From the Guidelines
The treatment approach for adenovirus infections is primarily supportive care, as most cases are self-limiting and resolve without specific antiviral therapy. This approach is based on the most recent evidence from 2024, which suggests that adenoviral conjunctivitis is highly contagious and can be managed with supportive measures such as artificial tears, topical antihistamines, and cold compresses to mitigate symptoms 1.
Key Considerations
- The use of antibiotics in the management of adenoviral conjunctivitis should be avoided due to potential adverse treatment effects 1.
- Topical corticosteroids may be helpful in reducing symptoms and scarring in severe cases, but close follow-up is warranted due to the potential for prolonged viral shedding 1.
- Strict hand hygiene and isolation precautions are essential to prevent transmission, especially in healthcare and institutional settings 1.
- Educating patients on proper hygiene practices, such as frequent handwashing and avoiding close contact with others, can help limit the spread of epidemic adenoviral conjunctivitis 1.
Supportive Care Measures
- Artificial tears and cold compresses can provide relief for adenoviral conjunctivitis 1.
- Antipyretics such as acetaminophen or ibuprofen may be used to manage fever and pain.
- Saline nasal drops or humidified air can help alleviate congestion.
Prevention
- Vaccination strategies, such as the recombinant zoster vaccine, can help reduce the incidence of varicella (herpes) zoster virus 1.
- Prophylactic treatment, such as single-use tubes of ophthalmic ointment containing 0.5% erythromycin, can help prevent neonatal conjunctivitis 1.
From the Research
Treatment Approach for Adenovirus Infections
The treatment approach for adenovirus infections is a complex issue, with various studies suggesting different strategies. Some of the key points to consider are:
- The use of antiviral agents such as ribavirin and cidofovir has yielded mixed results in case reports and small case series 2.
- New strategies, including pre-emptive therapy, should be tested in prospective, clinical trials 2.
- Adoptive transfer of specific T-cells to adenovirus might improve the current situation 2, 3.
- Brincidofovir, a lipid-linked derivative of cidofovir, represents a major advance in anti-adenovirus therapy and is being evaluated against adenovirus infections in transplant patients 4.
- Decreasing immunosuppression, whenever possible, is a primary initial therapy for adenovirus infection in pediatric transplant recipients 5.
- Cidofovir and brincidofovir can be used as rescue therapy for adenovirus disease or viremia in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) patients 5.
Antiviral Therapy
Antiviral therapy for adenovirus infections is still unsatisfactory, with several nucleoside or nucleotide analogues being described that target the adenovirus polymerase 6. Some of the key points to consider are:
- Cidofovir is an acyclic nucleoside phosphonate analog of cytidine monophosphate that can be used to treat adenovirus infections, but it has poor cellular uptake and nephrotoxicity 4.
- Brincidofovir is a lipid-linked derivative of cidofovir that is active against five families of double-stranded DNA viruses and has an improved oral bioavailability and favorable toxicity profile compared with cidofovir 4.
- Immunotherapy is a growing field in the management of adenovirus infection, with promising results in hematopoietic stem cell transplant (HSCT) patients 5.
Immunotherapy
Immunotherapy is a promising approach for the treatment of adenovirus infections, particularly in hematopoietic stem cell transplant (HSCT) patients. Some of the key points to consider are:
- Adoptive transfer of immune T cells offers a therapeutic option for adenovirus infections, but this strategy has been hindered by the lack of information on targets of protective cellular immunity 3.
- Immunotherapy has been proven successful in HSCT patients as an option for refractory cases or rescue therapy for adenovirus infection 5.