Which clinical history findings are characteristic of adenoviral infections in immunocompromised hosts?

Updated: Apr 15, 2021
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Adenovirus is known to cause disease during the posttransplantation period in patients who have received hematopoietic stem cell transplants. Risk factors for adenovirus disease include allogeneic stem cell transplantation, T-cell depletion and nonmyeloablative conditioning regimens such as high-dose alemtuzumab (Campath) antibody therapy, lymphopenia, young age, and graft versus host disease. Prolonged neutropenia or immunosuppression also enhances the risk of adenoviral infections. Manifestations may vary but include hemorrhagic cystitis/nephritis, pneumonitis, hepatitis/liver failure, and gastroenteritis, particularly during the acute posttransplantation period prior to engraftment. In one series, nephritis was associated with acute renal failure in more than 90% of patients. In a retrospective review of children with adenovirus infection, 2.5 percent (11 of 440) had disseminated disease. Of these, 54 percent (6 of 11) were immunocompromised. Mortality from disseminated disease was 73 percent overall (83 percent among immunocompromised and 60 percent among immunocompetent hosts). [24]  Adenovirus should be considered in patients with a fever, hematuria, flank pain, and worsening renal function. [25, 5]

Uncommonly, T-cell immunodeficiency related to HIV infection has been associated with adenoviral infections, particularly in infants and children infected with HIV. Pneumonitis and hemorrhagic cystitis are cited most often. Cholecystitis, severe hepatitis, and liver failure have been reported. [26]

Immunosuppression in recipients of solid organ transplants has also been associated with the above syndromes, as has diffuse adenoviral infection of the allograft itself. Both allograft loss and recovery have been reported. [25]  Adenoviral infection following pediatric lung transplantation has been reported. [27]

Importantly, note that a prior history of adenoviral infection in a patient with recovered immunocompetence may herald recurrence when the patient again becomes immunosuppressed. A high level of suspicion for adenovirus is warranted in these cases.

nce when the patient again becomes immunosuppressed. A high level of suspicion for adenovirus is warranted in these cases.

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