Adenovirus infections are common in pediatric populations, causing a wide spectrum of clinical manifestations. These DNA viruses belong to the Adenoviridae family and are known for their ability to cause respiratory, gastrointestinal, and ocular diseases, among others. With over 50 serotypes identified, adenoviruses pose significant challenges in diagnosis and management, particularly in children due to their immature immune systems.
Key points:
Adenoviruses are non-enveloped, double-stranded DNA viruses
They are capable of causing infections throughout the year
Infections can range from mild to severe, occasionally life-threatening in immunocompromised children
Understanding adenovirus infections is crucial for pediatricians and medical professionals dealing with child health
Epidemiology of Adenovirus Infections in Children
Adenovirus infections occur worldwide and affect individuals of all ages, but are particularly common in children.
Incidence:
Accounts for 5-10% of respiratory infections in children
Responsible for 10-15% of gastroenteritis cases in pediatric populations
Age distribution:
Peak incidence in children under 5 years of age
Infants and young children are most susceptible
Seasonality:
Can occur year-round
Some serotypes show seasonal patterns (e.g., types 3 and 7 more common in summer)
Outbreaks:
Common in closed or crowded settings (schools, daycare centers, summer camps)
Military recruits are also at high risk
Serotype distribution:
Types 1-7 and 14 are most commonly associated with respiratory disease
Types 40 and 41 are primary causes of gastroenteritis
Pathophysiology and Transmission of Adenovirus
Pathophysiology:
Adenoviruses infect and replicate in epithelial cells of the respiratory tract, eyes, and gastrointestinal tract. The pathogenesis involves:
Viral attachment to host cell receptors (e.g., CAR - Coxsackievirus and Adenovirus Receptor)
Endocytosis and release of viral DNA into the host cell nucleus
Viral replication and assembly within the host cell
Cell lysis and release of new viral particles
Inflammatory response leading to tissue damage and clinical symptoms
Transmission:
Adenoviruses are highly contagious and can spread through various routes:
Respiratory droplets (coughing, sneezing)
Fecal-oral route
Direct contact with infected secretions
Contaminated surfaces or objects (fomites)
Contaminated water (swimming pools)
The incubation period typically ranges from 2 to 14 days, depending on the serotype and route of transmission. Infected individuals can shed the virus for weeks to months, even after symptom resolution, contributing to its efficient spread, especially in close-contact settings.
Clinical Manifestations of Adenovirus Infections in Children
Adenovirus infections can affect multiple organ systems, leading to a diverse range of clinical presentations:
1. Respiratory Tract Infections:
Upper Respiratory Tract:
Common cold symptoms
Pharyngitis
Tonsillitis
Lower Respiratory Tract:
Bronchiolitis
Pneumonia (can be severe, especially in immunocompromised children)
2. Gastrointestinal Manifestations:
Acute gastroenteritis (particularly types 40 and 41)
Diarrhea, often watery and prolonged
Abdominal pain, vomiting
3. Ocular Infections:
Conjunctivitis (often bilateral)
Pharyngoconjunctival fever
Epidemic keratoconjunctivitis (more common in adults)
4. Genitourinary Tract:
Hemorrhagic cystitis (more common in immunocompromised children)
5. Central Nervous System:
Meningitis (rare)
Encephalitis (rare)
6. Systemic Infections:
Disseminated disease in immunocompromised hosts
Fever, often high and prolonged
Lymphadenopathy
Note: The severity and duration of symptoms can vary widely, from mild self-limiting illness to severe, life-threatening conditions, especially in immunocompromised children or those with underlying respiratory or cardiac conditions.
Diagnosis and Laboratory Findings in Adenovirus Infections
Clinical Diagnosis:
Initial diagnosis is often based on clinical presentation, but confirmatory tests are necessary due to the non-specific nature of symptoms.
