What is the treatment approach for adenovirus detected in stool?

Treatment of Adenovirus Detected in Stool

For immunocompetent patients with adenovirus gastroenteritis, supportive care alone is recommended, while cidofovir should be considered for severely ill or immunocompromised patients, particularly when stool viral loads exceed 1×10⁶ copies/gram or when there is risk of dissemination. 1, 2

Immunocompetent Patients

Supportive care is the standard of care for immunocompetent individuals with adenovirus gastroenteritis. 1, 2

• No specific antiviral therapy is indicated for self-limited gastroenteritis in immunocompetent patients 1
• Provide adequate hydration to maintain fluid balance 2
• Use antipyretics for fever management as needed 2
• Monitor for clinical deterioration over the typical 7-10 day illness course 1, 2
• Patients remain infectious for 10-14 days from symptom onset, requiring appropriate infection control measures 1, 2

Immunocompromised Patients

The approach differs significantly in immunocompromised patients, where adenovirus can cause life-threatening disseminated disease. 3

When to Consider Antiviral Treatment

• Cidofovir should be considered when adenovirus is detected in severely ill immunocompromised patients, particularly those with hematologic malignancies, stem cell transplant recipients, or those with impaired cellular immunity 3
• Quantitative viral load monitoring in stool is critical: levels exceeding 1×10⁶ copies/gram predict progression to viremia with 73% incidence versus 0% below this threshold 4
• Detection of high viral loads in stool typically precedes viremia by a median of 11 days, providing a window for preemptive treatment 4

Cidofovir Dosing and Monitoring

The recommended cidofovir regimen is 5 mg/kg IV once weekly for 2 weeks, then once every other week. 3, 1, 2

• Mandatory renal function monitoring is required due to considerable nephrotoxicity risk 3, 1, 2
• To reduce cidofovir toxicity, administer at least 2 liters of IV prehydration and probenecid 2g orally 3 hours prior, then 1g at 2 and 8 hours following cidofovir 3
• This treatment approach is based on case series and observational data, as randomized controlled trials are lacking 3, 1

Clinical Context and Pitfalls

A critical pitfall is failing to recognize that adenovirus in stool of immunocompromised patients may herald disseminated disease. 4, 5

• In pediatric stem cell transplant recipients, the gastrointestinal tract serves as the main site of viral replication preceding invasive infection 5
• Fatality rates for untreated severe adenovirus pneumonia or disseminated disease may exceed 50% in immunocompromised patients 6
• Regular monitoring of serial stool samples has become routine for post-transplant surveillance and can trigger early treatment initiation 5

Infection Control Measures

Rigorous infection control is essential regardless of immune status. 1, 2

• Hand hygiene with soap and water is mandatory, as adenovirus survives on surfaces for up to 28 days 1
• Use dilute bleach solution for equipment and surface disinfection 1, 2
• Isolate infected patients in hospitals and daycare settings to prevent outbreaks 1, 2