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Adenoviral Infections in Immunocompetent Children
1Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, 632004, India. valsan@cmcvellore.ac.in.
Insights
Adenoviruses cause common childhood illnesses but can lead to severe disease. Molecular surveillance is crucial for monitoring strains and preventing outbreaks of this adaptable virus.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health
Background:
- Adenoviruses are frequent causes of respiratory, gastrointestinal, and ocular infections in children.
- While often self-limiting, specific serotypes can cause severe pneumonia, CNS infections, and urinary tract infections, with potential long-term sequelae like bronchiectasis.
- Persistent subclinical infections and prolonged shedding are characteristic, posing risks during immunosuppression.
Purpose of the Study:
- To review the clinical manifestations, diagnosis, treatment, and control of adenoviral infections in children.
- To highlight the importance of molecular surveillance for emerging strains and epidemic prevention.
Main Methods:
- Review of current literature on adenoviral infections in pediatric populations.
- Discussion of diagnostic methods, focusing on Polymerase Chain Reaction (PCR) sensitivity and specificity.
- Analysis of treatment strategies, including supportive care and antiviral use in specific populations.
Main Results:
- PCR is a sensitive and specific diagnostic tool, but clinical correlation is essential for attributing causation.
- Supportive care is the mainstay of treatment; antivirals are reserved for immunocompromised children.
- Adenoviruses spread via droplets and fomites, necessitating strict infection control measures.
Conclusions:
- Effective management relies on supportive care, appropriate infection control, and judicious use of diagnostics.
- Continuous molecular surveillance is vital to track evolving adenoviral strains, detect new disease patterns, and mitigate epidemic potential.
- Understanding adenovirus transmission and mutation is key to preventing severe outcomes and co-infections.
Abstract:
Adenoviruses are a common cause of upper and lower respiratory infections, gastroenteritis and conjunctivitis in children. Although most adenoviral infections are self-limited, those caused by certain serotypes during outbreaks have led to severe pneumonias and poorer outcomes, with sequelae of bronchiectasis and bronchiolitis obliterans in survivors. Rarer manifestations such as central nervous system and urinary infections can also lead to severe disease. Adenoviruses can be shed for prolonged periods after infection and can also lead to persistent subclinical infection with the potential for reactivation during periods of immunosuppression. Diagnosis with polymerase chain reaction (PCR) testing is highly sensitive and specific but attributing causation in PCR positive children will depend on the presence of symptomatic disease. Treatment is predominantly supportive with maintenance of hydration in gastroenteritis and respiratory support in severe pneumonia. Although antiviral drugs are used in immunocompromised and transplanted children, they are not recommended for use in immune competent children especially in the absence of efficacy data. As adenoviruses are spread by droplet transmission and can survive on surfaces for weeks, infection control measures include isolation of patients, proper disinfection and use of personal protective equipment. Because adenoviruses are known to undergo spontaneous mutations and recombinant events leading to novel viruses and have caused fatal co-infections in the past, molecular surveillance of adenovirus is needed to monitor circulating serotypes, to recognise new disease emergence and to prevent epidemic spread.
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