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In this article Komarovsky Adenovirus infection, we will tell you how to treat, symptoms, prevention and much more.
Adenoviral infection is one of the types of ARVI. The causative agents are DNA viruses. Most often, the disease is diagnosed in children and adolescents. Outbreaks of the disease are most often recorded in the cold season. The infectious agent affects the mucous membranes of the respiratory system and intestines. Lymphoid tissue is often involved in the process. One of the rather characteristic symptoms is damage to the conjunctiva of the eyes, which is why this pathology is also called “pharyngoconjunctival fever.” Important: the disease is characterized by seasonality, but individual cases are recorded year-round. Adenovirus is most often spread by airborne droplets. Contact and nutritional transmission of the pathogen is also possible. Clinical signs of the disease are varied, but the most common symptoms are sore throat, runny nose and fever, i.e. symptoms characteristic of ARVI. The disease can be quite severe, especially in a small child (under 3 years old) with a weak immune system.
If your child develops acute symptoms, you should definitely contact your pediatrician. By self-medicating, you can only harm the patient. With adenovirus infection, quite serious complications cannot be ruled out. Please note: do not be surprised if a child is diagnosed with ARVI several times during one autumn-winter season. This does not mean that he does not develop immunity. Diseases from the ARVI group can be caused by a wide variety of pathogens, and acquiring immunity to one of the strains of the influenza virus does not completely exclude infection with an adenovirus.
ETIOLOGY AND PATHOGENESIS OF THE DISEASE
The causative agent of adenovirus infection is characterized by a very significant degree of resistance in the external environment, which makes the disease highly contagious. In this regard, outbreaks are not uncommon in preschool institutions. At room temperature, adenoviruses can remain viable for up to two weeks. The virus is able to withstand half an hour of heating and repeated freezing; It dies only when boiled and when the room is treated with an ultraviolet lamp. The source of the pathogen is an infected person. The virus is released in nasopharyngeal secretions and feces.
The patient poses a danger to others within three to four weeks from the moment of infection. Most often, transmission occurs through airborne droplets. Nutritional infection (fecal-oral transmission with insufficient personal hygiene) and the spread of the virus through household contact are also possible. The pathogen can be present in open bodies of water and enter the body through accidental ingestion of water. The duration of the incubation period in different cases ranges from 1-2 to 12 days. An infected child may not yet have characteristic symptoms, but the pathogen is already being released into the environment.
Please note: the likelihood of an infant becoming infected is relatively low, since the baby is reliably protected by antibodies present in the mother’s body and obtained through breast milk. After an adenovirus infection, children develop immunity that lasts 5-8 years. It should be noted that immunity is type-specific, and more than 50 types of adenovirus have already been identified.
In this regard, the previous disease does not protect against infection by another type of virus of this group. The mucous membranes of the respiratory and digestive systems, as well as the conjunctiva of the eyes, become the “gate of entry” for the adenovirus. Having penetrated the epithelium, the virus actively multiplies, killing cells within several hours. A characteristic feature of the disease is the high probability of damage to lymphoid tissue cells by the pathogen.
Prevention
The main preventive measures are aimed at increasing the general resistance of the child’s body and isolating sick children from an organized group.3748738
- Chlorination of water in swimming pools.
- Wellness procedures - hardening, proper nutrition;
- Prevention of drafts and hypothermia, clothing according to the weather.
- Taking herbal adaptogens - tinctures of Eleutherococcus, Schisandra, Echinacea;
- Periodic intake of vitamin-mineral complexes, and in the autumn-winter period - immunomodulating and immunostimulating drugs.
- Reducing contacts during the epidemic season, avoiding visiting large crowds of people.
After isolating a sick child from the children's group, final disinfection is carried out in the room. Surrounding objects are treated with chlorine-containing solutions - chloramine or sulfochlorantine. Emergency prevention is carried out in the outbreak by prescribing immunostimulants to contact children.
SYMPTOMS OF ADENOVIRUS INFECTION
All clinical manifestations can be combined into two syndromes:
Respiratory – characteristic of all acute respiratory viral infections, but with a particularly high probability of “overlap” of a secondary bacterial infection; pharyngoconjunctival fever syndrome.
