Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

66 Adenovirus Adrenal Insufficiency

management

■Supportive care

■Nosocomial spread in hospital and clinics (especially eye clinics)

can be decreased by isolating infected patients, good handwashing,

properly disinfecting instruments, equipment and surfaces.

■Healthcare personnel with adenoviral conjunctivitis should avoid

patient contact.

specific therapy

■No specific antiviral available. Benefit with cidofovir has been

reported in a few cases of immunocompromised patients with severe

disease.

■Supportive

follow-up

n/a

complications and prognosis

Most complications listed above under specific type of illness

■Most self-limiting; occasional deaths, especially due to pneumonia

■Residual lung disease may be seen in some children after recovery

from adenoviral pneumonia.

■Special hosts; in immunocompromised hosts adenovirus are often

severe – disseminated disease in BMT patients, and involvement of

the donor organ in solid organ transplant

Prevention

■Acute respiratory disease has been substantially reduced in the US

by live adenovirus type4&7vaccine in military recruits.

■No vaccine widely available in community settings

Adrenal Insufficiency..................................

RICHARD I. DORIN, MD

history & physical

History

■Acute Adrenal Insufficiency (AI)

➣Shock (resistant to pressor agents)

➣Tachycardia, high-output circulatory failure

➣Fever, confusion, nausea, vomiting

➣Abdominal, back, flank, or chest pain