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Adenovirus Infection

Adenovirus infection encompasses an array of clinical syndromes that can be caused by adenoviruses, ranging from benign and self-limiting upper respiratory illness to life-threatening conjunctival infection in neonates, hemorrhagic cystitis and severe disseminated infection of various tissues. Microbiological testing is pivotal in order to make the diagnosis, primarily through methods that are able to detect viral deoxyribonucleic acid (DNA) in patient samples.


Adenoviruses, belonging to the group of double-stranded positive (+) sense DNA viruses, are a large group of pathogens responsible for numerous types of human disease [1] [2]. They are divided into six subgroups (A, B, C, D, E, and F) and more than 60 different serotypes have been described in the literature [1] [2] [3]. Common modes of transmission include the fecal-oral, direct contact with infected secretions, and respiratory spread, suggesting that the virus is able to cause local outbreaks [3] [4]. As the pediatric population is the age group where adenovirus infections are most prevalent, kindergartens, summer or college camps and schools are the main sites of outbreaks [5]. In addition, hospital-based (nosocomial) and severe, sometimes even life-threatening outbreaks have known to occur [3]. Adenovirus infection is seen across all ages and gender, although immunocompromised hosts seem to be at an increased risk compared to the immunocompetent [1]. The clinical presentation of adenovirus infection depends on the organ or tissue affected. Keratoconjunctivitis ( the principal form of the disease that causes outbreaks) manifests with fever, vomiting, diarrhea, muscle pain and malaise, usually after an incubation period of 1-14 days, whereas rhinitis, fever, and cervical lymphadenopathy are typical for pharyngoconjunctival fever (PCF) [5]. Other notable infections caused by adenovirus are those of the respiratory tract (both lower and upper), gastroenteritis, central nervous system infection (CNS), and hemorrhagic cystitis [1]. Neonatal adenovirus infection, despite being rare, is a frequently fatal disease characterized by severe forms of conjunctivitis (as a result of viral transmission from the mother), cyanosis, respiratory failure, fever and a rash in neonates [6].