Adenoviral infection in children is manifested by the following symptoms: sore throat, soreness and sore throat (increases during swallowing); severe difficulty in nasal breathing; increase in general body temperature (from 37.5˚С to 39˚С); damage to the conjunctiva (accompanied by lacrimation, swelling of the eyelids, pain in the eyes and the presence of purulent discharge); loss of appetite; sleep disorders; general weakness; pallor; dyspnea; increased irritability; copious discharge from the nose (at the beginning of the disease the secretion is watery and transparent, and then thick green); cough (initially dry, and on the 3-4th day wet with sputum discharge); pain in the abdominal region (near the navel); vomiting (not always); diarrhea (up to 5 times a day, without mucus, blood, etc.); bloating; swelling and hyperemia of the tonsils; mucus on the back of the throat; pinpoint purulent plaque on the tonsils; enlarged lymph nodes.
The lymph nodes, although increased in size, are not fused with the surrounding tissues. Their palpation during the examination does not cause pain.
A particularly severe course of adenoviral infection is characterized by a symptom such as hepatosplenomegaly, i.e. enlargement of the liver and spleen. Important: in children of a younger age group (especially in infants) convulsions may develop at the peak of the febrile reaction. For younger children, bowel problems and bloating due to inflammation of the mesenteric (mesenteric) lymph nodes are more common. The severity of conjunctivitis with adenoviral infection varies.
Its symptoms appear at different stages of the disease (both at the very beginning and on days 3-5). First one eye is affected, and soon (usually after 1-2 days) the inflammatory process affects the second one. The child's eyelids are swollen, and in the morning it is difficult for the patient to open his eyes, since the purulent discharge sticks the eyelashes together. Depending on the form of adenoviral conjunctivitis (membranous or follicular), one of 2 standard treatment regimens can be used:
Adenovirus infection
The duration of the incubation period varies from 1 day to 2 weeks, most often being 5-8 days. The disease begins acutely with the development of mild or moderate symptoms of intoxication: chills or chills, mild and intermittent headache, myalgia and arthralgia, lethargy, adynamia, decreased appetite. From the 2-3rd day of illness, body temperature begins to rise, more often it remains low-grade for 5-7 days, only sometimes reaching 38-39 ° C. In rare cases, epigastric pain and diarrhea may occur. At the same time, symptoms of upper respiratory tract damage develop. Unlike influenza, moderate nasal congestion appears early with copious serous, and later serous-purulent, discharge. A sore throat and cough may occur. After 2-3 days from the onset of the disease, patients begin to complain of eye pain and excessive lacrimation.
When examining patients, one may notice facial hyperemia, scleral injection, and sometimes a papular rash on the skin. Conjunctivitis often develops with conjunctival hyperemia and mucous, but not purulent, discharge. In children of the first years of life and occasionally in adult patients, filmy formations may appear on the conjunctiva, and swelling of the eyelids increases. Possible damage to the cornea with the formation of infiltrates; when combined with catarrhal, purulent or membranous conjunctivitis, the process is usually initially unilateral. Infiltrates on the cornea resolve slowly, within 1-2 months.
Conjunctivitis can be combined with manifestations of pharyngitis (pharyngoconjunctival fever).
The mucous membrane of the soft palate and the posterior wall of the pharynx is slightly inflamed and may be granular and swollen. The follicles of the posterior pharyngeal wall are hypertrophied. The tonsils are enlarged, loosened, sometimes covered with easily removable loose whitish coatings of various shapes and sizes. They note enlargement and pain on palpation of the submandibular, often cervical and even axillary lymph nodes.
If the inflammatory process of the respiratory tract takes on a descending character, laryngitis and bronchitis may develop. Laryngitis is rarely observed in patients with adenovirus infection. It manifests itself as a sharp “barking” cough, increased pain in the throat, and hoarseness of the voice. In cases of bronchitis, the cough becomes more persistent, hard breathing and scattered dry wheezing in different parts are heard in the lungs.
The period of catarrhal symptoms can sometimes be complicated by the development of adenoviral pneumonia. It occurs 3-5 days after the onset of the disease; in children under 2-3 years of age it can begin suddenly. At the same time, the body temperature increases, the fever takes on an abnormal character and lasts for a long time (2-3 weeks). The cough becomes stronger, general weakness progresses, and shortness of breath occurs. The lips take on a cyanotic tint. When walking, shortness of breath increases, perspiration appears on the forehead, and cyanosis of the lips intensifies. According to radiological signs, pneumonia can be small-focal or confluent.
In young children in severe cases of viral pneumonia, a maculopapular rash, encephalitis, and foci of necrosis in the lungs, skin and brain are possible.
Pathological changes in the cardiovascular system develop only in rare, severe forms of the disease. Characterized by muffled heart sounds and soft systolic murmur at its apex.
