ADENOVIRUSES

Dr.T.V.Rao MD

10/12/2012

Dr.T.V.Rao MD

Human Adenoviruses
Adenoviruses were first isolated in 1935 from human adenoid tissues. Since then, at least 49 distinct antigenic types have been isolated from humans and many other types from animals. All human serotypes are included in a single genus within the family Adenoviridae.

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What are Adenoviruses

Adenoviruses are a group of medium sized, nonenvelopedd, double stranded DNA viruses that share a common complement fixing antigen They infect humans and animals

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Dr.T.V.Rao MD

Adenoviruses

Adenoviruses are medium-sized (90100 nm), nonenvelopedd (naked) icosahedral viruses composed of a nucleocapsid and a double-stranded linear DNA genome. There are over 52 different serotypes in humans, which are responsible for 510% of upper respiratory infections in children, and many infections in adults as well.
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Classification
Adenoviruses are divided into six groups (A to F) based on:

physical, chemical biological properties

Antigenic structure divides adenoviruses into: - 49 serotypes: - About 1/3 of the 49 known human serotypes are responsible for most cases of Adenovirus disease.
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Morphology of Adenovirus

Adenovirus are 70-75 nm in size

The capsid contains 252 capsomers arranged as icosahedrons with 20 triangular facets and 12 vertices 240 are called as hexons 12 are called as 10/12/2012 Dr.T.V.Rao MD pentons.

Appear as space vehicle

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Adenoviruses are prevalent all over the world

Over 50 serotypes are isolated Most of the recent isolates are from AIDS patients Infections are common in children and world wide prevalence.
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Morphological configuration

Each penton unit consists of penton base anchored in the capsid and projection or fibre consists of a rode like portion with a knob attached at the distal end The virus appears like a space vehicle.
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Classification

Contain two genera Mast adenovirus. Infects the mammals Aviaadenovirus Infects birds They infect only the homologues species with the exception of oncogenic human adenovirus Type 12, 18,and 31 cause sarcoma when injected into new born hamsters.
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Pathogenesis
Adenovirus

cause infections in Respiratory tract Eye, Urinary bladder, and Intestines More than one type of virus may cause clinically different diseases
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Clinical Features

Clinical features: Adenoviruses most commonly cause respiratory illness; however, depending on the infecting serotype, they may also cause various other illnesses, such as gastroenteritis, conjunctivitis, cystitis, and rash illness. Symptoms of respiratory illness caused by adenovirus infection range from the common cold syndrome to pneumonia, croup, and bronchitis.
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Respiratory diseases:

The most important etiological association of adenoviruses is with the respiratory diseases. They are responsible for 5% of acute respiratory diseases in: young children and much less in adults.

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A. Respiratory diseases:
Four different syndromes of respiratory infection have been linked to Adenoviruses.

Acute febrile pharyngitis:

most commonly seen in infants and young children, symptoms include cough, stuffy nose, fever and sore throat.

Pharyngo Conjunctival fever:

symptoms are similar to those of acute febrile pharyngitis but conjunctivitis is also present. It tends to occur in outbreaks such as at children's summer camps (swimming pool conjunctivitis).

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Respiratory diseases:

Acute respiratory disease:

is characterized by pharyngitis, fever, cough and malaise. It occurs in an epidemic form among young recruits under conditions of fatigue and overcrowding

Pneumonia: a complication of acute respiratory disease in both children and adults.

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Adenovirus infections are important in Military Medicine Adenoviruses are responsible for 3-5% of acute respiratory infections in children and 2% of respiratory illnesses in civilian adults. They are more apt to cause infection among military recruits and other young people who live in institutional environments. Outbreaks among children are frequently reported at boarding schools and summer
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Adenovirus - Pharyngitis

Major cause of infections associated with nonbacterial pharyngitis and tonsillitis Causes febrile common cold Types 1 7 are common types
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Adenovirus Common cause of Respiratory infections

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Pneumonia - Adenovirus

Adenovirus types 3 and 7 are associated with pneumonia resembles like atypical pneumonia in adults. Type 7 causes serious and even fatal pneumonia in infants and young children

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ARD Acute respiratory disease with Adenovirus

Occurs

usually in military recruits Serotypes 4,7,and 21 are agents commonly associated.

