Can Adenovirus Cause a Rash?
Yes, adenovirus can cause a rash, though it is not a typical or common manifestation of adenovirus infection. Rash occurs in approximately one-third of children with adenovirus infection, while it is rare in adults 1.
Frequency and Characteristics of Adenovirus-Associated Rash
- Rash is reported in up to 66% of children with certain adenovirus infections, though the overall frequency across all adenovirus infections is approximately 33% 1.
- Rash patterns vary considerably and may present as petechial, maculopapular, diffuse erythema, or other morphologies 1.
- The rash typically appears later in the disease course, with a median onset of 5 days after symptom onset 1.
- Distribution is variable, potentially involving the extremities, trunk, face, or rarely the palms and soles 1.
Primary Clinical Manifestations (More Common Than Rash)
Adenovirus primarily causes other clinical syndromes rather than rash-predominant illness:
- Respiratory tract infections are the most common manifestation, occurring in 84-92% of hospitalized children with adenovirus 2.
- Conjunctivitis is a well-recognized presentation, with adenovirus contributing to 5-20% of acute conjunctivitis cases 1.
- Gastroenteritis occurs frequently, with adenovirus serotypes 40 and 41 contributing to 5-20% of hospitalizations for childhood diarrhea 1.
- Fever is present in approximately 80% of cases and typically lasts 5-6 days 2.
Important Clinical Context
A critical pitfall is assuming rash excludes adenovirus or that adenovirus always causes rash. The presence or absence of rash should not be used as a primary diagnostic criterion for adenovirus infection 1.
When evaluating a febrile child with rash, consider:
- Associated symptoms such as respiratory symptoms (cough, rhinorrhea), conjunctivitis, or gastrointestinal symptoms point toward adenovirus 1, 2.
- Epidemiologic factors including recent exposure to sick contacts, daycare attendance, or community outbreaks 1, 2.
- The differential diagnosis for febrile illness with rash is extensive and includes enteroviral infections, measles, rickettsial diseases, drug reactions, and other viral exanthems 1.
Diagnostic Approach When Rash Is Present
- Rapid immunodiagnostic testing for adenovirus has 88-89% sensitivity and 91-94% specificity and can prevent misdiagnosis 1.
- PCR testing provides highly sensitive and specific detection of adenovirus DNA when available 1.
- Clinical diagnosis is often sufficient in the setting of typical respiratory or gastrointestinal symptoms with known community adenovirus activity 3, 4.
Management Implications
The presence of rash does not change management for immunocompetent children:
- Supportive care remains the cornerstone, including hydration, antipyretics, and respiratory support as needed 3, 4.
- The typical illness duration is 7-10 days regardless of whether rash is present 3, 4.
- Infection control measures are critical, as patients remain infectious for 10-14 days from symptom onset 3, 5, 4.