What are the symptoms of adenovirus and rhinovirus?

Symptoms of Adenovirus and Rhinovirus Infections

Rhinovirus Symptoms

Rhinovirus infections present primarily with upper respiratory symptoms including sneezing, nasal discharge (initially clear and watery, becoming cloudy), nasal congestion, sore throat, cough, postnasal drip, facial pressure, reduced sense of smell, and sometimes fever and muscle aches. 1

Key Clinical Features:

• Nasal symptoms dominate: Sneezing and rhinorrhea are the hallmark features, with discharge initially clear and watery, then becoming cloudy due to white blood cells and desquamated epithelium 1
• Cough persistence: May continue for up to 10 days or longer 1
• Sore throat duration: Can persist up to 12 days in 60% of patients 1
• Symptom timeline: Most infections are self-limiting and resolve within 7-10 days, though symptoms may last more than 15 days in approximately 7-13% of cases 1
• Associated symptoms: Postnasal drip, facial pressure, hyposmia/anosmia, fever, and myalgia may occur 1

Important Clinical Context:

The symptoms are primarily caused by the host inflammatory response rather than direct viral damage to the nasal epithelium, with release of inflammatory mediators including interleukin-1, interleukin-6, interleukin-8, tumor necrosis factor-α, and leukotriene C4 1, 2

Adenovirus Symptoms

Adenovirus infections typically cause mild upper or lower respiratory tract symptoms with fever (98% of cases), rhinorrhea (89%), and cough (71%), often accompanied by prolonged high fever, tonsillitis, and acute otitis media. 3, 4

Key Clinical Features:

• Fever: Present in 98% of cases with mean peak body temperature of 39.8°C (103.6°F), often prolonged 4
• Upper respiratory symptoms: Rhinorrhea (89%), cough (71%), sore throat, sneezing, and nasal congestion 5, 4
• Pharyngeal involvement: Tonsillitis present in 59% of hospitalized children 4
• Ear complications: Acute otitis media occurs in 28% of patients 4
• Conjunctival symptoms: May present with conjunctivitis 5
• Systemic symptoms: Fever, malaise, and constitutional symptoms are common 5

Distinguishing Laboratory Features:

Unlike typical viral infections, adenovirus can mimic bacterial infections with:

• Leukocytosis (>15.0×10⁹/L) in 77% of patients 4
• Elevated C-reactive protein (>40 mg/L) in 56% of patients 4
• Elevated erythrocyte sedimentation rate (≥30 mm/h) in 71% of patients 4

Important Clinical Distinctions:

• Epithelial damage: Unlike rhinovirus, adenovirus causes actual damage to the nasal epithelium 2
• Severe manifestations: Rare complications include hemorrhagic cystitis, hepatitis, hemorrhagic colitis, pancreatitis, nephritis, or encephalitis 3
• Immunocompromised patients: Disease is more severe with dissemination more likely; fatality rates for untreated severe adenovirus pneumonia or disseminated disease may exceed 50% 3

Common Pitfalls to Avoid:

• Do not assume bacterial infection based on laboratory values alone in adenovirus: The elevated inflammatory markers (leukocytosis, CRP, ESR) can mimic bacterial infection, but antibiotics are not indicated for viral illness 4
• Do not prescribe antibiotics for uncomplicated rhinovirus: These infections are self-limiting and antibiotics are ineffective, occurring in less than 2% of cases with bacterial superinfection 1
• Consider bacterial superinfection only if: Symptoms worsen after 5-7 days, persist beyond 10 days with severe unilateral pain or high fever, or show "double sickening" (deterioration after initial improvement) 1