Adenoviruses are a family of viruses that can infect people of all ages. These infections most often affect the upper respiratory tract. They are slightly more common in the late winter, spring, and early summer months, but can develop at other times of the year as well.
Different adenoviruses cause illness at different areas in the body. Some strains cause infection of the lining of the eyelids, breathing passages, and lungs, while others affect the bowel or bladder.
The adenoviruses are spread by person-to-person contact, including through secretions that are sneezed or coughed into the air or onto hands and faces.
Some adenoviruses are present in the bowels and stools. A person who gets the virus on his hands while bathing or using the bathroom can spread these viruses. The virus can go from one set of hands to the next and then into the mouth or nose or onto the eyes.
Children who are in child care, especially those from 6 months to 2 years of age, have a greater chance of getting these viruses.
The viruses also are spread in schools or summer camps. On occasion, children may get the infection through contaminated swimming pool water or by sharing towels.
Symptoms and Signs
In immunocompetent hosts, most adenovirus infections are asymptomatic; when infections are symptomatic, a broad spectrum of clinical manifestations is possible.
The most common syndrome, especially in children, involves fever that tends to be > 39° C and to last > 5 days. Sore throat, cough, rhinorrhea, or other respiratory symptoms may occur. A separate syndrome involves conjunctivitis, pharyngitis, and fever (pharyngoconjunctival fever).
Rare adenoviral syndromes in infants include severe bronchiolitis (see Bronchiolitis) and pneumonia. In closed populations of young adults (eg, military recruits), outbreaks of respiratory illness may occur; symptoms include fever and lower respiratory tract symptoms, usually tracheobronchitis but occasionally pneumonia.
Epidemic keratoconjunctivitis (see Etiology) is sometimes severe and occurs sporadically and in epidemics. Conjunctivitis is frequently bilateral.
Preauricular adenopathy may develop. Chemosis, pain, and punctate corneal lesions that are visible with fluorescein staining may be present. Systemic symptoms and signs are mild or absent.
Epidemic keratoconjunctivitis usually resolves within 3 to 4 wk, although corneal lesions may persist much longer.
Nonrespiratory adenoviral syndromes include hemorrhagic cystitis, diarrhea in infants, and meningoencephalitis.
Most patients recover fully. Even severe primary adenoviral pneumonia is not fatal except for rare fulminant cases, predominantly in infants, military recruits, and immunocompromised patients.
Laboratory diagnosis of adenovirus infection rarely affects management. During the acute illness, virus can be isolated from respiratory and ocular secretions and frequently from stool and urine.
A 4-fold rise in the serum antibody titer indicates recent adenoviral infection.
What You Can Do
Make sure your child gets extra rest and drinks plenty of fluids. If he is uncomfortable, you can consider giving him acetaminophen to reduce his fever or ease the pain of a sore throat, but remember that fever is one way your child’s body fights these viruses.
When to Call Your Pediatrician
If your school-aged child has a sore throat and fever, contact your pediatrician to be sure the illness is not caused by group A streptococcus bacteria (strep throat).
Call if your child has symptoms that last more than a few days, he has difficulty breathing, or he appears to be getting worse.
Also, let your pediatrician know if your youngster shows signs of dehydration, such as a decreased output of urine or crying without tears.
Treatment is symptomatic and supportive. Ribavirin and cidofovir have been used in immunocompromised patients; results varied.
To minimize transmission, heath care practitioners should change gloves and wash hands after examining infected patients, sterilize instruments adequately, and avoid using ophthalmologic instruments in multiple patients.
What is the Prognosis?
Most children with adenovirus infections tend to get better in a few days, although coughs and eye infections often last longer. Complications occasionally develop, particularly in young infants and children with weakened immune systems.
These may include severe pneumonia leading to respiratory failure or an overwhelming infection leading to failure of multiple organs and subsequent death.
Vaccines containing live adenovirus types 4 and 7, given orally in an enteric-coated capsule, can reduce lower respiratory disease.
The vaccine was unavailable for a number of years but was reintroduced in 2011. However, it is available only for military personnel.
It may be given to patients aged 17 through 50 yr and should not be given to women who are pregnant or breastfeeding.