Laboratory Diagnosis:
Viral Detection:
PCR (Polymerase Chain Reaction):
Most sensitive and specific method
Can detect multiple serotypes
Results available within hours
Rapid Antigen Detection Tests:
Less sensitive than PCR
Provides quick results (within 30 minutes)
Useful for point-of-care testing
Viral Culture:
Gold standard for live virus detection
Time-consuming (7-21 days for results)
Allows for serotype identification
Serology:
Complement Fixation Test
ELISA (Enzyme-Linked Immunosorbent Assay)
Useful for epidemiological studies but less practical for acute diagnosis
Specimen Collection:
Nasopharyngeal swabs or aspirates for respiratory infections
Conjunctival swabs for ocular infections
Stool samples for gastrointestinal infections
Urine samples for suspected urinary tract involvement
Other Laboratory Findings:
Complete Blood Count (CBC):
May show leukocytosis or lymphocytosis
Atypical lymphocytes may be present
C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR):
May be elevated, indicating inflammation
Chest X-ray (in respiratory infections):
May show interstitial infiltrates or lobar consolidation
Differential Diagnosis: Consider other viral and bacterial pathogens causing similar symptoms, such as influenza, respiratory syncytial virus (RSV), and bacterial pneumonia.
Treatment of Adenovirus Infections in Children
General Approach:
Treatment is primarily supportive, as most adenovirus infections are self-limiting in immunocompetent children.
Supportive Care:
Hydration:
Oral rehydration for mild cases
Intravenous fluids for severe dehydration or inability to tolerate oral intake
Fever management:
Acetaminophen or ibuprofen for fever and pain relief
Avoid aspirin in children due to the risk of Reye's syndrome
Respiratory support:
Oxygen therapy for hypoxemia
Nebulized bronchodilators for wheezing (if indicated)
Mechanical ventilation in severe cases
Nutritional support:
Ensure adequate caloric intake
Consider nasogastric or parenteral nutrition in prolonged illness
Antiviral Therapy:
No FDA-approved antiviral drugs specifically for adenovirus. However, in severe cases or immunocompromised patients, the following may be considered:
Cidofovir:
Used in severe infections, especially in immunocompromised patients
Significant nephrotoxicity limits its use
Brincidofovir:
An oral prodrug of cidofovir with less nephrotoxicity
Still under investigation for adenovirus infections
Ribavirin:
Limited evidence of efficacy
Sometimes used in combination with immunoglobulin in severe cases
Immunoglobulin Therapy:
Intravenous immunoglobulin (IVIG) may be considered in severe cases or immunocompromised patients, although evidence for efficacy is limited.
Management of Specific Manifestations:
Conjunctivitis: Artificial tears, cold compresses
Pharyngitis: Salt water gargles, throat lozenges (in older children)
Diarrhea: Probiotics may be considered
Antibiotic Use:
Antibiotics are not effective against adenovirus and should be reserved for suspected or confirmed bacterial co-infections.
Note: Treatment decisions should be individualized based on the severity of illness, patient's immune status, and specific clinical manifestations. Close monitoring is essential, especially in severe cases or immunocompromised children.
Prevention of Adenovirus Infections in Children
General Preventive Measures:
Hand Hygiene:
Regular handwashing with soap and water for at least 20 seconds
Use of alcohol-based hand sanitizers when soap and water are not available
Respiratory Etiquette:
Covering mouth and nose when coughing or sneezing
Proper disposal of used tissues
Environmental Cleaning:
Regular disinfection of frequently touched surfaces
Use of EPA-approved disinfectants effective against adenovirus
Isolation Precautions:
Keeping infected children at home until symptoms resolve
In healthcare settings, implement contact and droplet precautions
Avoid Sharing Personal Items:
Towels, washcloths, and other personal hygiene items
Specific Prevention Strategies:
Vaccination:
Currently, an oral adenovirus vaccine is available only for U.S. military personnel
No licensed vaccine for civilian use, but research is ongoing
Swimming Pool Safety:
Proper chlorination and maintenance of swimming pools
Avoid swimming when experiencing diarrhea
Eye Care:
Avoid touching or rubbing eyes with unwashed hands
Do not share eye makeup or contact lens solutions
Healthcare Setting Precautions:
Proper sterilization of medical equipment
Use of personal protective equipment (PPE) when caring for infected patients
Cohorting of infected patients during outbreaks
Prevention in High-Risk Groups:
Immunocompromised Children:
Strict adherence to hand hygiene and environmental cleaning
Limited exposure to potentially infected individuals
Consider prophylactic measures in consultation with specialists
Neonates and Infants:
Breastfeeding may provide some protective antibodies
Limit exposure to sick contacts
Children with Chronic Lung Diseases:
Ensure up-to-date vaccinations for other preventable respiratory diseases
Optimize management of underlying conditions
Education and Awareness:
Educate families, caregivers, and school staff about adenovirus transmission and prevention
Promote awareness of symptoms to encourage early detection and isolation
Note: While these preventive measures can significantly reduce the risk of adenovirus infections, complete prevention is challenging due to the virus's ubiquitous nature and multiple transmission routes. Consistent implementation of these strategies is key to minimizing spread, especially in high-risk settings.
