{{Short description|Class of viral infections, usually of the respiratory tract}} {{Infobox medical condition (new) | name = Adenovirus infection | synonyms = | image = Adenovirus infection Case 161 (5443939520).jpg | caption = | pronounce = | field = Infectious diseases<ref name=CDCoverview/> | symptoms = Cough, runny nose, sore throat, pink eye, abdominal pain, muscle ache, fever, diarrhea, vomiting, fatigue | complications = Adenoviral keratoconjunctivitis, pneumonia, acute respiratory distress syndrome, bronchiolitis, acute bronchitis, meningoencephalitis, myocarditis, cardiomyopathy, pericarditis, hepatitis, nephritis<ref name=Shieh2021/> | onset = 2–14 days after exposure | duration = | types = | causes = ''Adenoviruses''<ref name=CDCtransmission/> | risks = Endemic, hematopoietic stem cell transplantation<ref name=Arnold2021/> | diagnosis = Signs and symptoms, PCR test<ref name=MSD2022/> | differential = Whooping cough, influenza, parainfluenza, respiratory syncytial virus<ref name=Goldman2019/> | prevention = The most important prevention is wearing a high-quality, well-fitting N95 or better respirator. Also hand washing, social distancing, avoid touching eyes, nose, and mouth<ref name=CDCtreat/> | treatment = Symptomatic and supportive<ref name=CDCtreat/> | medication = | prognosis = Usually recover without treatment<ref name=CDCtreat/> | frequency = Common, all ages,<ref name=ATS2019/> typically children under 5 years<ref name=Shieh2021/> | deaths = }} '''Adenovirus infection''' is a contagious viral disease, caused by adenoviruses, commonly resulting in a respiratory tract infection.<ref name=CDCoverview>{{cite web |title=Adenovirus Clinical Overview for Healthcare Professionals {{!}} CDC |url=https://www.cdc.gov/adenovirus/hcp/clinical-overview.html |website=www.cdc.gov |access-date=5 May 2022 |language=en-us |date=29 November 2021}}</ref><ref name=CDC>{{cite web |title=Adenovirus |url=https://www.cdc.gov/adenovirus/index.html |website=www.cdc.gov |access-date=23 April 2022 |language=en-us |date=16 March 2021}}</ref> Typical symptoms range from those of a common cold, such as nasal congestion, rhinitis, and cough, to difficulty breathing as in pneumonia.<ref name="CDC" /> Other general symptoms include fever, fatigue, muscle aches, headache, abdominal pain and swollen neck glands.<ref name=Goldman2019/> Onset is usually two to fourteen days after exposure to the virus.<ref name=Lynch2016/> A mild eye infection may occur on its own, combined with a sore throat and fever, or as a more severe adenoviral keratoconjunctivitis with a painful red eye, intolerance to light and discharge.<ref name=Shieh2021>{{cite journal |last1=Shieh |first1=Wun-Ju |title=Human adenovirus infections in pediatric population - An update on clinico-pathologic correlation |journal=Biomedical Journal |date=10 September 2021 |volume=45 |issue=1 |pages=S2319–4170(21)00109–8 |doi=10.1016/j.bj.2021.08.009 |pmid=34506970 |pmc=9133246 |s2cid=237479412 |issn=2320-2890}}</ref> Very young children may just have an earache.<ref name=Goldman2019/> Adenovirus infection can present as a gastroenteritis with vomiting, diarrhea, and abdominal pain, with or without respiratory symptoms.<ref name=Shieh2021/> However, some people have no symptoms.<ref name=MSD2022/>

Adenovirus infection in humans are generally caused by ''Adenoviruses'' types B, C, E and F.<ref name=Flint2017>{{cite book |last1=Flint |first1=S. Jane |last2=Nemerow |first2=Glen R. |title=Human Adenoviruses: From Villains To Vectors |date=2017 |publisher=World Scientific |location=Singapore |isbn=978-981-310-979-7 |chapter-url=https://books.google.com/books?id=qRSyDgAAQBAJ&pg=PA153 |pages=153–183 |language=en |chapter=8. Pathogenesis}}</ref> Spread occurs mainly when an infected person is in close contact with another person.<ref name=CDCtransmission>{{cite web |title=Adenovirus: transmission|url=https://www.cdc.gov/adenovirus/about/transmission.html |website=www.cdc.gov |access-date=7 May 2022 |language=en-us |date=29 November 2021 }}</ref> This may occur by either fecal–oral route, airborne transmission or small droplets containing the virus.<ref name=CDCtransmission/> Less commonly, the virus may spread via contaminated surfaces.<ref name=CDCtransmission/> Other respiratory complications include acute bronchitis, bronchiolitis and acute respiratory distress syndrome.<ref name=Shieh2021/> It may cause myocarditis, meningoencephalitis or hepatitis in people with weak immune systems.<ref name=Shieh2021/>

