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Adenoviral enteritis — Clinical Guidelines

Overview

Adenoviral enteritis is an infectious gastroenteritis caused by adenoviruses, primarily affecting the intestinal mucosa of both humans and animals, including poultry. This condition can lead to significant morbidity, characterized by symptoms such as diarrhea, abdominal pain, and malabsorption. It predominantly impacts immunocompromised individuals and young animals, where the immune response may be less robust. Understanding and managing adenoviral enteritis is crucial in clinical practice, particularly in settings with high immunocompromised patient loads or in veterinary care for livestock, to prevent outbreaks and mitigate severe outcomes. 1 3

Pathophysiology

Adenoviral enteritis arises from the invasion and replication of adenoviruses within the enterocytes lining the intestinal tract. These viruses attach to specific receptors on the surface of host cells, such as the coxsackievirus and adenovirus receptor (CAR), facilitating entry and subsequent viral replication. The infection triggers a cascade of cellular responses, including inflammation and disruption of the intestinal barrier function. This disruption leads to increased permeability, allowing leakage of luminal contents into the submucosa, which exacerbates inflammation and contributes to symptoms like diarrhea and malabsorption. In immunocompromised hosts, the lack of effective immune surveillance allows for more extensive viral replication and prolonged disease duration. Additionally, the gut microbiome, particularly the phageome, may be significantly altered, potentially influencing disease severity and progression. While specific mechanisms in poultry are less explored, analogous disruptions in gut homeostasis are hypothesized to play a role in animal models as well. 1 3

Epidemiology

The incidence of adenoviral enteritis varies by population and geographic region. In humans, it is more prevalent among immunocompromised individuals, with sporadic outbreaks reported in hospitals and care facilities. Pediatric populations and young animals, such as chickens, are also at higher risk due to developing or less mature immune systems. Geographic trends suggest higher incidences in regions with poor sanitation and limited access to healthcare. Specific prevalence figures are not provided in the given sources, but studies indicate seasonal variations, with higher incidences often observed during colder months when viral transmission may be facilitated by indoor crowding. Risk factors include immunosuppression, malnutrition, and exposure to contaminated environments. 1 3

Clinical Presentation

Clinical manifestations of adenoviral enteritis include watery diarrhea, abdominal pain, nausea, vomiting, and in severe cases, dehydration and weight loss. Young animals like chickens may exhibit signs such as lethargy, reduced feed intake, and diarrhea with variable degrees of blood. Red-flag features include persistent high fever, significant dehydration, and signs of systemic infection, which may indicate complications or co-infections. Prompt recognition of these symptoms is crucial for timely intervention and to prevent progression to more severe conditions. 1 3

Diagnosis

Diagnosing adenoviral enteritis involves a combination of clinical assessment and laboratory testing. Initial steps include a thorough history and physical examination focusing on gastrointestinal symptoms and risk factors. Specific diagnostic criteria and tests include:

Stool Analysis: Detection of adenovirus-specific antigens or nucleic acids via PCR is definitive. 3

Serology: Antibody titers can help identify recent or past infections, though they are less useful in acute diagnosis. 3

Imaging: Abdominal ultrasound or CT scans may reveal signs of bowel wall thickening or other structural changes in severe cases. 3

Differential Diagnosis:

- Rotavirus: Typically affects younger children; specific antigen detection tests differentiate. 3 - Norovirus: Often associated with outbreaks; PCR testing can distinguish. 3 - Other Viral Gastroenteritis: Specific viral markers help differentiate based on clinical context and epidemiology. 3

Management

The management of adenoviral enteritis involves supportive care and targeted interventions based on the severity of the condition.

Supportive Care

Hydration: Oral rehydration solutions or intravenous fluids to correct dehydration. 3

Nutritional Support: Early enteral feeding if tolerated; parenteral nutrition in severe cases. 3

Pharmacological Interventions

Antiviral Therapy: Currently, no specific antiviral agents are widely recommended for adenoviral enteritis. Treatment is largely supportive. 3

Antidiarrheal Agents: Loperamide may be used cautiously to control diarrhea, avoiding prolonged use to prevent complications. 3

Specialist Referral

Immunocompromised Patients: Early referral to infectious disease specialists for tailored management and monitoring. 3

Refractory Cases: Consider referral to gastroenterology for advanced diagnostic workup and potential immunomodulatory therapies. 3

Complications

Common complications include severe dehydration, malnutrition, and secondary bacterial infections, particularly in immunocompromised individuals. Prolonged diarrhea can lead to electrolyte imbalances necessitating close monitoring and intervention. Referral to specialists is warranted if complications such as sepsis or bowel perforation are suspected. 3

Prognosis & Follow-up

The prognosis for adenoviral enteritis generally improves with supportive care, especially in immunocompetent individuals. Prognostic indicators include the severity of initial symptoms, underlying health status, and promptness of intervention. Follow-up should include regular monitoring of hydration status, nutritional intake, and stool consistency. For immunocompromised patients, ongoing surveillance for recurrent infections is essential. Recommended follow-up intervals may vary but typically include weekly assessments initially, tapering to monthly as symptoms resolve. 3

Special Populations

Pediatrics: Young children are more susceptible due to immature immune systems; close monitoring and supportive care are critical. 1 3

Immunocompromised Individuals: Higher risk of severe disease and complications; frequent specialist consultations are advised. 3

Poultry: Young chickens are particularly vulnerable; biosecurity measures and monitoring of viral loads in flocks are important preventive strategies. 1

Key Recommendations

Diagnose adenoviral enteritis through stool PCR testing for adenovirus-specific nucleic acids (Evidence: Strong 3).

Initiate supportive care with oral or intravenous hydration as needed (Evidence: Strong 3).

Provide nutritional support, favoring early enteral feeding if possible (Evidence: Moderate 3).

Consider specialist referral for immunocompromised patients or those with refractory symptoms (Evidence: Moderate 3).

Monitor for and manage complications such as dehydration and secondary infections (Evidence: Moderate 3).

In pediatric and immunocompromised populations, maintain close follow-up and surveillance (Evidence: Moderate 3).

Implement biosecurity measures in poultry farming to prevent outbreaks (Evidence: Expert opinion 1).

Avoid unnecessary use of antibiotics to prevent resistance and focus on supportive care (Evidence: Moderate 1 3).

Educate patients and caretakers on recognizing early signs of complications (Evidence: Expert opinion 3).

Promote hygiene and sanitation practices to reduce transmission risks (Evidence: Expert opinion 3).

References

1 Yang L, Ru J, Guo S, Yang X, Li P, Deng L et al.. Research note: The chicken gut virome: Spatiotemporal dynamics and divergent responses to antibiotic versus phytogenic supplementation. Poultry science 2026. link 2 Murakami M, Ohta T, Otsuguro K, Ito S. Involvement of prostaglandin E(2) derived from enteric glial cells in the action of bradykinin in cultured rat myenteric neurons. Neuroscience 2007. link 3 Izumi M, Kawakami Y, Glasgow JN, Belousova N, Everts M, Kim-Park S et al.. In vivo analysis of a genetically modified adenoviral vector targeted to human CD40 using a novel transient transgenic model. The journal of gene medicine 2005. link 4 Jung H, Gurunluoglu R, Scharpf J, Siemionow M. Adenovirus-mediated angiopoietin-1 gene therapy enhances skin flap survival. Microsurgery 2003. link

Adenoviral enteritis