What is the treatment for adenovirus infections?

Treatment of Adenovirus Infections

Primary Management Approach

For immunocompetent patients with adenovirus infections, treatment is entirely supportive, as there is no established antiviral therapy with proven efficacy for routine use. 1, 2

Immunocompetent Patients (Most Common Scenario)

Supportive care is the cornerstone of management:

• No antiviral therapy is recommended for typical adenovirus infections in immunocompetent individuals, as the disease is self-limited 1, 2
• Artificial tears provide symptomatic relief for conjunctivitis and help dilute viral particles on the ocular surface 2
• Cold compresses reduce inflammation and provide comfort 2
• Topical antihistamines may alleviate itching and discomfort 2
• Oral analgesics can be used for pain management 2
• Avoid topical antibiotics entirely - they provide no benefit for viral infections and may cause unnecessary toxicity or allergic reactions 2, 3

Infection Control (Critical Component)

Patient education about contagiousness is essential to prevent transmission:

• Patients should minimize contact with others for 10-14 days from symptom onset in the last affected eye 2, 4
• Adenovirus can survive for weeks on surfaces without proper disinfection, making transmission highly efficient 2, 4
• Recommend frequent handwashing with soap and water (not just sanitizer), use of separate towels, and avoiding close contact with others 1
• Healthcare workers and childcare providers should avoid work during the contagious period 1

Severe Cases in Immunocompetent Patients

For severe adenoviral keratoconjunctivitis with subepithelial infiltrates causing visual symptoms:

• Topical corticosteroids may be considered only when there is blurred vision, photophobia, or decreased visual acuity, but mandatory close ophthalmology follow-up is required 2, 3
• Use corticosteroids with poor ocular penetration (fluorometholone, rimexolone, or loteprednol) to minimize intraocular pressure elevation and cataract formation 2
• 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
• Never use corticosteroids without confirming the diagnosis is not HSV 2

Immunocompromised Patients (Different Approach)

For severely immunocompromised patients with progressive or disseminated disease:

• Cidofovir is considered the drug of choice for severe adenovirus infections, though it is not FDA-approved for this indication 5, 6, 7, 8
• Brincidofovir (lipid ester of cidofovir) appears effective but also lacks specific approval 5
• Treatment decisions should be based on disease severity, as not all immunocompromised patients require antiviral therapy 6, 7, 8
• Monitor quantitative viral loads in blood - a significant drop (>1 log) is associated with higher probability of clinical response 5
• Important limitation: Even with antiviral therapy, established adenovirus disease is often difficult to treat, with fatality rates exceeding 50% for untreated severe pneumonia or disseminated disease 6, 7, 8

When to Refer to Ophthalmology

Immediate ophthalmology referral is required for:

• Visual loss or decreased vision 2, 3
• Moderate or severe pain 2, 3
• Severe purulent discharge 2, 3
• Corneal involvement 2, 3
• Conjunctival scarring 2
• History of HSV eye disease 2, 3
• Immunocompromised state 2, 3
• Membranous conjunctivitis (may require debridement to prevent permanent cicatricial changes) 2

Follow-Up Recommendations

• Patients with severe disease should be re-evaluated within 1 week 2, 3
• Patients not treated with corticosteroids should return if symptoms persist beyond 2-3 weeks 2, 3
• For patients on topical corticosteroids, regular monitoring of intraocular pressure and periodic pupillary dilation is mandatory 2, 3

Common Pitfalls to Avoid

• Do not prescribe antibiotics for viral conjunctivitis - this is the most common error and provides no benefit while risking adverse effects 2, 3
• Do not use 70% isopropyl alcohol wipes for tonometer disinfection - they do not provide adequate disinfection against adenovirus; use 1:10 dilution of sodium hypochlorite instead 1
• Do not underestimate contagiousness - inadequate patient education leads to community spread 3, 4
• Avoid corticosteroids without ophthalmology follow-up - risks include elevated intraocular pressure, cataract formation, and worsening of undiagnosed HSV 2, 3