Complications of Adenovirus Infections in Children
While most adenovirus infections in immunocompetent children are self-limiting, complications can occur, especially in severe cases or in immunocompromised individuals. Understanding these complications is crucial for early recognition and management.
Respiratory Complications:
Acute Respiratory Distress Syndrome (ARDS):
Severe lung inflammation leading to impaired gas exchange
May require mechanical ventilation
Bronchiolitis Obliterans:
Chronic airway obstruction due to inflammation and fibrosis
Can lead to long-term respiratory impairment
Superinfection:
Secondary bacterial infections, such as pneumonia
Can complicate recovery and prolong hospitalization
Gastrointestinal Complications:
Intussusception:
Rare but serious complication, especially in infants
Requires prompt diagnosis and management
Hepatitis:
More common in immunocompromised children
Can range from mild to severe liver dysfunction
Neurological Complications:
Meningoencephalitis:
Inflammation of the brain and meninges
Can lead to seizures, altered mental status, and long-term neurological sequelae
May cause temporary or permanent vision impairment
Urinary Tract Complications:
Hemorrhagic Cystitis:
More common in immunocompromised children
Can cause significant hematuria and bladder discomfort
Systemic Complications:
Disseminated Intravascular Coagulation (DIC):
Rare but life-threatening complication
Can occur in severe, systemic adenovirus infections
Myocarditis:
Inflammation of the heart muscle
Can lead to cardiac dysfunction and arrhythmias
Long-term Sequelae:
Post-viral Fatigue Syndrome:
Prolonged fatigue and weakness following infection
Can persist for weeks to months
Bronchiectasis:
Permanent dilatation of bronchi following severe respiratory infection
Can lead to recurrent respiratory infections
Note: The risk and severity of complications are significantly higher in immunocompromised children, those with underlying medical conditions, and in very young infants. Close monitoring and early intervention are crucial in managing these complications.
Special Considerations in Adenovirus Infections in Children
1. Immunocompromised Children:
Higher risk of severe and disseminated infections
May have prolonged viral shedding
Consider early antiviral therapy (e.g., cidofovir)
Close monitoring for complications
May benefit from IVIG therapy
2. Neonates and Young Infants:
Higher risk of severe disease due to immature immune systems
May present with sepsis-like syndrome
Consider adenovirus in differential diagnosis of neonatal hepatitis
Careful monitoring for dehydration and respiratory distress
3. Children with Chronic Lung Diseases:
Higher risk of severe respiratory complications
May experience exacerbations of underlying conditions (e.g., asthma)
Close monitoring of respiratory status and oxygen saturation
Early intervention with respiratory support if needed
4. Nosocomial Infections:
Adenovirus can cause outbreaks in healthcare settings
Implement strict infection control measures
Consider cohorting infected patients during outbreaks
Educate healthcare staff on prevention strategies
5. Adenovirus in Transplant Recipients:
High risk of severe and disseminated disease
May affect graft function in solid organ transplants
Regular screening may be necessary in high-risk periods
Consider pre-emptive or prophylactic strategies in consultation with transplant specialists
6. Persistent or Recurrent Infections:
Some children may experience prolonged or recurrent symptoms
Consider underlying immune deficiencies in these cases
Evaluate for other concurrent infections or complications
7. Vaccine Considerations:
No licensed vaccine for general pediatric use
Research ongoing for potential vaccine development
Discuss potential future vaccine options with families
8. Psychosocial Aspects:
Address parental concerns and anxiety
Provide education on expected course and warning signs
Consider impact of prolonged illness on school attendance and family dynamics
9. Follow-up Care:
Arrange appropriate follow-up, especially for severe cases
Monitor for long-term sequelae in complicated cases
Consider pulmonary function testing for children with severe respiratory involvement
10. Emerging Serotypes and Variants:
Stay informed about emerging adenovirus serotypes or variants
Be aware of changing epidemiological patterns
Consider participation in surveillance programs or research studies
These special considerations highlight the importance of individualized care and the need for a comprehensive approach to managing adenovirus infections in different pediatric populations. Collaboration between primary care providers, specialists, and infection control teams is often necessary for optimal management.
