Colon non tumor
Infectious colitis (specific microorganisms)
Adenovirus colitis

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 27 December 2017, last major update March 2015

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: adenovirus colitis[title]
Cite this page: Adenovirus colitis. PathologyOutlines.com website. http://pathologyoutlines.com/topic/colonadenovirus.html. Accessed March 30th, 2017.
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
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
Micro 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)
Micro Images

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Figures C-E

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Infected cells with
irregular amphophilic
nuclei

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Cells have eccentric
nuclei and vacuolated
cytoplasm

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Adenovirus immunostain

Positive Stains
  • Adenovirus immunostain
Electron Microscopy Images

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Figure 1

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Figure 2


Fig 1: intranuclear inclusions with (inset) regular pattern of arrangement
Fig 2: hexagonal arrangement (site unknown)