Adenovirus Infections
Basics
Description
- Acute, typically self-limited, febrile illnesses characterized by inflammation of mucous membranes including the conjunctivae, respiratory, and GI tracts
- Adenovirus infections can occur as epidemic or endemic outbreaks.
- Common types:
- Acute febrile respiratory illness—affects primarily children
- Acute respiratory disease—affects adults
- Viral pneumonia—affects children and adults
- Acute pharyngoconjunctival fever—affects children, particularly after summer swimming
- Acute follicular conjunctivitis—affects all ages
- Epidemic keratoconjunctivitis—affects adults
- Intestinal infections leading to enteritis, mesenteric adenitis, and intussusception
- Conjunctivitis
- Common types:
- System(s) affected: cardiovascular; GI; hematologic/lymphatic/immunologic; musculoskeletal; nervous; pulmonary; renal/urologic; ophthalmologic
Geriatric Considerations
Complications more likely in elderly populations
Pediatric Considerations
Viral pneumonia in infants and neonates (may be fatal)
Epidemiology
- Predominant age: <10 years but epidemics in all ages
- Predominant sex: male = female
- Occurs worldwide and throughout the year but more frequently in warmer months
Incidence
- Common infection: 2–5% of all upper respiratory infections (URIs) and >10% of URIs in children
- Most individuals show evidence of prior adenovirus infection by age 10 years.
- 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 tissue (adenoids and tonsils) after exposure, and viral shedding may persist for months (1).
- Transmission
- Aerosol droplets, fomites, fecal–oral
- Virus survives on skin and environmental surfaces.
- Incubation period is 5 to 9 days (2).
- Most common known pathogens:
- Types 1 to 5, 7, 14, and 21 cause upper respiratory illness and pneumonia.
- Types 3, 7, and 21 cause pharyngoconjunctival fever.
- Types 31, 40, and 41 cause gastroenteritis.
- Types 8, 19, 37, 53, and 54 cause epidemic keratoconjunctivitis.
- Types 5, 7, 14, and 21 cause more severe illness.
Risk Factors
- Large number of people gathered in a confined area (e.g., military recruits, college students, daycare centers, summer camps, community swimming pools)
- Immunocompromised are at risk for severe disease.
General Prevention
- Live, enteric-coated oral type 4 and type 7 adenovirus vaccine available for military recruits (or other personnel at high risk ages 17 to 50 years); reduces incidence of acute respiratory disease (3)
- Frequent hand washing
- Decontamination of environmental surfaces using chlorine, bleach, formaldehyde, or heat
- Universal precautions, particularly when examining patients with epidemic keratoconjunctivitis; droplet precautions if suspected respiratory infection
- Health care providers with suspected bilateral adenoviral conjunctivitis should avoid direct patient contact for 2 weeks after onset of symptoms in the second eye.
Commonly Associated Conditions
- Otitis media
- Conjunctivitis
- Bronchiolitis
- Viral enteritis
- Less frequent syndromes (seen primarily in immunocompromised individuals): meningoencephalitis, hepatitis, myocarditis, pancreatitis, genital infections, intussusception and mesenteric adenitis hemorrhagic cystitis, and interstitial nephritis
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Citation
Domino, Frank J., et al., editors. "Adenovirus Infections." 5-Minute Clinical Consult, 34th ed., Wolters Kluwer, 2026. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116009/0.5/Adenovirus_Infections.
Adenovirus Infections. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2026. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116009/0.5/Adenovirus_Infections. Accessed July 17, 2025.
Adenovirus Infections. (2026). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (34th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116009/0.5/Adenovirus_Infections
Adenovirus Infections [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2026. [cited 2025 July 17]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116009/0.5/Adenovirus_Infections.
* Article titles in AMA citation format should be in sentence-case
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ED - Baldor,Robert A,
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ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
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DB - Medicine Central
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