What is the treatment for adenovirus infections?

Treatment of Adenovirus Infections

Adenovirus infections are primarily self-limited and do not require specific antiviral treatment in immunocompetent individuals; management focuses on supportive care with artificial tears, topical antihistamines, cold compresses, and oral analgesics to alleviate symptoms. 1, 2

Management Based on Clinical Presentation

Adenoviral Conjunctivitis (Most Common Presentation)

• Supportive care only:
  • Artificial tears for lubrication
  • Cold compresses for symptomatic relief
  • Topical antihistamines to reduce itching
  • Oral analgesics for pain management 1, 2
• Avoid antibiotics as they provide no benefit against viral infections and may cause adverse effects 1
• Topical corticosteroids may be considered in severe cases with:
  • Marked chemosis or eyelid swelling
  • Epithelial sloughing
  • Membranous conjunctivitis 1
  • Caution: Requires close follow-up as corticosteroids may prolong viral shedding 1
• For membranous conjunctivitis, consider debridement of membranes to prevent corneal epithelial abrasions or permanent cicatricial changes 1

Severe/Disseminated Adenovirus Infections (Immunocompromised Patients)

• Cidofovir is considered the drug of choice for severe adenovirus infections in immunocompromised patients 3, 4, 5
• Brincidofovir (lipid ester of cidofovir) has shown efficacy in treating adenovirus infections 3
• Monitor quantitative viral loads in blood to predict response to therapy (>1 log drop indicates higher probability of clinical response) 3
• Fatality rates for untreated severe adenovirus pneumonia or disseminated disease may exceed 50% in immunocompromised patients 4, 6, 5

Infection Control Measures

• Educate patients about the highly contagious nature of adenovirus
• Advise patients to minimize contact with others for 10-14 days from symptom onset in the last affected eye 1, 2
• Implement proper hygiene measures:
  • Frequent handwashing with antimicrobial soap and water
  • Use separate towels and pillows
  • Avoid sharing personal items 2
• For healthcare settings:
  • Disinfect surfaces with EPA-registered hospital disinfectants
  • Disinfect tonometer tips with dilute bleach soak (1:10 concentration) for 5-10 minutes 1
  • Avoid 70% isopropyl alcohol wipes for tonometer disinfection as they may not provide adequate disinfection 1

Follow-up Recommendations

• Patients with severe disease should be re-evaluated within 1 week 1
• For patients on topical corticosteroids:
  • Monitor intraocular pressure periodically
  • Check for pupillary dilation to evaluate for glaucoma and cataract
  • Taper corticosteroids once inflammation is controlled 1
• Patients not on corticosteroids should return if symptoms persist after 2-3 weeks 1

Special Considerations

• For immunocompromised patients, consider early antiviral therapy with cidofovir or brincidofovir 3, 4
• Pre-emptive therapy may be beneficial in high-risk immunocompromised patients 7
• Adenovirus pneumonia in immunocompromised hosts has high mortality and requires aggressive treatment 4, 5
• Herpes zoster vaccination is recommended for patients ≥50 years to prevent herpes zoster ophthalmicus 1

Treatment Pitfalls to Avoid

1. Using antibiotics for viral conjunctivitis (ineffective and may cause adverse effects)
2. Failing to recognize severe cases that may benefit from topical corticosteroids
3. Inadequate infection control measures leading to outbreaks
4. Improper disinfection of tonometer tips using only alcohol wipes
5. Delayed recognition of adenovirus infection in immunocompromised patients where early treatment is critical