SAN DIEGO—Although usually associated with mild, self-limited illness, adenovirus can cause severe morbidity or death—even in healthy young adults. The US Navy learned this lesson firsthand when two recruits died last year of adenovirus-related illness at the same basic training center in Illinois.

“While [death from adenovirus] is rare, we must remember that it is possible,” Margaret A. K. Ryan, MD, told RESPIRATORY REVIEWS. Dr. Ryan, Director of the Department of Defense Center for Deployment Health Research at the Naval Health Research Center in San Diego, was lead author of a report describing the two cases.[1]

In the first case, the recruit, age 21 years, began basic training May 19, 2000. He had no underlying illnesses, took no medications, and denied tobacco or alcohol use. He was given standard vaccinations within a week of arrival. About a month later, he reported upper respiratory symptoms and was given azithromycin for possible bronchitis. “His clinical evaluation did not suggest severe illness,” stated Dr. Ryan, and throat cultures were negative. The following day, he was found unconscious in the barracks and was hospitalized. He developed tonic-clonic seizures and respiratory failure.

A chest film showed a right–upper-lobe infiltrate, and computed tomography revealed sinusitis. Because no pathogens were identified in cultures of blood or cerebrospinal fluid, the recruit received broad-spectrum antibacterials and antivirals.

He died from complications of encephalitis after about a week in the hospital. Autopsy revealed bronchiolitis obliterans and organizing pneumonia in both lungs. Molecular tests of lung and brain tissue were positive for adenovirus DNA, and analysis of pre-morbid and postmortem serum samples detected a rise in neutralizing antibody titers to adenovirus serotypes 4 and 7.

The second patient, age 18 years, began basic training August 1, 2000. He, too, denied tobacco use, got standard vaccinations within a week, and took no medications. He visited the medical clinic for upper respiratory symptoms several times during the next month and a half; clinical evaluation disclosed no severe illness. Therapy consisted of acetaminophen and decongestants.

The day after his third visit, the recruit presented with severe dyspnea, weakness, and a petechial leg rash. He was hospitalized after chest radiography detected multilobar infiltrates. Despite intravenous antibiotics and respiratory and hemodynamic support, he died nine hours after admission; the diagnosis was acute respiratory distress syndrome. Autopsy revealed diffuse hemorrhagic pneumonia and diffuse alveolar injury, and a polymerase chain reaction test of lung tissue found adenovirus DNA. A sputum sample collected the day of admission contained group A streptococcus.

These deaths are particularly tragic, Dr. Ryan said, because they may have been prevented with the adenovirus vaccine—no longer available because the sole manufacturer ceased production. In the two years since the vaccine supplies have been used up, 10% to 12% of all recruits have had adenovirus infections during basic training.

—Timothy Begany