Which clinical history findings are characteristic of adenovirus-related acute respiratory disease (ARD)?

Updated: Apr 15, 2021
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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As with many other viral syndromes, ARD is more common in spring and winter months. Approximately half of adenovirus respiratory infections do not cause symptoms. Adenoviruses account for 10% of all childhood lower respiratory tract infections.

Epidemics of acute respiratory disease have been associated with adenovirus species E serotype 4 and species B serotypes 3, 7, 11, 14, and 21. As molecular detection and sequencing methods evolve and expand in use during outbreak investigations, serotypes and epidemiologic patterns continue to emerge.  [10, 11]

The contagiousness of adenovirus is facilitated by very high levels of viral particles (100,000-1,000,000/mL) in the respiratory or oral secretions of infected adults. Additionally, adults who lack antibody may be infected by the inhalation of as few as 5 virions in droplet nuclei.

Fever, rhinorrhea, cough, and sore throat, usually lasting 3-5 days, are typical symptoms of adenoviral ARD. Causes of sore throat may include pharyngitis, adenoiditis, or tonsillitis. Tonsillitis and otitis media were reported in up to 60% and 30%, respectively in a series of young children with serotype 4 predominance. Prolonged fevers, leukocytosis, and elevations in C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were also noted in over half of cases, suggesting potential for confusion of this viral syndrome with bacterial infections. [12]

Lower respiratory tract infections, including tracheobronchitis, bronchiolitis, and pneumonia, may mimic respiratory syncytial virus infection or influenza. Notably, conjunctivitis in the presence of bronchitis suggests adenoviral infection.

Pneumonia is more severe in infants than older children and may be associated with lethargy, diarrhea, and vomiting. There is a high incidence of pulmonary sequelae following adenoviral pneumonia in young children, including bronchiectasis and bronchiolitis obliterans.

Extra pulmonary complications occasionally occur, including meningoencephalitis, hepatitis, myocarditis, nephritis, neutropenia, and disseminated intravascular coagulation. Fatal pneumonia is uncommon but is more likely in neonates and has been associated with serotypes 3, 7, 14, 21, and 30. [13]

From the 1950s to 1971 (prevaccine era), adenoviruses accounted for significant acute disease in 70% of military recruits. Adenovirus serotypes 4 and 7 were primarily involved. A live enteric-coated oral vaccine against these serotypes was introduced in 1971 and reduced adenovirus-related respiratory illness by more than 95% in recruits and thus attenuated outbreaks. Vaccine production ceased in 1996 for economic reasons, and vaccination administration was limited to high-risk periods until supplies ran out in 1999. In 1997, a large epidemic of more than 500 cases associated with serotypes 3 and 7 occurred in US Navy recruits. Most recent analyses suggest that serotype 4 has caused most military outbreaks since 1999, with the exception of Ad14. Outbreaks in basic trainees declined with the reintroduction of live oral enteric-coated adenovirus vaccine against types 4 and 7. [14, 15]


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