Colon
Infectious colitis
Adenovirus
Author: Hanni Gulwani, M.B.B.S.
Last author update: 1 March 2015
Last staff update: 7 December 2020
Copyright: 2003-2023, PathologyOutlines.com, Inc.
PubMed Search: adenovirus colitis[title]
Table of Contents
Definition / general | Pathophysiology | Clinical features | Diagnosis | Prognostic factors | Case reports | Treatment | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Electron microscopy images | Additional referencesCite this page: Gulwani H. Adenovirus. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonadenovirus.html. Accessed March 21st, 2023.
Definition / general
- Disease by adenovirus is most common in the upper respiratory tract, but also causes pneumonia and conjunctivitis, and may affect the genitourinary tract, liver, central nervous system or other sites
- Adenovirus is a common cause of pediatric diarrhea, although at least half of infections are subclinical
- The colon may be involved as part of systemic infection
- Most cases are community acquired but nosocomial outbreaks occur
- Infection is associated with immunodeficiency including HIV infection, solid organ and hematopoietic stem cell transplantation, congenital immunodeficiency (Hum Pathol 2010;41:1777)
- There are over 50 serotypes with seven species that affect humans
- In intestinal disease, serotypes 31, 40, and 41 are mostly reported in infants; 2, 3, and 5 mostly in children
- It is not well understood why specific serotypes are associated with specific syndromes; however, differences in mode of transmission and viral tropism likely play a role
Pathophysiology
- Adenovirus is ubiquitous; transmission is by respiratory droplets, fomites, fecal-oral route
- It is a hardy virus and prolonged survival in the environment is possible
- Adenovirus is a nonenveloped, lytic double stranded DNA virus (CDC - Adenoviruses)
- Adenovirus enters the cytoplasm after binding to a receptor and then is transported to the nucleus where replication occurs
- Cell rupture leads to dispersion of viral particles, cytokine production and an inflammatory response
- Chronic or latent infection, usually involving lymphoid tissue, may occur
- Virus may be shed for months to years after infection
Clinical features
- With only very rare exceptions, diarrheal disease is mild and self-limited in immunocompetent individuals
- Infants may develop watery diarrhea, fever and vomiting that lasts 8-12 days (Gastroenterol Clin North Am 2001;30:779)
- Subclinical disease is frequent
- Significant morbidity or mortality can occur in immunocompromised patients, with symptoms of fever, weight loss, abdominal pain
- Other infections, especially CMV, may coexist with adenovirus infection in immunocompromised patients
- Nosocomial outbreaks may occur; appropriate hand hygiene and isolation procedures effectively prevent this
- Infection may cause ileal or cecal intussusception in children
Diagnosis
- Characteristic inclusions in biopsy material are highly consistent with infection; immunohistochemical stains provide confirmation
- PCR, viral culture and stool electron microscopy may be used for diagnosis
- Serologic studies may also be obtained
Prognostic factors
- In immunocompromised patients, high viral load by PCR is associated with a poorer prognosis
Case reports
- Infant with necrotizing enterocolitis associated with adenovirus infection (J Pediatr Surg 2008;43:e5)
- 3 year and 17 year old boys with adenovirus enterocolitis following bone marrow transplantation (Arch Pathol Lab Med 2003;127:1615)
Treatment
- Generally only supportive care
- Cidofovir has been used in immunocompromised patients, but significant toxicity may occur (Biol Blood Marrow Transplant 2007;13:74)
- Immune reconstitution, if possible, is usually curative
Microscopic (histologic) description
- Surface epithelial cells, especially goblet cells, are infected
- Cowdry type B nuclear inclusions with enlarged, homogeneous, smudgy basophilic nuclei (smudge cells) are more common than Cowdry type A inclusions, which are eosinophilic to amphophilic with nuclear halos
- Usually present are necrotic cells, apoptotic bodies and cellular debris with a mononuclear cell infiltrate and generally mild architectural distortion (Histopathology 2015;66:467)
Microscopic (histologic) images
Images hosted on other servers:
Infected cells with
irregular amphophilic
nuclei
Cells have eccentric
nuclei and vacuolated
cytoplasm
Adenovirus immunostain
Positive stains
- Adenovirus immunostain
Electron microscopy images
Images hosted on other servers:
Intranuclear inclusions
with (inset) regular
pattern of arrangement
