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Key Features

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  • Multiple syndromes, depending on the type of adenovirus

  • Upper respiratory infections; most notable is severe pharyngitis with tonsillitis and cervical adenopathy

  • Conjunctivitis

  • Pneumonia

  • Enteric adenoviruses cause mild diarrheal illnesses

  • Definitive diagnosis by antigen detection, polymerase chain reaction (PCR), or culture

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Clinical Findings

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  • Pharyngitis

    • Most common adenoviral disease

    • Fever and adenopathy are common

    • Tonsillitis may be exudative

    • Rhinitis and an influenza-like systemic illness may be present

    • Laryngotracheitis or bronchitis may accompany pharyngitis

  • Pharyngoconjunctival fever

    • Conjunctivitis may occur alone and be prolonged

    • Most often associated with preauricular adenopathy, fever, pharyngitis, and cervical adenopathy

    • Foreign body sensation in the eye and other symptoms last less than a week

    • Lower respiratory symptoms are uncommon

  • Epidemic keratoconjunctivitis

    • Severe conjunctivitis with punctate keratitis and occasionally visual impairment

    • A foreign body sensation, photophobia, and swelling of conjunctiva and eyelids are characteristic

    • Preauricular adenopathy and subconjunctival hemorrhage are common

  • Pneumonia

    • May occur at all ages; it is especially common in children younger than age 3

    • Symptoms persist for 2–4 weeks

    • Can be necrotizing and cause permanent lung damage, such as bronchiectasis and bronchiolitis obliterans

    • A pertussis-like syndrome with typical cough and lymphocytosis can occur with lower respiratory tract infection

    • A new variant of adenovirus serotype 14 can cause unusually severe, sometimes fatal pneumonia in children and adults

  • Rash

    • A diffuse morbilliform (rarely petechial) rash resembling measles, rubella, or roseola may be present

    • Koplik spots are absent

  • Diarrhea

    • Enteric adenoviruses (types 40 and 41) cause 3–5% of cases of short-lived diarrhea in afebrile children, especially in those younger than 4 years old

  • Mesenteric lymphadenitis

    • Fever and abdominal pain may mimic appendicitis

    • Pharyngitis is often associated

    • Adenovirus-induced adenopathy may be a factor in appendicitis and intussusception

  • Other syndromes

    • Immunosuppressed patients, including neonates, may develop severe or fatal pulmonary or gastrointestinal infections or multisystem disease

    • Hemorrhagic cystitis can be a serious problem in immunocompromised children

    • Other rare complications that can occur in the immunocompetent child include

      • Encephalitis

      • Hepatitis

      • Myocarditis

    • Adenoviruses have been implicated in the syndrome of idiopathic myocardiopathy

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Diagnosis

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  • Conventional culture of conjunctival, respiratory, or stool specimens can be done but several days to weeks are required

  • Viral culture using the rapid culture technique with immunodiagnostic reagents detects adenovirus in 48 hours; however, this method is less sensitive than culture methods

  • PCR is an important, relatively rapid and sensitive diagnostic method for adenovirus infections

  • Enzyme-linked immunosorbent assay (ELISA) tests rapidly detect enteric adenoviruses in diarrheal specimens

  • Chest radiographs show bilateral peribronchial and patchy ground-glass interstitial infiltrates in the lower lobes in patients with pneumonia

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Treatment

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  • No specific treatment

  • Intravenous immunoglobulin (IVIG) may be tried in immunocompromised patients with severe pneumonia

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