Clinical Features, Adenovirus Types, and Local Production of Inflammatory Mediators in Adenovirus Infections

Background: Adenovirus infection manifests in many ways, with respiratory and gastrointestinal symptoms predominating. Methods: We performed a retrospective chart review on children evaluated at our center who had a nasal wash culture positive for adenovirus. Archived nasal washes were retrieved. Polymerase chain reaction for 15 respiratory viruses was performed on these samples. Patients who were coinfected with another virus were excluded. Adenovirus typing was performed using polymerase chain reaction primers directed at the conserved hexon gene. Bead proteomics was used to measure concentrations of inflammatory mediators. Results: Seventy-eight patients were infected only with adenovirus. The clinical diagnosis was upper respiratory infection in 60%, pneumonia in 18%, febrile seizure in 8%, and bronchiolitis in 6%. Subgroup-C and B1 infections were most common. Seventy percent of patients with upper respiratory infection and all 5 patients with bronchiolitis had a subgroup-C infection; pneumonia was caused by subgroup-B1 and C viruses. Compared with asymptomatic control patients, adenovirus infected patients had higher nasal wash concentrations of interleukin (IL)-1 alpha, IL-6, inducible protein-10, macrophage inflammatory protein-1 alpha, tumor necrosis factor a, monokine induced by gamma interferon, and interferon-a (P < 0.05). In addition, we found that IL-8 and IL-1 alpha (P < 0.05) were higher in the nasal washes obtained from hospitalized patients than in nonhospitalized patients. Conclusions: Adenovirus infection causes an array of clinical disease and is associated with local production of several proinflammatory cytokines. The observation that nasal wash IL-8 and IL-1 alpha concentrations were higher in patients requiring hospitalization suggests that these mediators contribute to disease severity.