What is the treatment for adenovirus infection?

Treatment of Adenovirus Infection

For immunocompetent patients with adenovirus infection, supportive care alone is the standard treatment, while severely ill or immunocompromised patients with life-threatening disease should receive cidofovir (5 mg/kg IV weekly for 2 weeks, then every other week) with mandatory renal function monitoring. 1

Immunocompetent Patients

The vast majority of adenovirus infections in immunocompetent individuals are self-limited and resolve within 7-10 days without specific antiviral therapy. 1 Management focuses entirely on supportive measures:

• Hydration: Maintain adequate fluid balance, particularly important in children with fever and decreased oral intake 1
• Antipyretics: Use acetaminophen or ibuprofen for fever management 1
• Respiratory support: Provide oxygen supplementation and nebulizer treatments as needed for respiratory symptoms 1
• Monitor for deterioration: Observe patients over the typical illness course for any signs of clinical worsening 1

Antibiotics provide no benefit for viral infections and should be avoided unless there is clear evidence of secondary bacterial infection. 2

Infection Control Measures

Adenovirus is highly contagious and can survive for weeks on surfaces without proper disinfection. 2 Critical prevention strategies include:

• Isolation period: Patients remain infectious for 10-14 days from symptom onset in the last affected area 2, 1
• Hand hygiene: Soap and water is essential, as alcohol-based sanitizers are less effective against adenovirus 1
• Surface disinfection: Use dilute bleach solution (1:10 dilution of household bleach) or EPA-registered hospital disinfectants containing sodium hypochlorite 2, 1
• Healthcare settings: Consider dedicated examination rooms and abbreviated exams during outbreaks 2

Adenoviral Conjunctivitis (Specific Management)

For ocular adenovirus infections, treatment remains primarily supportive with specific considerations:

• Artificial tears: Provide comfort and help dilute viral particles on the ocular surface 2, 1
• Cold compresses: Reduce inflammation and provide symptomatic relief 2
• Topical antihistamines: May alleviate itching and discomfort 2, 1
• Avoid antibiotics: They provide no benefit and may cause toxicity or allergic reactions 2, 3

For severe adenoviral keratoconjunctivitis with subepithelial infiltrates causing blurred vision, photophobia, or decreased visual acuity, topical corticosteroids may be considered, but only with mandatory close ophthalmology follow-up. 2, 3 When using corticosteroids:

• Prefer agents with poor ocular penetration (fluorometholone, rimexolone, or loteprednol) to minimize intraocular pressure elevation and cataract formation 2, 3
• Monitor intraocular pressure regularly and perform periodic pupillary dilation 3
• Taper slowly to the minimum effective dose 2
• Critical caveat: Corticosteroids may prolong viral shedding and can worsen HSV infections if misdiagnosed, potentially leading to corneal scarring and vision loss 2, 3

Severe or Life-Threatening Infections in Immunocompromised Patients

Cidofovir is the treatment of choice for severe adenovirus infections, particularly in immunocompromised children or adults with disseminated disease, pneumonia, or organ transplant recipients. 1, 4, 5

Cidofovir Dosing and Administration

• Standard regimen: 5 mg/kg IV once weekly for 2 weeks, then every other week 1
• Mandatory co-administration: Give probenecid and isotonic saline before and after cidofovir infusion to reduce nephrotoxicity 5
• Renal monitoring: Check renal function before each dose due to considerable nephrotoxicity risk 1, 5

Additional Management Strategies for Immunocompromised Patients

• Reduce immunosuppression: Decrease immunosuppressive medications when clinically feasible 5
• Monitor viral loads: Quantitative adenovirus PCR in blood helps predict response to therapy; a significant drop (>1 log) is associated with higher probability of clinical response 4
• Consider brincidofovir: This oral lipid conjugate of cidofovir has better cellular uptake, no nephrotoxicity, and shows promise in transplant recipients, though it is not yet FDA-approved for adenovirus 6, 7, 8

Prognostic Factors Indicating Higher Risk

• Adenovirus serotypes 3 and 7 have worse prognosis 1
• Age under 1 year with myocarditis has only 66% 5-year survival rate 1
• Immunocompromised patients with untreated severe pneumonia or disseminated disease have fatality rates exceeding 50% 1

When to Refer to Ophthalmology

Immediate ophthalmology referral is required for: 2, 3

• Visual loss or decreased vision
• Moderate or severe eye pain
• Corneal involvement
• Conjunctival scarring
• Membranous conjunctivitis requiring debridement
• Lack of response to therapy after 2-3 weeks
• History of HSV eye disease
• Immunocompromised status

Common Pitfalls to Avoid

• Do not use antibiotics indiscriminately for viral conjunctivitis—they cause unnecessary toxicity without benefit 2, 3
• Do not use corticosteroids without confirming the diagnosis is not HSV, as this can worsen HSV infections and lead to corneal scarring 2, 3
• Do not delay cidofovir in severely ill immunocompromised patients with disseminated disease or pneumonia, as mortality rates are extremely high without treatment 1, 4
• Do not forget infection control measures—inadequate patient education about contagiousness leads to community spread 3