Adenoviral Infections in Immunocompetent Children.

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.