Acute respiratory tract infection: Respiratory infection is more common in children. Upper respiratory tract infection is more common and usually mild in nature. In symptomatic cases, it manifests with pharyngitis or tracheitis accompanied with constitutional symptoms, such as fever, myalgia, headache, malaise. In infants, it may be associated with otitis media. Exudative tonsillitis caused by adenovirus is clinically indistinguishable from group A streptococcal infection. HAdV has also been associated with pertussis-like syndrome. Lower respiratory tract illness is characterized by fever, cough, and shortness of breath with bilateral ground glass patchy lung opacity.

The upper respiratory tract illnesses are commonly caused by AdV serotypes 1, 2, 5, and 6 of species C, whereas serotypes 3, 7, 14 and 21 of species B are mostly responsible for lower respiratory tract illness including severe complicated pneumonia.

Ocular infection: Eye infections of AdV can occur in the form of pharyngoconjunctival fever (PCF) or epidemic keratoconjunctivitis (EKC).

Pharyngoconjunctival fever (PCF) is a syndrome that is characterized by pharyngitis, follicular conjunctivitis, fever and cervical lymphadenopathy. Infection can occur as sporadic infection in children or as community outbreaks mostly due to improper chlorination in swimming pools. Disease is usually self limiting in nature with rare corneal complications. HAdV types 3 and 7 are the two most common serotypes associated with PCF.

Epidemic keratoconjunctivitis (EKC) is characterized by severe unilateral or bilateral follicular conjunctivitis, edema of eyelids and subepithelial corneal infiltrates. Corneal involvement is usually painful and leads to blurring of vision. Incubation period is around 4–7 days. Symptoms may subside in 2 weeks to 1 month but corneal opacity may persist for a long time; months to years with reduced vision, photophobia and foreign body sensation (Fig. 1).

Fig1. Adenovirus keratoconjunctivitis

EKC commonly occurs in outbreaks in schools or hospital settings. The infection is highly contagious and commonly transmitted through ophthalmic instruments and lotions or directly through eye secretion. HAdV serotypes 8, 19 and 37 have been commonly associated with EKC.

Gastrointestinal disease: Acute gastrointestinal infection is caused by HAdV serotypes 40 and 41. The disease is common in infants and attribute to around 5% of acute diarrheal illness in children. It is manifested as acute diarrhea which is accompanied by fever, vomiting and abdominal pain. Symptoms usually last for about 8–10 days.

Hemorrhagic cystitis (HC): Acute hemorrhagic cystitis occurs in children and immunocompromised individuals. The disease is characterized by sudden onset of hematuria with dysuria. Hematuria lasts for around 3 days, whereas dysuria and microscopic hematuria may persist for a few more days. Adenoviruses 11 and 21 have been commonly associated with HC.

Myocarditis: Adenovirus is considered to be one of the major causes of acute viral myocarditis, particularly in children. The disease process is believed to be immune mediated following the acute respiratory tract infection. The association of adenovirus has been shown by detection of viral DNA in myocardial tissue. Outbreaks of adenovirus associated acute myocarditis have been reported.

Infections in immunocompromised patients: Amongst the immunocompromised patients, symptomatic adenoviral infection is more common in transplant recipients. Most of the infections occur within 3 months of transplantation. In solid organ transplant recipients (SOT), the transplanted organ is the primary site of infection. Hence, the manifestation is mostly related to the organ transplant such as hepatitis in liver transplant, hemorrhagic cystitis in renal transplant and pneumonia in lung transplant cases. In hematologic stem cell transplant (HSCT) recipients, symptoms can range from pneumonia, hepatitis, nephritis, enteritis, meningoencephalitis or disseminated disease.

The severity of infection is much more in pediatric patients as compared to the adults and more in patients receiving antilymphocyte antibodies. Presence of viral DNA in the blood has been associated with severity of disease and high rate of mortality.

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المزيد

مواضيع ذات صلة

JCPyV and progressive multifocal leukoencephalopathy (PML)

Polyomavirus-associated nephropathy (PVAN)

Mechanisms of RNA virus genome replication

Epidemiology Human Papillomavirus

Pathogenesis of Human Papillomavirus

Clinical Syndromes of EBV

EBV Life Cycle

Epstein–Barr virus

Treatment of Cytomegalovirus

Diagnosis of Cytomegalovirus

Clinical Manifestations of Cytomegalovirus

The Viral Genome