What is the treatment for adenovirus infection?

Treatment of Adenovirus Infection

Adenovirus infections are self-limited and require no specific antiviral treatment in immunocompetent patients; management focuses on supportive care and preventing transmission through strict hygiene measures. 1, 2

Supportive Care for Immunocompetent Patients

For typical adenoviral conjunctivitis and respiratory infections, treatment is entirely symptomatic:

• Artificial tears provide comfort and help dilute viral particles on the ocular surface 1, 2
• Cold compresses reduce inflammation and provide symptomatic relief 1, 2
• Topical antihistamines may alleviate itching and discomfort 1, 2
• Oral analgesics can be used for pain management 1, 2
• Avoid topical antibiotics as they provide no benefit for viral infections and may cause adverse effects 1, 2

Severe Adenoviral Keratoconjunctivitis

In cases with marked chemosis, lid swelling, epithelial sloughing, or membranous conjunctivitis, topical corticosteroids may reduce symptoms and scarring, but require close monitoring:

• Use corticosteroids only in severe cases with significant inflammation 1, 2
• Monitor closely for increased intraocular pressure and cataract formation 2
• Prefer corticosteroids with poor ocular penetration to minimize systemic side effects 2
• Taper slowly to the minimum effective dose 2
• Be aware that animal studies suggest corticosteroids may prolong viral shedding, though human data are lacking 1

For membranous conjunctivitis specifically, debridement of membranes may prevent corneal epithelial abrasions or permanent cicatricial changes 2

Treatment for Immunocompromised Patients

In immunocompromised patients (transplant recipients, HIV patients, those with hereditary immunodeficiencies), severe or disseminated adenovirus infection requires antiviral therapy:

• Cidofovir is the drug of choice for severe adenovirus infections in immunocompromised patients, though not all patients require treatment 3, 4, 5, 6
• Brincidofovir (lipid ester of cidofovir) appears effective, though neither drug is specifically FDA-approved for adenovirus 4
• Monitor quantitative viral loads in blood; a significant drop (>1 log) is associated with higher probability of clinical response 4
• Untreated severe adenovirus pneumonia or disseminated disease carries fatality rates exceeding 50% 3, 5

Infection Control and Prevention of Transmission

The ophthalmologist plays a critical role in breaking the chain of transmission through patient education:

• Patients must minimize contact with others for 10-14 days from symptom onset in the last affected eye 1, 2
• Counsel patients to wash hands frequently with soap and water (not sanitizer alone) 1
• Instruct patients to use separate towels and avoid sharing personal items 1
• Educate that adenovirus can survive for up to 28 days on surfaces in a desiccated state 1

Healthcare facility infection control measures:

• Wear gloves when entering rooms of patients with confirmed or suspected adenovirus infection 1
• Wear gown when soiling with respiratory secretions is anticipated 1
• Wear surgical mask and eye protection when within 3 feet of a patient with suspected or confirmed adenovirus infection 1
• Place patients in private rooms when possible, or cohort with other adenovirus-infected patients 1
• Disinfect tonometers with 1:10 dilute bleach (sodium hypochlorite) for 5-10 minutes; 70% isopropyl alcohol is no longer recommended 1
• Discard multiple-dose eyedrop containers after inadvertent contact with the ocular surface 1
• Disinfect exposed surfaces with EPA-registered hospital disinfectant or 1:10 sodium hypochlorite 1

Follow-up Recommendations

• Patients with severe disease should be re-evaluated within 1 week 2
• Patients not treated with corticosteroids should return if symptoms persist beyond 2-3 weeks 2
• Follow-up visits should include visual acuity measurement and slit-lamp biomicroscopy 2

Common Pitfalls to Avoid

• Do not prescribe antibiotics indiscriminately—viral conjunctivitis will not respond to antibacterial agents 1, 7
• Do not use 70% isopropyl alcohol wipes for tonometer disinfection—they do not provide adequate disinfection against adenovirus 1
• Do not underestimate contagiousness—patients working in healthcare, food service, or sales need specific guidance about work restrictions 1
• Do not start corticosteroids without close follow-up plans—they require monitoring for complications 1, 2