Introduction to Complications of Adenovirus Infections in Children
Adenovirus infections in children can range from mild, self-limiting illnesses to severe, life-threatening conditions. While most immunocompetent children recover without significant sequelae, a subset may develop complications that can affect various organ systems. Understanding these complications is crucial for early recognition, appropriate management, and improved outcomes.
Key points:
Complications can occur in both immunocompetent and immunocompromised children
The severity and type of complications can vary based on the adenovirus serotype, age of the child, and underlying health conditions
Complications may arise during the acute phase of infection or as long-term sequelae
Prompt recognition and management of complications are essential to prevent morbidity and mortality
Respiratory Complications of Adenovirus in Children
1. Acute Respiratory Distress Syndrome (ARDS):
Definition: Severe inflammatory lung condition leading to impaired gas exchange
Pathophysiology:
Diffuse alveolar damage
Increased capillary permeability leading to pulmonary edema
Hyaline membrane formation
Clinical features:
Severe dyspnea
Hypoxemia refractory to oxygen therapy
Bilateral infiltrates on chest imaging
Management:
Mechanical ventilation with lung-protective strategies
Prone positioning in severe cases
Consideration of extracorporeal membrane oxygenation (ECMO) in refractory cases
2. Bronchiolitis Obliterans:
Definition: Chronic airway obstruction due to inflammation and fibrosis of small airways
Pathophysiology:
Injury to bronchiolar epithelium
Inflammatory response leading to fibrosis and scarring
Progressive narrowing or obliteration of small airways
Clinical features:
Persistent cough and wheezing
Exercise intolerance
Recurrent respiratory infections
Diagnosis:
Pulmonary function tests showing fixed airway obstruction
Positive bacterial cultures from respiratory specimens
Management:
Appropriate antibiotic therapy based on local resistance patterns
Supportive care including oxygen therapy and hydration
Close monitoring for clinical improvement
4. Persistent Atelectasis:
Definition: Collapse of lung tissue due to obstruction of airways by mucus plugs or inflammation
Clinical features:
Decreased breath sounds over affected area
Persistent cough
Recurrent respiratory infections
Management:
Chest physiotherapy and postural drainage
Bronchodilators to improve airway clearance
Consideration of bronchoscopy for mucus plug removal in severe cases
Note: The severity and likelihood of these respiratory complications can vary based on the child's age, underlying health status, and the specific adenovirus serotype involved. Early recognition and appropriate management are crucial to prevent long-term respiratory sequelae.
Gastrointestinal Complications of Adenovirus in Children
1. Intussusception:
Definition: Telescoping of one portion of the intestine into another
Pathophysiology:
Adenovirus infection can cause lymphoid hyperplasia in the intestinal wall
Enlarged lymphoid tissue acts as a lead point for intussusception
Clinical features:
Sudden onset of severe, colicky abdominal pain
Vomiting, often bilious
"Currant jelly" stools (mixed with blood and mucus)
Diagnosis:
Ultrasound showing "target" or "doughnut" sign
Abdominal CT in equivocal cases
Management:
Air or hydrostatic enema for reduction (if no signs of perforation)
Surgical intervention if enema reduction fails or complications are present
2. Hepatitis:
Definition: Inflammation of the liver due to adenovirus infection
Pathophysiology:
Direct viral invasion of hepatocytes
Immune-mediated liver damage
Clinical features:
Jaundice
Hepatomegaly
Elevated liver enzymes (AST, ALT)
Diagnosis:
Liver function tests showing elevated transaminases
PCR detection of adenovirus in liver tissue or blood
Management:
Supportive care
Monitoring of liver function and coagulation parameters
Consideration of antiviral therapy in severe cases or immunocompromised patients
3. Mesenteric Adenitis:
Definition: Inflammation of mesenteric lymph nodes, often mimicking appendicitis
Definition: Excessive loss of protein through the gastrointestinal tract
Pathophysiology:
Damage to intestinal mucosa leading to increased permeability
Lymphatic obstruction due to inflammation
Clinical features:
Edema
Hypoalbuminemia
Prolonged diarrhea
Diagnosis:
Low serum albumin and total protein levels
Elevated fecal alpha-1 antitrypsin
Management:
Nutritional support
Albumin replacement in severe cases
Treatment of underlying adenovirus infection
Note: Gastrointestinal complications of adenovirus can range from mild and self-limiting to severe and life-threatening. Early recognition and appropriate management are crucial, especially in cases of intussusception where timely intervention can prevent intestinal ischemia and perforation.
