Snapshot A 7-year-old boy presents to the pediatrician with complaints of a fever, sore throat, rhinorrhea, and red eyes. Physical exam revealed a non-exudative pharyngitis and pre-auricular lymphadenopathy. Introduction Classification linear, non-enveloped, double-stranded DNA virus Associated conditions pharyngitis coryza pneumonia infectious conjunctivitis Prevention vaccinations live, oral, enteric-coated vaccines military recruits 17-50 years of age infection control procedures contact and droplet precaution chlorination of swimming pools Epidemiology Worldwide distribution most individuals have serologic evidence by 10 years of age Demographics young children Risk factors daycare centers and households with young children closed or crowded settings e.g., public swimming pools, military barracks, and medical facilities ETIOLOGY Pathogenesis Transmission aerosol droplets fecal-oral contact via contaminated fomites Reservoir ubiquitous and can survive for long periods on environmental surfaces Presentation Symptoms febrile pharyngitis fever coryza painful pharyngitis most common cause of tonsillitis in young children pneumonia more severe in infants and older children croup bronchitis pharyngoconjunctivitis conjunctival injection pharyngitis and cervical adenitis outbreaks in swimming pools or lakes acute hemorrhagic cystitis bloody urine self-limiting gastrointestinal nausea zvomitinging diarrhea Physical exam febrile pharyngitis tonsillitis +/- exudative cervical adenopathy pharyngoconjunctivitis fever cervical adenitis Studies Labs viral culture viral antigen assays PCR assays quick way to identify adenoviral pathogen serology Histology histopathology via biopsy basophilic inclusions Making the diagnosis based on clinical presentation and laboratory studies most cases are clinically diagnosed Differential Rhinovirus distinguishing factor does not usually present with conjunctivitis GAS pharyngitis distinguishing factor Centor criteria - no cough Influenza distinguishing factor presents with minimal coryza and acute onset Infectious mononucleosis distinguishing factor presents with signficant lymphadenopathy Treatment Mostly self-limited and treatment is supportive Medical cidofovir immunocompromised patients or severe disease dose-limiting nephrotoxicity Complications Bronchiectasis and bronchiolitis obliterans Disseminated adenovirus infection Prognosis Depends on clinical presentation