P1: SBT
0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18
Adenovirus 65■Genitourinary tract
➣Acute hemorrhagic cystitis; sudden onset of gross hematuria,
dysuria, urgency of urination, self limited (Types 11, 21)
➣Herpes-like genital lesions, may be associated with orchitis, cer-
vicitis and/or urethritis
■Cardiovascular
➣Myocarditis/pericarditistests
■Viral isolation from affected site – respiratory samples, eye swabs,
urine, stool/rectal swab∗
■∗note that fecal shedding may occur for months after primary infec-
tion
➣Enteric adenovirus (40/41) cannot be isolated, antigen detection
(EIA) available
➣Immunofluorescence (IF) assays useful for direct detection res-
piratory secretions or conjunctival swab
➣PCR available on experimental basis for affected site (e.g.,
spinal fluid from aseptic meningitis, respiratory secretions from
pharyngitis, serum used for generalized infection)
➣Serologic studies are of limited utility for acute diagnosis, mostly
useful for epidemiologic studies or retrospective diagnosis (EIA,
CF used for diagnosis of adenovirus group, HI and neutralization
tests are used for type-specific)differential diagnosis
■Adenoviruses are often impossible to distinguish clinically from
other viral infection and even some bacterial infections, and spe-
cific diagnostics must be used when a specific diagnosis is warran-
ted
➣Respiratory: fever is often higher in adenoviral infections than
parainfluenza and RSV, similar to influenza A/B, if high and pro-
longed fever must also distinguish from bacterial infection
➣Pharyngitis: distinguish from EBV, parainfluenza, influenza,
enterovirus and strep
➣Pneumonia: adenovirus more likely bilateral than bacterial
➣Pertussis-like syndrome: clinically indistinguishable from Bor-
datella pertussis, must distinguish by culture (do viral and spe-
cific bacterial)
➣Gastrointestinal: clinically resemble other viral causes of diar-
rhea, need EIA for adenovirus