  • Continued Symptoms Each type of adenovirus can affect you differently: Bronchitis : Cough , runny nose , fever, chills Colds and other respiratory infections : Stuffy and runny nose, cough, sore throat , and swollen glands Crou p: Barking cough, trouble[webmd.com]
  • Fever Dehydration Cough with expectoration.[epainassist.com]
  • Adenovirus can cause a cough that sounds like whooping cough (pertussis) . Gastroenteritis is an infection of the stomach and intestines. Symptoms include diarrhea, vomiting, belly pain, and fever.[kidshealth.org]
  • Cover your mouth and nose with tissue paper when sneezing or coughing. Dispose the soiled tissues into a lidded rubbish bin, then wash hands thoroughly.[chp.gov.hk]
Common Cold
  • Adenoviruses are a group of viruses that cause respiratory (breathing) illnesses, such as a common cold , conjunctivitis (an infection in the eye), croup , bronchitis , bronchiolitis (inflammation of the lower airways) and pneumonia .[childrenshospital.org]
  • They most commonly cause upper respiratory tract infections, including the common cold , sore throats, tonsillitis , ear infections, and conjunctivitis .[drgreene.com]
  • Adenoviruses can cause a wide range of illnesses such as Common cold Sore throat Bronchitis (a condition that occurs when the airways in the lungs become filled with mucus and may spasm, which causes a person to cough and have shortness of breath) Pneumonia[cdc.gov]
  • In the upper respiratory tract there is frequent involvement of the regional lymph nodes , bearing considerable resemblance to the common cold . Lower respiratory infection occasionally results in pneumonia .[britannica.com]
Throat Irritation
  • Adenovirus 14 infections usually begin with cold symptoms such as: a cough , runny nose, and mild fever and possibly throat irritation.[medicinenet.com]
Dry Cough
  • cough Fever lasting 2 to 4 days Illness subsiding in 10 to 14 days DDx: rhinovirus, influenza, parainfluenza, RSV Viral pneumonia Sudden onset of high fever, rapid infection of upper and lower respiratory tracts, skin rash, diarrhea Occurs mostly in[unboundmedicine.com]
  • The elder brother developed a high fever and was diagnosed with HAdV infection with an immunochromatographic kit for HAdV (IC-kit). He was transferred to our institute after persistent fever for 7 days.[ncbi.nlm.nih.gov]
  • Bring down a fever . Ask your doctor if you can give your child acetaminophen ( Tylenol ) or ibuprofen ( Motrin ) to relieve aches and fever.[webmd.com]
  • Pharyngoconjunctival fever causes very red eyes, a sore throat, fever, runny nose, and swollen glands. Keratoconjunctivitis is a more severe eye infection that involves both the conjunctiva and cornea (the transparent front part of the eye).[kidshealth.org]
  • Fever Dehydration Cough with expectoration.[epainassist.com]
  • HAdV infection also shows KD-like symptoms such as conjunctival injection, red cracked lips, and cervical lymphadenopathy. However, skin erythema and swollen red palms and soles followed by desquamation are distinctive features of KD.[ped-rheum.biomedcentral.com]
  • Figure 4: Lymphadenopathy. A large pre-auricular node can be palpated and visible on examination by studying the shadowing and elevation of the skin.[eyerounds.org]
  • Sore throat Cough, coryza Fever (moderate to high) Vomiting, diarrhea, abdominal pain Ear pain Urinary symptoms/hematuria Eye redness and pain Irritative voiding symptoms (bladder involvement) Physical Exam Fever Tonsillar erythema/exudate Cervical lymphadenopathy[unboundmedicine.com]
  • Children may have fever and lymphadenopathy. Malaise and headache are reported. Inflammation may persist for weeks, and residual scarring and visual impairment may occur.[emedicine.medscape.com]
  • […] involvement) Physical Exam Fever Tonsillar erythema/exudate Cervical lymphadenopathy Otitis media Conjunctivitis Differential Diagnosis Characteristics of adenovirus infections: Acute respiratory illness Mostly in children Incubation period: 2 to 5 days Malaise[unboundmedicine.com]
  • […] a specific presentation of adenovirus infection, manifested as: high fever that lasts 4–5 days pharyngitis (sore throat) conjunctivitis (inflamed eyes, usually without pus formation like pink eye) enlargement of the lymph nodes of the neck headache, malaise[en.wikipedia.org]
  • Malaise and headache are reported. Inflammation may persist for weeks, and residual scarring and visual impairment may occur.[emedicine.medscape.com]
  • Respiratory diseases: Acute respiratory disease:  is characterized by pharyngitis, fever, cough and malaise.  It occurs in an epidemic form among young recruits under conditions of fatigue and overcrowding Pneumonia: a complication of acute respiratory[slideshare.net]
Hodgkin's Disease
  • We report a case of an AV-induced unilateral mass lesion in the kidney of a patient with Hodgkin's disease (HD) following bone marrow transplantation.[ncbi.nlm.nih.gov]
  • You can buy medicines at the drugstore that can help stop or slow diarrhea. Do not use these medicines without talking to your provider if you have bloody diarrhea, a fever, or if the diarrhea is severe. Do not give these medicines to children.[mountsinai.org]
  • Enteric viral infectious should be considered in solid organ transplant recipients with chronic diarrhea.[ncbi.nlm.nih.gov]
  • Intractable diarrhea in a 40-year-old woman with terminal acquired immunodeficiency syndrome resulted from adenovirus infection of the duodenal mucosa.[ncbi.nlm.nih.gov]
  • The main clinical symptom presented by infected patients was diarrhea, and Graft-versus-host disease (GVHD) was the main intercurrence. An association was observed between HAdV-positivity and diarrhea and also between HAdV-positivity and GVHD.[ncbi.nlm.nih.gov]
  • Analysis of stool specimen in adenovirus infected patients showed watery diarrhea in 87% (55/63), diarrhea with mucus in 19% (12/63) and diarrhea with mucus and blood in 3% (2/63).[dx.doi.org]
  • Localized bleeding was observed in two cases, but there was no generalized bleeding tendency or evidence of thrombosis.[ncbi.nlm.nih.gov]
Exudative Pharyngitis
  • Health Hazard: PATHOGENICITY: Varies in clinical manifestation and severity; symptoms include fever, rhinitis, pharyngitis, tonsillitis, cough and conjunctivitis; common cause of nonstreptococcal exudative pharyngitis among children under 3 years; more[viracore.ucsf.edu]
  • In some series of hospitalized children with documented adenoviral infection high fever, leukocytosis and exudative pharyngitis resembling bacterial infection has been observed.[infectiousdiseaseadvisor.com]
Visual Hallucination
  • The most frequently cited CNS symptoms were seizure (64%), altered state of consciousness (13%), visual hallucination (9.3%) and lethargy (7.5%).[ncbi.nlm.nih.gov]
  • , fever, stomach cramps Swelling of the brain and spinal cord ( meningitis and encephalitis ): Headache , fever, stiff neck, nausea , and vomiting (this is rare) Urinary tract infections: Burning and pain while urinating, frequent need to go, blood in[webmd.com]
  • Conjunctival redness and edema Photophobia and blurry vision Swelling of eyelids Foreign body sensation within eye Symptoms of Meningitis and Encephalitis High Fever Stiff neck Headache Seizures Confusion and Sleepiness Nausea and Vomiting Skin Rash[epainassist.com]
  • […] onset of high fever, rapid infection of upper and lower respiratory tracts, skin rash, diarrhea Occurs mostly in children from newborn to 3 years DDx: bacterial pneumonia, RSV, influenza, parainfluenza Acute pharyngoconjunctival fever Spiking fever, headache[unboundmedicine.com]
  • While each child may experience symptoms differently, the most common include: Respiratory infections runny nose sore throat fever severe cough swollen lymph nodes headache feeling of uneasiness non-productive "croupy" cough Intestinal tract infections[childrenshospital.org]
  • […] throat pharyngitis runny nose rhonchi & rales nasal congestion swollen lymph nodes dry, harsh cough sounds like pertussis cough If adenovirus causes an infection in your gastrointestinal tract, then inflammation and symptoms might involve: fever vomiting headache[healthblurbs.com]