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Pharyngocongunctival fever

Occurs in civilian population manifest with syndrome of febrile Pharyngitis and conjunctivitis Serotypes 3, 7, and 14 are associated.
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Epidemic keratoconjunctivitis
Occurs

with

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serious epidemic Caused by serotypes 8, and less frequently with 19, and 37.

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A severe Adenoviral Infection

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Other manifestations

Acute follicular conjunctivitis, types 3,4 and 11 are responsible Adenoviral and chlamydial conjunctivitis are clinically similar Diarrhoea not conclusively established Acute haemorrhagic cystitis in children and types 11 and 21 are responsible Mesenteric adenitis and intussusceptions in children.
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Adenovirus in Immunocompromised

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Patients with compromised immune systems are especially susceptible to severe complications of adenovirus infection. Acute respiratory disease (ARD), first recognized among military recruits during World War II, can be caused by adenovirus infections during conditions of crowding and stress.
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Immunity in Children
Most

children have been infected by at least one adenovirus by the time they reach school age. Most adults have acquired immunity to multiple adenovirus types due to infections they had as children.
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Diagnosis

Diagnosis: Antigen detection, polymerase chain reaction assay, virus isolation, and serology can be used to identify adenovirus infections. Adenovirus typing is usually accomplished by Hemagglutination-inhibition and/or neutralization with type-specific antiserum. Since adenovirus can be excreted for prolonged periods, the presence
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Laboratory Diagnosis
Direct detection: Virus particle by EM can be detected by direct examination of fecal extracts

Detection of adenoviral antigens by ELISA. Enteric Adenoviruses Detection of adenoviral NA by Polymerase chain reaction: can be used for diagnosis of Adenovirus infections in tissue samples or body fluids.
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Laboratory Diagnosis
Isolation Isolation depending on the clinical disease, the virus may be recovered from throat, or Conjunctival swabs or and urine. Isolation is much more difficult from the stool or rectal swabs

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Demographics

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Adenoviruses are responsible for 3 to 5 percent of acute respiratory infections in children. Most adenovirus infections occur between the ages of six months and five years. The incidence of adenovirus infection does not appear to differ among males and females or individuals of different race.
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Treatment

Treatment of adenovirus infections is usually supportive and aimed at relieving symptoms of the illness. Bed rest may be recommended along with medications to reduce fever and/or pain . (Aspirin should not be given to children because it is associated with Reye's syndrome.)
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Treatment
Eye

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infections may benefit from topical corticosteroids to relieve symptoms and shorten the course of the disease. Hospitalization is usually required for severe pneumonia in infants and for keratoconjunctivitis (to prevent blindness).
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Prevention of Adenoviral Infections

Prevention: Vaccines were developed for adenovirus serotypes 4 and 7, but were available only for preventing ARD among military recruits. Strict attention to good infection-control practices is effective for stopping nosocomial outbreaks of adenovirus-associated disease, such as epidemic keratoconjunctivitis. Maintaining adequate levels of chlorination is necessary for preventing swimming poolassociated outbreaks of adenovirus conjunctivitis.
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Prevention and control

Careful hand washing is the easiest way to prevent infection. Disinfection of Environmental surfaces with hypochlorite's. The risk of water borne outbreaks of conjunctivitis can be minimized by chlorination of swimming pools. Epidemic keratoconjunctivitis can be controlled by strict asepsis during eye examination.
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Adenovirus a emerging tool in Genetic Engineering

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Experiments with Adenovirus

Adenovirus vectors are used by researchers to deliver genetic material into the cells. Not only is this but they also being used by molecular biologists for vaccination purposes. They are mostly used in in-vitro experiments at this time.
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Simple Hand Washing Can Save Us From Serious Adenoviral Infections

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Created by Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World

Programme

Email

doctortvrao@gmail.com
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10/12/2012