity for adenovirus compared to conventional culture

Adenovirus, Quantitative PCR 2007192
Method: Quantitative Real-Time Polymerase Chain Reaction

Limitations 

Lower false-negative rate compared to DFA

Adenovirus by Qualitative PCR 2007473
Method: Qualitative Real-Time Polymerase Chain Reaction

Limitations 

Lower false-negative rate compared to DFA

Adenovirus 40-41 Antigens by EIA 0065066
Method: Qualitative Enzyme Immunoassay

Adenovirus by Immunohistochemistry 2003430
Method: Immunohistochemistry

Viral Culture, Non-Respiratory and Cytomegalovirus Rapid Culture 2006496
Method: Cell Culture/Immunofluorescence

Limitations 

Slow growth; not ideal for acute identification

General References

Echavarría M. Adenoviruses in immunocompromised hosts. Clin Microbiol Rev. 2008; 21(4): 704-15. PubMed

Kehl SC, Kumar S. Utilization of nucleic acid amplification assays for the detection of respiratory viruses. Clin Lab Med. 2009; 29(4): 661-71. PubMed

Lenaerts L, De Clercq E, Naesens L. Clinical features and treatment of adenovirus infections. Rev Med Virol. 2008; 18(6): 357-74. PubMed

Lion T. Adenovirus infections in immunocompetent and immunocompromised patients. Clin Microbiol Rev. 2014; 27(3): 441-62. PubMed

Lynch JP, Fishbein M, Echavarría M. Adenovirus. Semin Respir Crit Care Med. 2011; 32(4): 494-511. PubMed

Sivan AV, Lee T, Binn LN, Gaydos JC. Adenovirus-associated acute respiratory disease in healthy adolescents and adults: a literature review. Mil Med. 2007; 172(11): 1198-203. PubMed

Tebruegge M, Curtis N. Adenovirus: an overview for pediatric infectious diseases specialists. Pediatr Infect Dis J. 2012; 31(6): 626-7. PubMed

Medical Reviewers

Last Update: August 2016