Presentation:
(1) hematuria, typically macroscopic
(2) dysuria
(3) frequency
Risk factors:
(1) children
(2) transplant patient (bone marrow, HSCT, renal, liver, other solid), especially in those:
(2a) receiving antilymphocyte antibody therapy
(2b) with donor positive and recipient negative for adenovirus exposures
(3) other causes of immunosuppression
Diagnosis often depends on identification of the virus in the urine (adenoviruria):
(1) demonstrating a change in antibody titers is slow, insensitive and sometimes nonspecific
(2) culture of virus
(3) PCR is sensitive and specific. A negative result in the proper clinical setting should include exclusion of an inhibitor.
Some serotypes of adenovirus are encountered more often, such as types 11, 14 and 35.
Adenovirus infections may co-exist with other causes of hemorrhagic cystitis (viral, chemical, etc) so a panel of testing is often needed for an individual patient.
Some patients may develop disseminated disease, which can be fatal. This has been associated with severe absolute lymphopenia (less than 300 lymphocytes per microliter).
