Treatment of Adenovirus in Infants
For immunocompetent infants with adenovirus infection, supportive care alone—including hydration, antipyretics, and respiratory support as needed—is the recommended treatment, with cidofovir reserved exclusively for life-threatening infections in severely ill or immunocompromised infants. 1, 2
Supportive Care for Immunocompetent Infants
The cornerstone of management for the vast majority of infants with adenovirus infection is supportive care, as the infection typically resolves within 7-10 days without specific antiviral therapy. 1
Key supportive measures include:
- Adequate hydration to maintain fluid balance 1
- Antipyretics for fever management 1
- Respiratory support (oxygen, nebulizers) as clinically indicated 1
- Close monitoring for clinical deterioration over the typical 7-10 day illness course 1, 2
No specific antiviral therapy is indicated for self-limited gastroenteritis or upper respiratory infections in immunocompetent infants. 2
Cidofovir for Severe or Life-Threatening Infections
Cidofovir is the treatment of choice for severe adenovirus infections, particularly in immunocompromised infants or those with disseminated disease. 1, 2 This recommendation stands despite the lack of randomized controlled trials. 2
Dosing regimen:
- 5 mg/kg IV once weekly for 2 weeks, then every other week 1, 2
- Mandatory renal function monitoring is essential due to considerable nephrotoxicity risk 1, 2
Recent real-world data from 2022 showed cidofovir was used in 21 children with severe adenovirus infection (including 11 previously healthy children) without attributed side effects, though this was in a PICU setting. 3
High-Risk Populations Requiring Vigilance
Infants at highest risk for severe disease include:
- Age under 1 year with myocarditis: 5-year survival rate of only 66% with adenovirus versus 95% without 1, 2
- Immunocompromised status: fatality rates exceeding 50% for untreated severe pneumonia or disseminated disease 1, 4
- Adenovirus serotypes 3 and 7: associated with worse prognosis 1, 2
Infection Control Measures
Critical infection control practices:
- Infants are infectious for 10-14 days from symptom onset 1, 2
- Hand hygiene with soap and water is essential (adenovirus survives on surfaces up to 28 days) 2
- Dilute bleach solution for equipment and surface disinfection 1, 2
- Isolation in hospitals and daycare settings to prevent outbreaks 1, 2
Special Clinical Scenarios
For adenoviral conjunctivitis in infants:
- Symptomatic relief with artificial tears and topical antihistamines 1
- Topical corticosteroids may be indicated for severe cases with marked chemosis, lid swelling, epithelial sloughing, or membranous conjunctivitis 1
Critical Pitfalls to Avoid
Avoid unnecessary antibiotic use: In one study, 46% of adenovirus-positive children received antibiotics at presentation, but only 1.4% had documented bacterial infection. 5 Identifying adenovirus can prevent unnecessary antibiotic therapy. 5
Do not delay cidofovir in severe cases: For immunocompetent infants with fulminant presentations (such as liver failure), early cidofovir treatment based on rapid diagnostic testing can be life-saving. 5 One case report documented recovery from fulminant liver failure after cidofovir treatment, avoiding liver transplant. 5
Consider adenovirus in differential diagnosis: When infants present with fever ≥5 days, particularly with conjunctivitis, pharyngitis, or respiratory symptoms, adenovirus should be considered. 2 This is especially important to differentiate from Kawasaki disease, where withholding immune globulin may be appropriate if adenovirus is confirmed. 5