Lesions in various parts of the respiratory tract can be combined with gastrointestinal disorders. Abdominal pain and intestinal dysfunction occur (diarrhea is especially common in young children). The liver and spleen enlarge.
Adenovirus infection most often affects children and middle-aged people. The disease lasts on average from several days to 1 week, but if the virus remains in the body for a long time, a recurrent course is possible, with the infection dragging on for 2-3 weeks.
Based on the predominance of certain symptoms and their combination, several forms of the disease are distinguished: • ARVI; • nasopharyngitis; • rhinopharyngotonsillitis; • nasopharyngobronchitis; • pharyngoconjunctivitis (pharyngoconjunctival fever); • conjunctivitis and keratoconjunctivitis; • pneumonia, etc.
Complications of adenovirus infection The most typical are otitis and purulent sinusitis, obstruction of the Eustachian tube in children due to prolonged hypertrophy of lymphoid tissue in the pharynx, laryngospasm (false croup), secondary bacterial pneumonia, kidney damage. The prognosis of the disease is usually favorable.
COMPLICATIONS OF ADENOVIRAL INFECTION IN CHILDREN
The average duration of the disease in children is 1 week, provided the course is uncomplicated. With a prolonged course, symptoms are observed for 2-3 weeks. Clinical manifestations of conjunctival damage subside earlier, and inflammation in the nasopharynx and upper respiratory tract can persist for 3 weeks. In some cases, the process progresses when, against the background of obvious improvement, some characteristic symptoms again clearly appear.
Complications that develop against the background of an adenovirus infection are usually caused by the active proliferation of pathogenic microflora due to a general weakening of the body. The bacterial infection primarily affects the respiratory system, which often results in bronchitis and pneumonia (pneumonia of bacterial origin).
If the virus infects the lymph nodes of the peritoneum (mesentery) located in the abdominal cavity, the development of appendicitis is possible, which requires urgent surgical intervention. Other possible complications include tonsillitis, sinusitis and exacerbation of chronic diseases.
In infants, there is a high risk of complications such as inflammation of the middle ear (otitis media). In addition, in children the so-called “generalization” of the pathological process. The pathogen can enter various organs through the bloodstream. In particular, the development of viral (hemorrhagic) pneumonia cannot be ruled out. In this severe complication, the infectious agent affects the blood vessels of the pulmonary alveoli (vesicles). As a result of blood stagnation, gas exchange is disrupted, and the child quickly develops respiratory failure.
DIAGNOSTICS
Very characteristic symptoms in most cases allow an accurate diagnosis to be made based on the patient’s complaints and clinical manifestations. It is also important to correctly differentiate adenovirus infection from others, for example, from rhinovirus:
The atypical course of an adenoviral infection may require differential diagnosis of the disease with a pathology such as infectious mononucleosis. A laboratory test of the patient's blood is carried out to detect antibodies.
During an epidemic, a virological diagnostic method is used to accurately determine the type of adenovirus. The material for the study is a wash from the mucous membrane of the patient’s nasopharynx. A laboratory study of peripheral blood reveals changes common to viral diseases - lymphocytosis, leukopenia and a slight increase in erythrocyte sedimentation rate. General blood and urine tests for this disease are not very informative.
TREATMENT OF ADENOVIRAL INFECTION IN CHILDREN
In most cases, treatment of adenoviral infection in children is carried out on an outpatient basis, that is, at home. Placing a child in a hospital may be necessary in case of severe disease or the development of serious complications, in particular when the process generalizes.
Specific treatment methods have not been developed, and standard antiviral drugs are ineffective. In this regard, only symptomatic therapy is carried out. Bed rest is necessary for the child until the fever passes. Indications for the prescription of antipyretics (antipyretic drugs) is a rise in body temperature above 38.5˚C.
At lower values, these drugs are used if there is a high probability of developing seizures against the background of a febrile reaction (for example, in young children). Pediatricians recommend giving children Nurofen or Paracetamol, strictly observing age-specific dosages.
In addition to pharmacological means to reduce temperature in the treatment of adenoviral infection, you can use physical methods, such as cold rubbing and applying a heating pad with ice to the projection of large blood vessels. To speed up the removal of toxins from the body, the patient is advised to drink plenty of warm drinks.
Milk with a small amount of baking soda and alkaline mineral waters help soften a dry hacking cough. It is not advisable to use antitussives!
