How are adenovirus infections treated?

Updated: Apr 15, 2021
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Specific therapy for adenovirus infection, other than supportive and symptomatic treatment, remains a matter of debate. Fortunately, most infections are self-limited in the setting of a normal immune response and do not warrant specific therapy.

In immunocompromised patients, several drugs, such as cidofovir, ribavirin, ganciclovir, and vidarabine, have been used to treat adenovirus infections. Most of these agents are virostatic, may induce drug resistance, and have significant risks of toxicities, as well as risks to healthcare staff, depending on mode of delivery (eg, aerosolized ribavirin).

Adenovirus viremia is not uncommon among solid organ transplant recipients, and most cases appear to be self-limited and without sequelae. [34]  In cases involving severe disease, such as adenoviral pneumonia after lung transplantation, cidofovir has been used successfully. [35]

Pediatric solid organ transplant recipients fare considerably worse, with greater incidence of adenoviral viremia and mortality rates of 50%. Surveillance for viremia is of benefit in determining need for antiviral therapy.

Adenoviral disease in allogeneic (as opposed to autologous) hematologic stem cell transplantation (HSCT) is quite significant, and the management and prevention of severe adenovirus-related disease is complex and continues to evolve. Reduction of immunosuppression is not always feasible during the first 100 days post-transplantation, during which the risk of death is highest. Disease may be fulminant, with mortality as high as 80% for both adults and children with viremia and disseminated disease. Consequently, attention has focused on predictive value of PCR quantitation in blood and stool. Indeed, both nasopharyngeal and stool detection prior to allo-HSCT predicts invesive disease in pediatric reciptients of allo-HSCT. Children status post allo-HSCT experiencing either a rapid rise in quantitative PCR or very high stool burden (PCR over 06 virus copies per gram of stool experienced 70% of disseminated adenoviral infections in children at one center.  [32]


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