Adenovirus infections are transmitted person-to-person and cause upper respiratory infections, conjunctivitis, pneumonia, gastroenteritis, and meningitis.
CASES/YEAR
43,000,000 (US); 860,000,000 (Global)
OTHER NAMES
Pharyngoconjunctival fever; Epidemic keratoconjunctivitis (EKC);
INCUBATION
5-12 days for EKC;
INITIAL SYMPTOMS
Cold symptoms, conjunctivitis, diarrhea in infants, cystitis, and pneumonia; [Merck Manual, p. 1684]
PRECAUTIONS
In an outbreak, use standard precautions and cohort patients and staff. [ABX Guide] See conjunctivitis, gastroenteritis, and pneumonia;
COMMENTS
Adenoviruses cause upper respiratory infections, conjunctivitis, pneumonia, gastroenteritis, and meningitis. Epidemic keratoconjunctivitis (EKC) is associated with serotypes 8, 19, and 37. Outbreaks occur in patients who have eye exams in clinics with inadequate disinfection of eye solution bottles and other equipment. Subconjunctival hemorrhages may occur. Some cases are associated with fever, pharyngitis, and keratitis. Outbreaks of rhinitis, fever, pharyngitis, conjunctivitis, and cervical adenitis (pharyngoconjunctival fever) occur in summer camps for children. Types 4 and 7 cause outbreaks of acute respiratory disease (ARD) first recognized in military recruits during World War II. Adenoviruses are icosahedron-shaped particles that are fairly resistant to chemicals and persist in the environment. Waterborne transmission occurs in swimming pools and small lakes. Infections of the lung, liver, and urinary tract in immunosuppressed patients are reported, especially in those receiving bone marrow or solid organ transplants. Encephalitis occurs in children and immunocompromised hosts in association with pneumonia. Acute hemorrhagic cystitis occurs in children. [CCDM, p. 120-3, 127-30, 402, 476; ID, p. 1898; PPID, p. 1235t, 1910-12; CDC website: "Adenoviruses";] Types 1, 2, 5, and 6 can cause mesenteric lymphadenitis, mimicking appendicitis, and occasionally cause intussusception." [PPID, p. 1911] Transmission occurs by inhalation, conjunctival inoculation, and probably by the fecal-oral route. [Harrison ID, p. 781]
DIAGNOSTIC
Culture; Paired sera; Detect antigens by immunofluorescence; DNA probe; [CCDM, p. 129]
SIGNS & SYMPTOMS
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>fever
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>myalgia
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E pharyngitis
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E rhinitis
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G abdominal pain
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G diarrhea
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G nausea, vomiting
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H leukopenia
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H lymphadenopathy
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N headache
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O conjunctivitis, acute
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O oculoglandular syndrome
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R chest pain
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R cough
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S lymphadenitis, acute
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U hematuria
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X hilar lymphadenopathy
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X lung infiltrates
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X pleural effusions
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*arthritis
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*bleeding tendency
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*bowel obstruction
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*encephalitis
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*hepatitis
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*meningitis
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*myocarditis
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*pancreatitis
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*pericarditis
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*pneumonia
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*pneumonitis
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*rhabdomyolysis
ENTRY
Inhalation, Ingestion, Skin or Mucous Membranes (Includes Conjunctiva), Swimming
SOURCE
Person-to-Person, Human Fecal-Oral, Waterborne (Ingesting, Inhaling, or Swimming)
RISK FACTORS
- Care for patients (droplet/airborne)
- Live together in close quarters
- Swim in contaminated water (ingestion or inhalation)
TREATMENT
Anti-viral drugs are used in immunocompromised patients/severe infections. [ABX Guide]
REFERENCES FOR CASES/YEAR
1. (US) About 10% of all acute respiratory infections in children, but <2% of those in civilian adults; [Harrison ID, p. 781] Calculate: use 1.2 billion URIs (US); Assume children are 20% of population; 10% x (20% x 1.2 billion) = 0.1 x 240,000,000 = 24,000,000; 2% x (80% x 1.2 billion) = 0.02 x 960,000,000 = 19,200,000; 24 million + 19 million = 43 million (US);
2. (Global) 20 X US cases/yr;