To reduce inflammation of the mucous membrane of the respiratory tract, the child is recommended to inhale with the drug Lazolvan, as well as with a physiological solution of sodium chloride. To thin bronchial secretions (sputum), it is recommended to give Bromhexine and ACC. To improve sputum discharge during a wet cough, mucolytic and expectorant drugs (Ambroxol, Mucaltin) are indicated.
Remember that only your doctor can prescribe the optimal medications. Inflammation of the conjunctiva requires regular eye rinsing. To carry out the procedure, you can use a weak (pale pink) solution of potassium permanganate, or furatsilin. Natural remedies are also effective - a decoction of chamomile flowers and weak tea leaves. Among the drugs for the treatment of conjunctivitis in case of adenoviral infection, Ophthalmoferon drops (even with unilateral inflammation should be instilled in both eyes) and Oxolinic ointment (placed behind the lower eyelids) are also indicated.
For nasal congestion, you can use vasoconstrictor drops Nazivin or Galazolin (in “children’s” concentration). You can use these drugs 3-4 times a day and preferably no more than 3-5 days in a row to avoid the development of drug dependence. For gargling a sore throat, products with an antiseptic effect are indicated - furatsilin solution and chamomile decoction. The presence of complications due to the addition of a bacterial infection is an indication for treatment with a course of systemic antibiotic therapy.
With an adenovirus infection, it is difficult for a child with a sore throat to eat regular food, so his diet should include pureed and semi-liquid foods. To strengthen the immune system, vitamins are necessary, which the baby should receive both with fresh vegetables and fruits (or juices), and in the form of complex preparations. The room where the sick child is located must be wet cleaned twice a day. The room should be ventilated more often. Until the symptoms of conjunctivitis subside, it is important to provide dim lighting. Walking in the fresh air is allowed only as symptoms disappear and general health is normal.
Adenovirus infection in children
01.Feb.2021
Typically, with adenoviral disease, the lymph nodes, cornea and mucous membrane of the eyeball are affected, and ocular conjunctivitis occurs. This group of microorganisms was first isolated and subjected to research in 1953, after which in 1957 adenoviruses received the name by which they are known in today's medicine - “Adenoviridae”. These viruses, even when deep frozen, retain their vitality, and at room temperature their vital activity lasts up to two or more weeks. The best means of combating these viruses is ultraviolet radiation and solutions of chlorine-containing compounds. Moreover, if influenza and acute respiratory diseases are seasonal, then adenovirus infection affects people all year round.
The likelihood of infection and subsequent development of the disease is especially high in children from six months to seven years. Military personnel are also at risk. Infection most often occurs through contact with a sick person. In this case, the patient continues to remain a virus carrier for 2 - 3 weeks from the onset of the disease. An infected person releases an infectious substance when talking, and infection through shared objects is also possible. There are frequent cases of the virus entering the body by eating unwashed fruit.
Adenoviruses, like influenza pathogens, enter the human body through the upper respiratory tract. In addition, infection occurs through the mucous membranes of the eyeball and through the small intestine. The duration of the incubation period is usually from 2 to 12 days (usually 5-7) days. The symptoms of the disease are very similar to the initial course of the flu. There is also chills, aches in the joints and muscles, but the body temperature rarely reaches 38.0°C ... 38.0°C. The disease is often accompanied by a dry cough, and in the initial stages there is chills. If the infection penetrates through the gastrointestinal tract, then there are paroxysmal pain in the umbilical and right iliac region, fever, diarrhea, vomiting, and mesenteric lymphadenitis. With severe pain, the clinical picture resembles acute appendicitis. Fever with adenoviral infection lasts 1-2 weeks and can be wavy. Signs of rhinitis and conjunctivitis subside after 7-14 days, catarrh of the upper respiratory tract - after 14-21 days.
Children's adenoviral infection has its own characteristics; it usually has symptoms of catarrh of the respiratory tract, with pain in the goal. There is an increase in the submandibular and cervical lymph nodes. If there are signs of rhinitis, then it is diagnosed by serous discharge from the nasal sinuses, due to which breathing is difficult and has a guttural character. In children of the younger age group, in addition to catarrhal syndrome, signs of diarrhea often appear.
Treatment of childhood adenovirus infection is carried out at home with strict bed rest in the first days after the first symptoms appear. The baby should rest in complete peace with painstaking care. After the end of the illness, during the rehabilitation period (3-5 days), it is advisable to avoid physical activity.
E. Shishigina, doctor - epidemiologist of the Nyagan City Children's Clinic