Neurological Complications of Adenovirus in Children
1. Meningoencephalitis:
Definition: Inflammation of the brain and surrounding meninges
Pathophysiology:
Direct viral invasion of the central nervous system
Immune-mediated damage to neural tissues
Clinical features:
Altered mental status
Seizures
Focal neurological deficits
Signs of meningeal irritation (neck stiffness, Kernig's sign, Brudzinski's sign)
Diagnosis:
CSF analysis showing pleocytosis and elevated protein
PCR detection of adenovirus in CSF
MRI brain showing areas of inflammation or edema
Management:
Supportive care
Anticonvulsants for seizure control
Monitoring of intracranial pressure
Consideration of antiviral therapy in severe cases
Nerve conduction studies showing demyelination or axonal damage
Management:
Intravenous immunoglobulin (IVIG) or plasmapheresis
Supportive care, including respiratory support if needed
Physical therapy and rehabilitation
3. Acute Disseminated Encephalomyelitis (ADEM):
Definition: Immune-mediated demyelinating disorder affecting the brain and spinal cord
Pathophysiology:
Post-infectious autoimmune reaction leading to multifocal demyelination
Clinical features:
Encephalopathy
Multifocal neurological deficits
Seizures
Optic neuritis
Diagnosis:
MRI showing multifocal white matter lesions
CSF analysis may show mild pleocytosis and elevated protein
Management:
High-dose corticosteroids
IVIG in steroid-resistant cases
Supportive care and rehabilitation
4. Cerebellitis:
Definition: Inflammation of the cerebellum
Clinical features:
Ataxia
Nystagmus
Dysarthria
Headache and vomiting due to increased intracranial pressure
Diagnosis:
MRI showing cerebellar edema or inflammation
CSF analysis may show pleocytosis
Management:
Supportive care
Monitoring for hydrocephalus
Consideration of corticosteroids in severe cases
5. Transverse Myelitis:
Definition: Inflammation of the spinal cord
Clinical features:
Rapid onset of motor, sensory, and autonomic dysfunction
Bilateral symptoms with a clear sensory level
Urinary retention and constipation
Diagnosis:
MRI spine showing cord inflammation
CSF analysis may show pleocytosis and elevated protein
Management:
High-dose corticosteroids
Plasmapheresis or IVIG in severe cases
Supportive care and rehabilitation
Note: Neurological complications of adenovirus infections in children can be severe and potentially life-threatening. Early recognition, prompt diagnosis, and appropriate management are crucial for improving outcomes. Long-term follow-up may be necessary to monitor for neurological sequelae and provide ongoing support and rehabilitation.
