From the Guidelines
Adenovirus infections, including conjunctivitis, are typically self-limiting and do not require antimicrobial treatment, with management focusing on supportive care and prevention of spread. The primary approach to managing adenoviral conjunctivitis involves educating patients on the contagious nature of the infection and advising them to minimize contact with others for 10 to 14 days from the onset of symptoms in the last eye affected 1. This is crucial in preventing the spread of the infection, especially in communal settings.
Key Considerations
- Patients should be informed about the importance of careful disinfection to prevent the spread of adenovirus, which can survive on surfaces for many weeks if not properly disinfected 1.
- Artificial tears, topical antihistamines, topical steroids, oral analgesics, or cold compresses may be used to mitigate symptoms, but there is no proven effective treatment for eradicating the adenovirus infection 1.
- The use of antibiotics should be avoided due to potential adverse treatment effects and the risk of promoting antibiotic resistance 1.
- Topical corticosteroids can be helpful in reducing symptoms and may reduce scarring in severe cases, but close follow-up is warranted due to the potential for prolonged viral shedding 1.
Prevention and Public Health
- Regular handwashing, avoiding touching the face with unwashed hands, and proper disinfection of surfaces are key prevention measures against adenovirus spread 1.
- In clinical settings, an abbreviated exam in a dedicated room with limited physical interaction can help minimize the spread of the infection 1.
- The economic impact of adenoviral conjunctivitis can be significant, with potential savings through the use of point-of-care tests to avoid unnecessary antibiotic therapy and reduce lost productivity 1.
From the Research
Adenovirus Infections
- Adenovirus infections can cause a range of clinical syndromes in immunocompromised patients, including localized disease of the respiratory tract, gastrointestinal tract, or urinary tract, as well as disseminated disease 2.
- These infections can be potentially progressive with high rates of mortality in patients with pneumonia and disseminated disease 2, 3.
- The disease is more severe, and dissemination is more likely in patients with impaired immunity, such as organ transplant recipients, human immunodeficiency virus infection, and congenital immunodeficiency syndromes 3.
Treatment of Adenovirus Infections
- Cidofovir and its lipid ester, brincidofovir, appear to be effective for the treatment of adenovirus, although neither is specifically approved for this indication 2, 4.
- Cidofovir is considered the drug of choice for severe adenovirus infections, but not all patients require treatment 3, 5.
- Ribavirin is another antiviral agent that has been used to treat adenovirus infections, but its effectiveness is still uncertain 6, 5.
- New strategies, including pre-emptive therapy, and adoptive transfer of specific T-cells to adenovirus, may improve the current situation 6.
Diagnosis and Monitoring of Adenovirus Infections
- Adenovirus should always be considered when immunocompromised patients present with any clinical syndrome that could be compatible with adenoviral infection 2.
- Cultures or molecular testing of appropriate specimens should be obtained, and blood should be sent for adenovirus polymerase chain reaction (PCR) whenever adenovirus is suspected 2.
- Monitoring of quantitative viral loads in blood is helpful in predicting response to therapy, with a significant drop (>1 log) associated with a higher probability of clinical response 2, 4.