Despite the nonspecific signs and symptoms of an adenovirus infection, the physician must perform a thorough physical examination and obtain a detailed patient history. Patients (or parents of the infected children) should be asked about similar symptoms in people with whom they were in contact (schools, kindergartens, camps, other crowded areas), as it may provide valuable clues toward the diagnosis. To confirm adenovirus infection, a comprehensive microbiological investigation is necessary. It must be pointed out that detection of adenoviruses readily occurs in asymptomatic individuals, and thus the term adenovirus infection does not always imply to a disease state [3]. In the presence of symptoms, however, the identification of this virus is highly suggestive that it is responsible for their onset. Direct methods in the form of isolation of virus in cultures or antigen/viral DNA detection from patient samples are recommended diagnostic tests, but since up to 3 weeks are necessary for viral cultures to yield conclusive results, the focus of diagnostics is turned to the latter method [1] [3]. Polymerase chain reaction (PCR) is the gold standard for both screening and diagnostic purposes [1] [3]. Based on the clinical and microbiological criteria, an adenovirus infection may be probable (absence of histologic criteria in the presence of typical symptoms) or proven (both microbiological and corresponding clinical confirmation), which can be further divided into local (when the virus is isolated from local specimens and not peripheral blood) or systemic (detection of virus in peripheral blood along with clinical manifestation) [2].


  • Three died on treatment. Disseminated adenovirus infection is uncommon in adult transplant patients and uncertainties remain surrounding effective treatment. In our cohort, brincidofovir has shown promise in treatment of adenoviral infection.[ncbi.nlm.nih.gov]
  • Despite prompt treatment with cidofovir, his respiratory function continued to deteriorate over the next two weeks and he was moved to intensive care. Intravenous immunoglobulin and ribavirin were subsequently added to his treatment.[ncbi.nlm.nih.gov]
  • The optimal surveillance and treatment strategies are under discussion.[ncbi.nlm.nih.gov]
  • Infection in Humans: Incubation, Transmission, Symptoms, Treatment Reovirus: Clinical Manifestation, Diseases Caused by Reovirus, its Symptoms, Treatment Retrovirus or HIV Infection: Transmission, Treatment, Clinical Manifestation, Prevention, Opportunistic[epainassist.com]
  • Patients who are immunocompromised or immunosuppressed, however, are at risk for disseminated adenovirus and suffer high morbidity and mortality, without well-defined treatment options.[ncbi.nlm.nih.gov]


  • There are several reports of adenovirus infections in adult solid organ transplant recipients and the prognosis is usually poor, with mortality rates of 40% to 60%.[ncbi.nlm.nih.gov]
  • The main objective of this study was to prospectively monitor ASCT recipients for HAdV occurrence in a reference center in Brazil, and also to correlate viral positivity, viral load, molecular variant, clinical symptoms, and patients' prognosis.[ncbi.nlm.nih.gov]
  • The prognosis declines as the severity of disease increases.[medicinenet.com]
  • The clinical prognosis seemed well. However, CNS dysfunction is a potentially serious complication of adenovirus infection in children.[ncbi.nlm.nih.gov]


