Adenovirus infection in children

Adenovirus infection in children is an acute respiratory disease with fever, moderate intoxication, damage to the mucous membranes of the respiratory tract, often conjunctiva of the eyes, as well as lymphoid tissue.

The disease occupies an important place in the pathology of young children. In the inter-epidemic period of influenza, adenovirus infection at this age accounts for up to 25-30% of all viral respiratory diseases. By the age of 5, almost all children have an adenoviral infection, with half of the children suffering the infection again.

[1], [2]

Epidemiology

The source of infection are patients with both obvious and hidden, inapparant form of the disease, as well as healthy carriers. The most dangerous patients in the acute period of the disease, when adenoviruses in a large concentration are found in nasopharyngeal washings, scrapings from the affected conjunctiva, in the blood and feces. Patients are dangerous during the first 2 weeks of the disease, in rare cases, the virus continues until 3-4 weeks.

The mechanism of transmission of infection is airborne, but an alimentary pathway of infection is also possible - by the type of intestinal infections. According to the epidemiological classification of infectious diseases, adenovirus infection is classified as a group of airborne and intestinal infections.

Children of the first months of life are unresponsive to adenovirus infection because of passive transplacental immunity. Beginning at 6 months, almost all children become susceptible. As a result of repeated diseases, children acquire active immunity, from the age of 5 the incidence of adenovirus infection is sharply reduced.

[3], [4], [5]

What causes adenovirus infection in children?

There are 41 varieties (serovars) of human adenoviruses. Viral particles contain DNA, have a diameter of 70 to 90 nm, are stable in the external environment.

Pathogenesis

The entrance gates of the infection are often the upper respiratory tract, sometimes the conjunctiva or the intestine. By pinocytosis adenoviruses penetrate the cytoplasm, and then into the nucleus of susceptible epithelial cells and regional lymph nodes. Viral DNA is synthesized in the nuclei of the affected cells and mature virus particles appear in 16-20 h. This process leads to an end to the division of the infected cells, and then to their death. Reproduction of the virus in epithelial cells and regional lymph nodes corresponds to the incubation period.

Causes and pathogenesis of adenovirus infection

Symptoms of adenovirus infection in children

The incubation period of adenovirus infection is from 2 to 12 days. The disease usually begins acutely, but the various symptoms of the disease do not appear simultaneously, but consistently. The first signs are often a rise in body temperature and catarrhal phenomena in the upper respiratory tract. The body temperature rises gradually, reaching a maximum (38-39 ° C, rarely 40 ° C) to the 2-3rd day. Symptoms of intoxication are moderately expressed. There is a slight lethargy, appetite worsens, headache, and rarely muscular and joint pain. Some patients experience nausea, vomiting, and abdominal pain.

From the first day of the disease, there are abundant serous discharge from the nose, which soon become mucopurulent. The mucous membrane of the nose is swollen, hyperemic. Nasal breathing is difficult. Changes in the oropharynx include mild hyperemia and swelling of the anterior arch and palatine tonsils. On the mucosa of the posterior pharyngeal wall, there is a so-called granulosis pharyngitis, in which the posterior wall looks edematous and hyperemic with hyperplastic bright follicles, lateral pharyngeal grooves are enlarged. With a pronounced exudative component of inflammation on the hyperplastic follicles, tender whitish coatings and thick mucus are seen.

Symptoms of adenovirus infection

Classification

With adenovirus infection, the main clinical syndrome is identified:

• pharyngoconjunctival fever;
• catarrh of the upper respiratory tract;
• keratoconjunctivitis, tonsillopharyngitis;
• diarrhea;
• mesenteric lymphadenitis, etc.

There are easy, medium and heavy forms without complications and with complications.

[6], [7], [8], [9], [10], [11],

Diagnosis of adenovirus infection in children

Adenovirus infection is diagnosed on the basis of fever, catarrh of the respiratory tract, hyperplasia of the oropharyngeal lymphoid tissue, enlargement of the cervical lymph nodes, and damage to the mucous membranes of the eyes. The sequential development of clinical symptoms is important for diagnosis, as a result of which the febrile period may extend to 7-14 days.

As a rapid diagnosis, the fluorescent antibody method is used, which makes it possible to detect a specific adenoviral antigen in the epithelial cells of the patient's airways. For serological diagnosis, the RCC and haemagglutination delay response (RDA) are put. Increasing the antibody titer to adenovirus by 4 times or more in paired sera in the course of the disease confirms the etiology of the disease. To isolate adenoviruses, nasopharyngeal washings, feces and blood of the patient are used.

[12], [13], [14], [15], [16]

Adenovirus infection in children: treatment

Adenovirus infection in children differs from respiratory infection of other viral etiology with damage to the mucous membranes of the eyes, non-simultaneous occurrence of the main clinical symptoms, a distinctly expressed reaction of lymphoid tissue, expressed exudative inflammation of the respiratory tract.

Adenovirus infection in children, treatment of the syndrome suggests the same as in the case of influenza. As antipyretics in infants, the appointment of paracetamol-containing drugs (Children's Panadol) is recommended. Hospitalization is required for young children with severe adenovirus infection and complications.

Adenovirus infection is treated in children at home. Assign bed rest, complete nutrition. Apply symptomatic drugs, desensitizing drugs, multivitamins. It is recommended to instill a 0,05% solution of deoxyribonuclease 3-4 drops every 3 hours for 2-3 days. Injection of interferon into the nasal cavity is ineffective.

Specific prophylaxis has not been developed yet. The usual methods of prevention are used: early isolation of the patient, ventilation and ultraviolet irradiation of the room, wet cleaning with the use of weak solutions of chlorine, boiling dishes, linen and clothes.

Diagnosis and treatment of adenovirus infection

Antibiotics are indicated only for bacterial complications: pneumonia, sinusitis, angina, etc. Interferon inducers can be used (for example, anaferon for children - for children from 6 months, and for children from 6 years of age - kagocel, which combines well with other antiviral drugs, immunomodulators and antibiotics).

[17], [18]