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Adenovirus Infection in Immunocompromised Adults

Severe and disseminated adenoviral disease in transplant recipients and immunosuppressed hosts

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is Adenovirus Infection in Immunocompromised Adults?

Adenoviruses are non-enveloped, double-stranded DNA viruses with over 100 known types causing diverse syndromes in immunocompetent hosts (mild upper respiratory illness, conjunctivitis, gastroenteritis, hemorrhagic cystitis in children) but devastating disease in immunocompromised adults. The most relevant types in immunocompromised disease are species A (12, 18, 31), B (3, 7, 11, 14, 21), and C (1, 2, 5, 6).

Risk factors include allogeneic HSCT (particularly umbilical cord blood, T-cell depleted, or haploidentical), severe T-cell lymphopenia, graft-versus-host disease (GVHD) requiring high-dose immunosuppression, lung transplantation, intestinal transplantation, pediatric SOT, and primary immunodeficiency. Disease results from primary infection or reactivation of latent virus persisting in lymphoid tissue.

Clinical syndromes range from limited (asymptomatic viremia, cystitis, gastroenteritis) to disseminated multi-organ involvement with respiratory failure (pneumonia, ARDS), hepatitis with fulminant hepatic failure, encephalitis, hemorrhagic cystitis with renal failure, retinitis, and coagulopathy. Mortality in disseminated disease approaches 50-80% in HSCT recipients despite therapy. Quantitative blood PCR with serial monitoring guides preemptive therapy initiation, and brincidofovir (oral, with better safety than cidofovir but limited availability) or cidofovir (intravenous, with significant nephrotoxicity) are mainstays of treatment.

Symptoms

Fever
Cough, dyspnea, hypoxemia
Diarrhea, abdominal pain
Hemorrhagic cystitis (gross hematuria, dysuria, urgency)
Hepatitis (elevated transaminases, jaundice)
Conjunctivitis, keratoconjunctivitis
Pharyngitis, sore throat
Encephalitis (altered mental status, seizures)
Pneumonia (often bilateral, multifocal)
ARDS (acute respiratory distress syndrome)
Acute kidney injury (cidofovir-related or hemorrhagic cystitis)
Coagulopathy, disseminated intravascular coagulation
Multi-organ failure
Cytopenia (engraftment failure or hemophagocytic syndrome)
Skin rash (rare)
Retinitis (rare)
Pancreatitis (rare)
Myocarditis (rare)
Hemophagocytic lymphohistiocytosis (HLH)
Sepsis-like presentation

Risk Factors

Allogeneic HSCT (highest risk: cord blood, T-cell depleted, haploidentical)
Pediatric HSCT (higher than adult)
Severe acute graft-versus-host disease (GVHD)
T-cell lymphopenia
Lung transplantation
Intestinal transplantation
Solid organ transplantation in general
Anti-thymocyte globulin (ATG) use
Alemtuzumab use
High-dose corticosteroids
CD40 ligand deficiency
Severe combined immunodeficiency (SCID)
DOCK8 deficiency
HIV with severe immunosuppression
Primary immunodeficiency (X-linked agammaglobulinemia, hyper-IgM)
Chemotherapy-induced neutropenia
Anti-CD20 monoclonal antibodies (rituximab)
JAK inhibitor therapy
Mucosal disruption from chemotherapy or radiation
Pediatric age (in transplant context)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Immunocompromised patient with new fever
  • Respiratory symptoms in transplant recipient
  • Diarrhea or hematuria in immunosuppressed patient
  • Hepatitis in transplant recipient
  • Routine post-HSCT or SOT monitoring
  • Pre-engraftment fever in HSCT
  • GVHD requiring intensified immunosuppression
  • Quantitative adenovirus blood PCR positivity
  • Conjunctivitis with respiratory symptoms in transplant recipient
  • Encephalopathy in immunosuppressed patient
  • Multi-organ dysfunction in transplant patient
  • Cytopenia worsening unexpectedly post-HSCT

Treatment Methods

01
Quantitative adenovirus blood PCR for diagnosis and monitoring
02
Tissue PCR (BAL, urine, stool, CSF, biopsy) as indicated
03
Comprehensive evaluation: CBC, comprehensive metabolic panel, hepatic function, urinalysis, blood cultures, chest imaging
04
Bronchoscopy with bronchoalveolar lavage for pulmonary disease
05
Endoscopy with biopsy for gastrointestinal disease
06
Brain MRI and lumbar puncture for encephalitis
07
Routine surveillance with weekly blood PCR in high-risk HSCT recipients (especially first 100 days)
08
Preemptive therapy initiation when blood PCR exceeds threshold (e.g., 1000 copies/mL or rising trend)
09
Reduction of immunosuppression when possible (balance with rejection or GVHD risk)
10
Brincidofovir 100 mg orally twice weekly (preferred where available)
11
Cidofovir 5 mg/kg IV weekly with probenecid and IV hydration to mitigate nephrotoxicity
12
Cidofovir 1 mg/kg IV three times weekly as alternative dosing for renal sparing
13
Adenovirus-specific donor-derived T cell therapy (third-party banked T cells, expanding availability)
14
Intravenous immunoglobulin (IVIG) as adjunct in selected cases
15
Supportive care including respiratory support, renal replacement therapy, transfusions
16
Treat coinfections (CMV, fungal, bacterial) common in this population
17
Discontinue or replace nephrotoxic agents when possible
18
Empiric broad-spectrum antibiotics for sepsis-like presentation pending workup
19
Multidisciplinary care including transplant infectious disease, nephrology, pulmonology, ICU
20
Long-term follow-up for relapse and chronic organ damage
21
Vaccination considerations (no live vaccines in immunosuppressed, adenovirus vaccine not widely available)

Which Department to Visit?

You can visit our Enfeksiyon Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.