• Primary infection usually occurs early in life (by age 10 years) and is most often characterized by upper respiratory symptoms.
• Military trainees are especially susceptible to infection, probably due to crowded living conditions.
• Respiratory and enteric infections may occur at any time of year. Epidemics of respiratory disease occur in winter and spring.
• Transmission of respiratory disease occurs via contact with infected secretions. Transmission of enteric adenoviruses is via fecal–oral route.
• Outbreaks of pharyngoconjunctival fever have been associated with inadequately chlorinated swimming pools.

• Bronchiolitis obliterans (rare), corneal opa-cities with visual disturbance (usually resolves spontaneously)

• Respiratory infection responsible for 10% of all pediatric respiratory illnesses; may cause upper respiratory symptoms, whooping cough syndrome; pneumonitis; lower respiratory tract disease associated with adenovirus types 4 and 7.
• Pharyngoconjunctival fever: low-grade fever associated with conjunctivitis, pharyngitis, rhinitis, and cervical adenitis; 15% of patients may have meningismus; increased incidence in summer months; common-source outbreaks most often associated with type 3.
• Epidemic keratoconjunctivitis: bilateral conjuncitivitis with preauricular adenopathy; may persist for up to 4 weeks; corneal opacities may persist for several months; associated with types 8, 19, and 37.
• Hemorrhagic cystitis may cause microscopic or gross hematuria; if present, gross hematuria persists on average for 3 days; often associated with dysuria and urinary frequency; more common in males than females; associated with types 11 and 21.
• Infantile diarrhea: watery diarrhea associated with fever; symptoms may persist for 1 to 2 weeks; associated with types 40 and 41.
• Central nervous system (CNS) infection epidemics (associated with outbreaks of respiratory disease) and sporadic cases of encephalitis and meningitis have been observed; often associated with pneumonia.
• Miscellaneous adenoviruses have been associated with intussusception (isolated in up to 40% of cases), fatal congenital infection, disseminated disease in immunocompromised patients.

• Respiratory infection
  • Influenza
  • Parainfluenza
  • Pertussis
  • Mycoplasma
  • Bacterial pneumonia
• Pharyngoconjunctival fever group A streptococcus
  • Epstein-Barr virus
  • Parainfluenza
  • Enterovirus
  • Measles
• Epidemic keratoconjunctivitis herpes simplex
  • Chlamydia
  • Enterovirus
• Hemorrhagic cystitis glomerulonephritis
  • Vasculitis
  • Renal tuberculosis
• Infantile diarrhea rotavirus
  • Norwalk agent
  • Astrovirus
  • Salmonella
  • Shigella
  • Campylobacter
• CNS infection herpes simplex virus
  • Enterovirus
  • Mycoplasma
  • Bacterial meningitis

Question: Fever
Significance: Nonspecific

Question: Rhinitis
Significance: URI

Question: Laryngitis, sore throat
Significance: URI

Question: Non-productive or croupy cough
Significance: Respiratory infection

Question: Headache, myalgias
Significance: CNS infection

Question: Hematuria (gross or microscopic), dysuria, urinary frequency
Significance: Hemorrhagic cystitis

Question: Watery diarrhea
Significance: Enteric adenovirus

Finding: Head and neck conjuctivitis, rhinitis, pharyngitis, exudate, meningismus
Significance: Typical findings of adenovirus

Finding: Pulmonary tachypnea, wheezing, rales
Significance: Pneumonia

Finding: Abdomen tenderness, distension
Significance: Gastroenteritis

Test: CBC
Significance: Leukocytosis or leukopenia, often with left shift in the differential count.

Test: Erythrocyte sedimentation rate
Significance: Often elevated

Test: Chest radiograph
Significance: Bilateral patchy interstitial infiltrates (lower lobes).

Test: Serology
Significance: Diagnosis may be made by a documented 4-fold rise in serum antibody.

Test: Viral isolation
Significance: From nasopharyngeal secretions, urine, conjuctivae, or stool.

Test: Viral identification
Significance: Either visualization of virion by electron microscopy or demonstration of viral antigen in infected cells by immunofluorescence; highest yield from nasopharyngeal swab or stool.

Baum SG. Adenovirus. In: Mandell GL, Douglas RG, Bennett JE, eds. Principles and practice of infectious diseases, 4th ed. New York: Churchill Livingstone, 1995;1382–1387.

Claesson BA, Trollfors B, Brolin I. et al. Etiology of community-acquired pneumonia in children based on antibody responses to bacterial and viral antigens. Pediatr Infect Dis J 1989;8(12):856–862.

Krajden M, Brown M, Petrasek A. Middleton PJ. Clinical features of adenovirus enteritis: a review of 127 cases. Pediatr Infect Dis J 1990;9:636–641.

Wirsing von Konig CH, Rott H, Bogaerts H, Schmitt HJ, A serologic study of organisms possibly associated with pertussis-like coughing. Pediatr Infect Dis J 1998;17(7):645–649.