What is the rash associated with adenovirus infection?

Adenoviral Infection Rash Characteristics

Adenoviral conjunctivitis is associated with a follicular conjunctival reaction that can progress to membranous or pseudomembranous conjunctivitis in severe cases, often accompanied by preauricular lymphadenopathy. 1

Clinical Presentation of Adenoviral Rash

Adenoviral infections typically present with:

• Ocular manifestations:

  • Follicular conjunctival reaction (hallmark finding)
  • Hyperemia of the conjunctiva
  • In severe cases, progression to complete sloughing of the ocular surface epithelium
  • Chemosis (conjunctival edema)
  • Eyelid swelling
  • Membranous or pseudomembranous conjunctivitis in severe cases

• Systemic manifestations:

  • Preauricular lymphadenopathy (swollen and tender)
  • Submandibular lymphadenopathy
  • Often accompanied by upper respiratory infection symptoms

Diagnostic Features

When examining a patient with suspected adenoviral conjunctivitis, look for:

• Distribution pattern: Typically bilateral, though may start in one eye and spread to the other
• Appearance: Follicular reaction of the conjunctiva, particularly in the inferior fornix
• Associated findings: Subepithelial infiltrates that typically appear 1-2 weeks after onset of conjunctivitis
• Physical exam: Swollen and tender preauricular or submandibular lymph nodes

Complications and Progression

Adenoviral conjunctivitis can lead to several complications:

• Subepithelial infiltrates: Appear 1+ weeks after onset, causing blurring, photophobia, and decreased vision
• Corneal involvement: Epithelial defects, filaments, or infiltrates
• Cicatricial changes: In severe cases, can lead to permanent symblepharon or fornix foreshortening

Diagnostic Testing

While most cases are diagnosed clinically, diagnostic tests may include:

• Rapid in-office immunodiagnostic tests: 88-89% sensitivity, 91-94% specificity 1
• PCR: Highly sensitive for detecting viral DNA
• Raman spectroscopy of tears: High sensitivity and specificity

Management Approach

Management is primarily supportive as there is no proven effective treatment for eradication of adenovirus infection:

1. Symptomatic relief:

   • Artificial tears
   • Topical antihistamines
   • Cold compresses
   • Oral analgesics

2. For severe cases with marked chemosis, lid swelling, epithelial sloughing, or membranous conjunctivitis:

   • Topical corticosteroids may help reduce symptoms and scarring
   • Close follow-up is required as corticosteroids may prolong viral shedding

3. For membranous conjunctivitis:

   • Consider debridement of membranes to prevent corneal epithelial abrasions or permanent cicatricial changes

Follow-up Recommendations

• Patients with severe disease (corneal epithelial ulceration or membranous conjunctivitis): Re-evaluate within 1 week
• Patients on topical corticosteroids: Monitor IOP and pupillary dilation periodically
• Patients not on topical corticosteroids: Return if symptoms persist beyond 2-3 weeks

Important Precautions

• Highly contagious: Adenovirus can survive for weeks on surfaces
• Infection control: Educate patients about reducing spread (handwashing, avoiding sharing towels/pillows)
• Isolation period: Minimize contact with others for 10-14 days from symptom onset in the last affected eye
• Avoid antibiotics: No benefit for viral infection and may cause adverse effects

By recognizing the characteristic rash pattern of adenoviral conjunctivitis and implementing appropriate management strategies, clinicians can help reduce patient discomfort and prevent complications while minimizing disease spread.