Ocular Complications of Adenovirus in Children
1. Epidemic Keratoconjunctivitis (EKC):
Definition: Severe form of viral conjunctivitis affecting both the conjunctiva and cornea
Etiology: Commonly caused by adenovirus serotypes 8, 19, and 37
Clinical features:
Sudden onset of red, painful eyes
Photophobia
Watery discharge
Subconjunctival hemorrhage
Preauricular lymphadenopathy
Complications:
Subepithelial corneal infiltrates
Corneal scarring in severe cases
Symblepharon formation
Management:
Supportive care with artificial tears and cold compresses
Topical antibiotics to prevent secondary bacterial infection
Topical corticosteroids for severe inflammation (under ophthalmological supervision)
2. Pharyngoconjunctival Fever:
Definition: Syndrome characterized by conjunctivitis, pharyngitis, and fever
Etiology: Often caused by adenovirus serotypes 3, 4, and 7
Clinical features:
Bilateral conjunctivitis
Sore throat and pharyngeal erythema
Fever
Preauricular and cervical lymphadenopathy
Management:
Symptomatic treatment for fever and sore throat
Artificial tears and cool compresses for eye symptoms
3. Acute Hemorrhagic Conjunctivitis:
Definition: Severe form of conjunctivitis characterized by subconjunctival hemorrhages
Clinical features:
Sudden onset of eye pain and redness
Subconjunctival hemorrhages
Lid edema
Watery discharge
Management:
Supportive care
Artificial tears and lubricants
Topical antibiotics if secondary bacterial infection is suspected
4. Corneal Complications:
Superficial Punctate Keratitis:
Multiple small epithelial defects on the cornea
Can cause foreign body sensation and photophobia
Corneal Ulceration:
Rare but serious complication
Can lead to corneal scarring and visual impairment
Management:
Frequent lubrication of the eye
Topical antibiotics to prevent secondary bacterial infection
Close monitoring by an ophthalmologist
5. Long-term Ocular Sequelae:
Dry Eye Syndrome:
Due to damage to conjunctival goblet cells
May require long-term use of artificial tears
Corneal Scarring:
Can cause permanent visual impairment
May require corneal transplantation in severe cases
Chronic Conjunctivitis:
Persistent inflammation of the conjunctiva
May require long-term management
Note: Ocular complications of adenovirus can be highly contagious and may lead to outbreaks in schools or households. Proper hand hygiene and avoidance of sharing personal items are crucial in preventing spread. Patients should be advised to seek prompt ophthalmological care if symptoms worsen or persist, as some complications can lead to long-term visual impairment if not managed appropriately.
Urinary Tract Complications of Adenovirus in Children
1. Hemorrhagic Cystitis:
Definition: Inflammation of the bladder characterized by hematuria
Etiology: Commonly associated with adenovirus serotypes 11 and 21
Pathophysiology:
Direct viral invasion of bladder epithelium
Immune-mediated damage to bladder mucosa
Clinical features:
Gross hematuria
Dysuria
Frequency and urgency
Suprapubic pain
Diagnosis:
Urinalysis showing hematuria and pyuria
PCR detection of adenovirus in urine
Cystoscopy may show hemorrhagic and inflamed bladder mucosa
Management:
Supportive care with hydration
Pain management
Bladder irrigation in severe cases
Antiviral therapy (e.g., cidofovir) in immunocompromised patients
2. Acute Kidney Injury (AKI):
Pathophysiology:
Direct viral cytopathic effect on renal tubular cells
Immune complex-mediated damage
Renal hypoperfusion due to severe systemic illness
Clinical features:
Decreased urine output
Edema
Hypertension
Diagnosis:
Elevated serum creatinine and blood urea nitrogen
Electrolyte imbalances
Renal ultrasound may show increased echogenicity
Management:
Fluid and electrolyte management
Renal replacement therapy in severe cases
Treatment of underlying adenovirus infection
3. Tubulointerstitial Nephritis:
Pathophysiology: Inflammation of the renal interstitium and tubules
Clinical features:
Non-specific symptoms such as fever and flank pain
Acute kidney injury
Diagnosis:
Urinalysis showing sterile pyuria and proteinuria
Renal biopsy showing interstitial inflammation and tubular damage
Management:
Supportive care
Corticosteroids in severe cases
4. Obstructive Uropathy:
Pathophysiology: Rarely, severe hemorrhagic cystitis can lead to clot formation and urinary tract obstruction
Clinical features:
Anuria or oliguria
Suprapubic pain
Bladder distension
Diagnosis:
Ultrasound showing hydronephrosis or bladder clots
CT urogram in complex cases
Management:
Bladder irrigation and clot evacuation
Urinary catheterization
Surgical intervention if conservative measures fail
5. Long-term Sequelae:
Chronic Kidney Disease:
Rare complication following severe or recurrent adenovirus-associated kidney injury
Requires long-term nephrological follow-up
Bladder Fibrosis:
Can occur following severe hemorrhagic cystitis
May lead to reduced bladder capacity and urinary symptoms
Note: Urinary tract complications of adenovirus are more common in immunocompromised children, particularly those who have undergone hematopoietic stem cell transplantation. Early recognition and management of these complications are crucial to prevent long-term renal and urological sequelae. Close collaboration between pediatricians, nephrologists, and urologists is often necessary for optimal management of these cases.
Adenovirus Infection in Children
What is the causative agent of adenovirus infections?
