Summary Points

• There are no specific antiviral agents designed for the treatment of adenoviral infections
• Most immunocompetent patients experience a full recovery without any type of specific treatment
• Under special circumstances, Ribavirin and Cidofovir have been used in the treatment of adenovirus infections
• Hot and New! A study published in January 2004 showed that early diagnosis of an adenovirus infection could favorably affect patient treatment and outcome

Treatment for Adenovirus Infection

In most persons, an adenovirus infection is asymptomatic, thus, most infected persons do not even attempt to seek medical care for their infection. For patients who do experience symptoms, there are no specific antiviral treatments; often times the symptoms of the infection will gradually disappear on their own. Even though the virus can remain latent in the host's body at this time, they usually do not cause any type of discomfort to the host.

In rare cases, Ribavirin is used to treat adenovirus infection. Ribavirin is more commonly used in patients who are experiencing hemorrhagic cystitis or are undergoing a bone marrow transplant. The efficacy of ribavirin is unknown as it has not been rigorously tested in clinical trials. Cidofovir, a nucleoside analog used to treat herpes simplex infections, has been shown to be effective at inhibiting adenovirus replication in culture. A few small clinical trials have also suggested that treatment with Cidofovir has a positive impact upon patients.

There is no specific treatment for adenovirus infections. And you could get conjunctivitis.

Above image courtesy of www.tased.edu.au/tasonline/ tasvolam/humerus.htm

Hot and New! The Importance of Early Diagnosis of Adenovirus Infection

As stated earlier, adenovirus infection is quite common among young children. However, until the year 2000, adenovirus infections were rarely diagnosed because there were no timely tests available. In 2000, direct fluorescent assay, DFA became available as a diagnostic tool for identifying adenovirus infection. DFA is a fast and costly test which can produce results in 4 hours. A study at the Primary Children's Medical Center in Salt Lake City, Utah used the assay to identify infections in pediatric patients who were admitted for respiratory infections. The purpose of the study was to determine if an early diagnosis of adenovirus infection could positively affect the patient's care and outcome.

During the study, a total of 1901 patients admitted to the children's hospital were tested for the presence of adenovirus infection using DFA. Of these 1901 patients tested, 143 (7.5%) tested positive for adenovirus infection. Amongst these patients, a differential diagnosis included bronchiolitis, pneumonia, Kawasaki's Disease and hepatitis.

The important findings of the study included the following:

• Many of the patients admitted to the hospital were on unnecessary antibiotic therapy
• Five children in the study were believed to have Kawasaki's Disease until DFA proved they were suffering from an adenovirus infection
• A diagnosis of adenovirus could improve the prognosis of children who are co-infected with hepatitis

The most pertinent finding of the study was that many of the children with adenovirus infections, 88%, admitted to the hospital were placed on antibiotic therapy to combat their illness. Antibiotic therapy is inappropriate for the treatment of adenovirus infections as it does not target the adenovirus. The outcomes of these patients could be improved in the future by a rapid diagnosis of adenovirus infection followed by treatment with antivirals.

The second significant finding of the study was that adenovirus infections can effectively mimic and infection with Kawasaki's disease. The diagnosis of adenovirus infection was important for these children because it could spare them unnecessary treatment for Kawasaki's Disease.

Finally, the study also showed that in patients with both fulminant hepatitis and adenovirus infection, a diagnosis of adenovirus infection can be life-saving. In a child with both fulminant hepatitis and adenovirus infection, cidofovir was administrated and could have helped the prognosis of the patient, though the role of cidofovir was not clear.