  • Adenovirus detection should be included in the diagnostic testing to determine the infectious etiology of fever and/or respiratory symptoms in SLE patients.[ncbi.nlm.nih.gov]
  • Human adenoviruses comprise an important group of etiologic agents that are responsible for various diseases in adults and children, such as respiratory, ocular, gastroenteric, and urinary infections.[ncbi.nlm.nih.gov]
  • Salivirus/klassevirus was first identified as an etiologic agent of gastroenteritis and was never reported in respiratory infection cases.[ncbi.nlm.nih.gov]
  • […] of diseases in human communities. 2. the field of medicine concerned with the determination of the specific causes of localized outbreaks of infection, such as hepatitis, of toxic disorders, such as lead poisoning, or any other disease of recognized etiology[vdh.virginia.gov]
  • The etiology of Kawasaki disease (KD) remains unknown. However, many studies have suggested that specific genetic factors and/or some infectious agents underlie the onset of KD.[ncbi.nlm.nih.gov]


  • Bulletin Archive Contact Us Laurie Forlano, DO, MPH, State Epidemiologist Director, Office of Epidemiology 109 Governor Street, 6th Floor East Richmond, VA 23219 Phone: (804) 864-8141 Fax: (804) 864-8139 Contact Us by Email[vdh.virginia.gov]
  • ‡Associate professor of epidemiology, University of Michigan School of Public Health.[nejm.org]
  • Prospective studies using molecular epidemiologic techniques will be helpful in evaluating transmission patterns of adenovirus in this population.[ncbi.nlm.nih.gov]
  • Epidemiologic evidence suggests that viral acquisition from the mother, perhaps via the birth canal, is a major mode of transmission.[ncbi.nlm.nih.gov]
  • We present two premature infants with disseminated neonatal adenovirus infection, whose epidemiology, clinical course and outcome differ to a great extent.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution


  • 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[pathologyoutlines.com]
  • Many adenovirus infections are subclinical or asymptomatic. 15–70% of conjunctivitis worldwide Etiology and Pathophysiology DNA virus 60 to 90 nm in size, 6 species (A through F) with 50 known serotypes Adenovirus can remain dormant in lymphoreticular[unboundmedicine.com]
  • Pathophysiology Adenovirus is a double-stranded DNA virus that measures 70-90 nm and that has an icosahedral capsid.[emedicine.medscape.com]


  • This article outlines the evolution of a rescue team in responding to adenovirus prevention with a deployable field hospital.[ncbi.nlm.nih.gov]
  • Prevention of Adenovirus Infection The vaccine to prevent recurrent adenovirus infection has been discontinued in USA and not produced for prevention.[epainassist.com]
  • Prevention [ edit ] Safe and effective adenovirus vaccines were developed for adenovirus serotypes 4 and 7, but were available only for preventing ARD among US military recruits, [7] and production stopped in 1996. [8] Strict attention to good infection-control[en.wikipedia.org]
  • How can adenovirus infection be prevented? There is no vaccine generally available to prevent adenovirus infection. Good health habits can help prevent adenovirus infection.[vdh.virginia.gov]
  • How can adenovirus be prevented? Adenovirus infections are difficult to prevent. Some cases can be prevented by good hand washing , and by avoiding contaminated objects.[drgreene.com]



  1. Ison MG. Adenovirus infections in transplant recipients. Clin Infect Dis. 2006;43(3):331-339.
  2. Lion T. Adenovirus Infections in Immunocompetent and Immunocompromised Patients. Clin Microbiol Rev. 2014;27(3):441-462.
  3. Echavarría M. Adenoviruses in Immunocompromised Hosts. Clin Microbiol Rev. 2008;21(4):704-715.
  4. Lee J. Mixed Respiratory Viral Infections in Children with Adenoviral Infections. Infection & Chemotherapy. 2016;48(4):347-349.
  5. Ghebremedhin B. Human adenovirus: Viral pathogen with increasing importance. Eur J Microbiol Immunol (Bp). 2014;4(1):26-33.
  6. Elnifro EM, Cooper RJ, Dady I, Hany S, Mughal ZM, Klapper PE. Three Nonfatal Cases of Neonatal Adenovirus Infection. J Clin Microbiol. 2005;43(11):5814-5815.

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Last updated: 2018-06-22 02:34