Answer: Adenovirus, a double-stranded DNA virus
How many serotypes of human adenoviruses have been identified?
Answer: Over 50 serotypes
What are the most common clinical manifestations of adenovirus infection in children?
Answer: Respiratory tract infections, gastroenteritis, and conjunctivitis
How is adenovirus primarily transmitted among children?
Answer: Through respiratory droplets, fecal-oral route, and direct contact with infected secretions
What is the typical incubation period for adenovirus infection?
Answer: 2-14 days, typically 5-6 days
Which age group is most commonly affected by adenovirus infections?
Answer: Children under 5 years old
What is the seasonality of adenovirus infections?
Answer: Can occur year-round, but some types peak in late winter, spring, and early summer
What is pharyngoconjunctival fever, and which adenovirus serotypes cause it?
Answer: A syndrome of fever, pharyngitis, and conjunctivitis; commonly caused by serotypes 3, 7, and 14
How long can adenovirus persist in the environment?
Answer: Can survive on surfaces for weeks
Which diagnostic test is most commonly used to detect adenovirus?
Answer: PCR of appropriate clinical specimens (e.g., nasopharyngeal swabs, stool)
What is the recommended treatment for uncomplicated adenovirus infections in children?
Answer: Supportive care, including hydration and symptom management
How long can children shed adenovirus after infection?
Answer: Weeks to months, depending on the site of infection
What is the most severe pulmonary complication of adenovirus infection in children?
Answer: Necrotizing pneumonia or bronchiolitis obliterans
How does adenovirus infection affect immunocompromised children?
Answer: Can cause severe, disseminated disease with high mortality
What is the role of cidofovir in treating adenovirus infections?
Answer: Used in severe cases, particularly in immunocompromised patients
Which adenovirus serotypes are most commonly associated with epidemic keratoconjunctivitis?
Answer: Serotypes 8, 19, and 37
How does adenovirus infection present in neonates?
Answer: Can cause severe pneumonia, hepatitis, and meningoencephalitis
What is the significance of adenovirus in pediatric transplant recipients?
Answer: Can cause graft failure and fatal disseminated disease
How does adenovirus infection affect children with asthma?
Answer: Can trigger asthma exacerbations and is associated with development of asthma
What is the role of adenovirus in causing acute gastroenteritis in children?
Answer: Second most common cause after rotavirus in young children
How does adenovirus infection present in the urinary tract of children?
Answer: Can cause hemorrhagic cystitis, particularly in immunocompromised patients
What is the potential long-term sequela of adenovirus pneumonia in children?
Answer: Bronchiectasis and bronchiolitis obliterans
How does adenovirus infection affect children with chronic lung diseases?
Answer: Can cause severe exacerbations and prolonged viral shedding
What is the role of intravenous immunoglobulin (IVIG) in treating adenovirus infections?
Answer: May be used in severe cases, particularly in immunocompromised patients
How does adenovirus infection present in the central nervous system of children?
Answer: Can cause meningoencephalitis, though less commonly than other viruses
What is the significance of adenovirus detection in stool samples of asymptomatic children?
Answer: May indicate prolonged shedding from a previous infection
How does adenovirus infection affect children with congenital heart disease?
Answer: Can cause more severe respiratory infections and myocarditis
What is the role of hand hygiene in preventing adenovirus transmission?
Answer: Critical; proper hand washing is one of the most effective prevention methods
How does adenovirus infection impact children undergoing hematopoietic stem cell transplantation?
Answer: Can cause severe, often fatal, disseminated disease
What is the potential role of adenovirus in causing obesity in children?
Answer: Some studies suggest adenovirus 36 may contribute to obesity, but evidence is inconclusive
How does adenovirus infection present in the eyes of children?
Answer: Can cause follicular conjunctivitis, which may be severe and prolonged
What is the significance of adenovirus serotype 14 in pediatric respiratory infections?
Answer: Associated with more severe pneumonia and higher mortality in some outbreaks
How does adenovirus infection affect children with primary immunodeficiencies?
Answer: Can cause severe, prolonged, and disseminated infections
What is the role of adenovirus typing in clinical management of infections?
Answer: Mainly used for epidemiological purposes; not routinely performed for patient management
How does adenovirus infection impact children with Down syndrome?
Answer: They are at higher risk for severe lower respiratory tract infections and hospitalization
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
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