Snapshot A 4-year-old boy presents to the pediatrician with fever and bilateral conjunctivitis. This was preceded by a 5-day history of a non-productive cough, rhinorrhea, and sore throat. There is no history of sick contacts, but the child attends daycare 3 times a week. Physical exam revealed an ill-looking child with bilateral conjunctival injection, scanty greenish discharge, and cervical lymphadenopathy. The mucosa of the oropharynx is hyperemic. Complete blood count shows a leukocyte count of 8500/mm3. Throat swab and blood cultures proved negative for bacteria and a swab of the posterior pharynx was sent for viral PCR. Introduction Classification linear, non-enveloped, double-stranded DNA virus 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, medical facilities Pathogenesis transmission aerosol droplets fecal-oral contact via contaminated fomites reservoir ubiquitous and can survive for long periods on environmental surfaces 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 Prognosis depends on clinical presentation Presentation Symptoms febrile pharyngitis fever coryza painful pharyngitis most common cause of tonsillitis in young children pneumonia more severe in infants and older children pharyngoconjunctivitis conjunctival injection pharyngitis and cervical adenitis outbreaks in swimming pools or lakes acute hemorrhagic cystitis bloody urine self-limiting bloody urine self-limiting bloody urine self-limiting bloody urine self-limiting 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 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