Adenovirus

Diagnosis

Indications for Testing

  • Immunocompromised patient, young child, or military recruit presenting with severe pneumonia

Laboratory Testing

  • CDC diagnosis recommendations for adenovirus
  • Most cases are diagnosed based on clinical presentation alone
  • Viral culture can be used in select clinical settings
    • Gold standard
    • Insensitive for blood samples (not recommended)
    • Slow growth makes early diagnosis difficult
  • Antigen/DNA testing
    • DFA – respiratory specimens or nasopharyngeal swabs
    • RT PCR (qualitative) – highly sensitive; nasopharyngeal swabs
      • Standard of care for diagnosing adenovirus in tissue specimen
    • EIA – most useful in fecal samples for types 40, 41
  • Serologic testing relies on demonstration of antibodies to group-specific antigens
    • Often requires acute and convalescent sera
    • Typically used in epidemiological studies
  • Nucleic acid amplification testing

Histology

  • Immunohistochemistry – adenovirus stain

Differential Diagnosis

Clinical Background

Adenoviruses usually cause mild, self-limiting respiratory illnesses, primarily in children.

Epidemiology

  • Prevalence
    • Causes 5-7% of respiratory infections in children
    • Year-round infection
    • Rarely fatal, but 50% of infants and young children have prolonged, intermittent disease
  • Age – usually <10 years (primary infection)
  • Transmission
    • Respiratory droplet transfer
    • Neonatal transmission following vaginal delivery (rare)
    • Nosocomial transmission reported

Organism

  • Double-stranded DNA virus; belongs to Adenoviridae family
  • Classified into 7 species, A-G – 52 serotypes described to date
    • Types 4 and 7 are common in military recruit outbreaks
    • Type 14 commonly associated with severe and sometimes fatal respiratory illnesses

Risk Factors

  • Military service (recruit)
  • Immunocompromised state
  • Malnutrition in children <2 years

Clinical Presentation

  • Most infections are mild, self-limited respiratory illness
  • Bronchiolitis, pneumonia (types 3, 7, 21)
  • Acute diarrhea (types 40, 41)
  • Hemorrhagic cystitis (types 7, 11, 21, 34, 35)
  • Epidemic keratoconjunctivitis (types 8, 19, 37)
  • Fatal adenovirus infections can occur in infants and immunocompromised adults (type 14)
  • Complications – hepatitis, acute colitis, cystitis, meningitis, encephalitis

Indications for Laboratory Testing

  • Tests generally appear in the order most useful for common clinical situations
  • Click on number for test-specific information in the ARUP Laboratory Test Directory
Test Name and Number Recommended Use Limitations Follow Up
Respiratory Viruses DFA with Reflex to Viral Culture, Respiratory 0060281
Method: Direct Fluorescent Antibody Stain/Cell Culture

Preferred test for outpatients and for severely immunocompromised patients with respiratory symptoms

Tests for adenovirus, influenza A and B, parainfluenza, respiratory syncytial virus, and human metapneumovirus

   
Respiratory Viruses Rapid Culture 2001504
Method: Cell Culture/Immunofluorescence

May aid in the isolation of common respiratory viruses, including influenza A and B; parainfluenza types 1, 2, 3; adenovirus; and RSV

Other viruses such as HSV, CMV, or human metapneumovirus not routinely detected in this culture

Limited sensitivity for adenovirus compared to conventional culture

 
Adenovirus, Quantitative PCR 2007192
Method: Quantitative Real-Time Polymerase Chain Reaction

Detect adenovirus

Monitor therapy

Highly sensitive and specific

Not a rapid test but fewer false negatives than DFA

 
Adenovirus by Qualitative PCR 2007473
Method: Qualitative Real-Time Polymerase Chain Reaction

Standard of care for detecting adenovirus infection in tissue specimens

Highly sensitive and specific

Not a rapid test but fewer false negatives than DFA

 
Adenovirus 40-41 Antigens by EIA 0065066
Method: Qualitative Enzyme Immunoassay

Confirm etiologic agent of gastroenteritis

   
Adenovirus by Immunohistochemistry 2003430
Method: Immunohistochemistry

Aid in histologic diagnosis of adenovirus

Stained and returned to client pathologist; if consultation required, contact anatomic pathology, surgical consult or hematopathology

   
Viral Culture, Non-Respiratory and Cytomegalovirus Rapid Culture 2006496
Method: Cell Culture/Immunofluorescence

Viruses that can be isolated – adenovirus, CMV, enterovirus, HSV, and VZV

Virus-specific tests are recommended

Slow growth; not ideal for acute identification

 
Additional Tests Available
 
Click the plus sign to expand the table of additional tests.
Test Name and NumberComments
Respiratory Viruses DFA 0060289
Method: Direct Fluorescent Antibody Stain

Low sensitivity compared to culture; culture or PCR backup recommended 

Rotavirus and Adenovirus 40-41 Antigens 0065067
Method: Qualitative Enzyme Immunoassay
Viral Culture, Respiratory and Cytomegalovirus Rapid Culture 2006497
Method: Cell Culture/Immunofluorescence

Viruses that can be isolated – adenovirus; CMV; enterovirus; HSV; influenza A and B; parainfluenza types 1,2, and 3; RSV; and VZV

Virus-specific tests are recommended