Diagnosis is by signs and symptoms, and a laboratory test is not usually required.<ref name=MSD2022/> In some circumstances, a PCR test on blood or respiratory secretions may detect adenovirus DNA.<ref name=MSD2022/><ref name=Arnold2021/> Other conditions that appear similar include whooping cough, influenza, parainfluenza, and respiratory syncytial virus.<ref name=Goldman2019/> Adenovirus gastroenteritis appears similar to diarrhoeal diseases caused by other infections.<ref name=Lee2020/> Infection by adenovirus may be prevented by washing hands, avoiding touching own eyes, mouth and nose with unwashed hands, and avoiding being near sick people.<ref name=CDCtreat/> A live vaccine to protect against types 4 and 7 adenoviruses has been used successfully in some military personnel.<ref name=CDCtreat>{{cite web |title=Adenovirus: preventing and treating Adenovirus |url=https://www.cdc.gov/adenovirus/about/prevention-treatment.html |website=www.cdc.gov |access-date=7 May 2022 |language=en-us |date=29 November 2021 }}</ref> Management is generally symptomatic and supportive.<ref name=CDCtreat/> Most adenovirus infections get better without any treatment.<ref name=CDCtreat/> Medicines to ease pain and reduce fever can be bought over the counter.<ref name=CDCtreat/>

Adenovirus infections affect all ages.<ref name=ATS2019/> They occur sporadically throughout the year, and outbreaks can occur particularly in winter and spring, when they may spread more quickly in closed populations such as in hospitals, nurseries, long-term care facilities, schools, and swimming pools.<ref name=Lynch2016/> Severe disease is rare in people who are otherwise healthy.<ref name=Lynch2016/> Adenovirus infection accounts for up to 10% of respiratory infections in children.<ref name=Lynch2016/> Most cases are mild and by the age of 10-years, most children have had at least one adenovirus infection.<ref name=Shieh2021/> 75% of conjunctivitis cases are due to adenovirus infection.<ref name=Labib2020/> In 2016, the Global Burden of Disease Study estimated that globally, around 75 million episodes of diarrhea among children under the age of five-years, were attributable to adenovirus infection.<ref name=Lee2020/> The first adenoviral strains were isolated in 1953 by Rowe et al.<ref name=Kimpen2004>{{cite book |last1=Haveman |first1=Lianne M. |last2=Bierings |first2=Marc |last3=Wolf |first3=Tom F.W. |editor1-last=Kimpen |editor1-first=Jan L. L. |editor2-last=Ramilo |editor2-first=Octavio |title=The Microbe-Host Interface in Respiratory Tract Infections |date=2004 |publisher=CRC Press |location=Norfolk |isbn=0-8493-3646-5 |page=271 |chapter-url=https://books.google.com/books?id=XpboXRRbJTYC&pg=PA271 |language=en |chapter=12. Adenovirus }}</ref>

==Signs and symptoms== Symptoms are variable, ranging from mild symptoms to severe illness.<ref name=Shieh2021/> They depend on the type of adenovirus, where it enters into the body, and on the age and well-being of the person.<ref name=Goldman2019>{{cite book |last1=Ison |first1=Michael G. |editor1-last=Goldman |editor1-first=Lee |editor2-last=Schafer |editor2-first=Andrew I. |title=Goldman-Cecil Medicine |date=2019 |publisher=Elsevier |isbn=978-0-323-55087-1 |page=2163 |edition=26th |chapter-url=https://books.google.com/books?id=7pKqDwAAQBAJ&pg=PA2163 |language=en |chapter=341. Adenovirus diseases}}</ref> Recognised patterns of clinical features include respiratory, eye, gastrointestinal, genitourinary and central nervous system.<ref name=Goldman2019/> There is also a widespread type that occurs in immunocompromised people.<ref name=Goldman2019/> Typical symptoms are of a mild cold or resembling the flu; fever, nasal congestion, coryza, cough, and pinky-red eyes.<ref name=CDCsymptoms>{{cite web |title=Adenovirus: symptoms |url=https://www.cdc.gov/adenovirus/about/symptoms.html |website=www.cdc.gov |access-date=23 April 2022 |language=en-us |date=16 March 2021 |archive-date=18 April 2020 |archive-url=https://web.archive.org/web/20200418091521/https://www.cdc.gov/adenovirus/about/symptoms.html |url-status=live }}</ref> Infants may also have symptoms of an ear infection.<ref name=Goldman2019/> Onset is usually two to fourteen days after exposure to the virus.<ref name=Lynch2016>{{cite journal |last1=Lynch |first1=Joseph P. |last2=Kajon |first2=Adriana E. |title=Adenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention |journal=Seminars in Respiratory and Critical Care Medicine |date=August 2016 |volume=37 |issue=4 |pages=586–602 |doi=10.1055/s-0036-1584923 |pmid=27486739 |pmc=7171713 |issn=1069-3424 }}</ref> There may be tiredness, chills, muscle aches, or headache.<ref name=Goldman2019/> However, some people have no symptoms.<ref name=MSD2022>{{cite web |last1=Tesini |first1=Brenda L. |title=Adenovirus Infections - Infectious Diseases |url=https://www.msdmanuals.com/en-gb/professional/infectious-diseases/respiratory-viruses/adenovirus-infections |website=MSD Manual Professional Edition |access-date=7 May 2022 |date=April 2022 }}</ref> Generally, a day or two after developing a sore throat with large tonsils, glands can be felt in the neck.<ref name=Kumar2020>{{cite book |last1=White |first1=Veronica |last2=Ruperelia |first2=Prina |editor1-last=Feather |editor1-first=Adam |editor2-last=Randall |editor2-first=David |editor3-last=Waterhouse |editor3-first=Mona |title=Kumar and Clark's Clinical Medicine |date=2020 |publisher=Elsevier |isbn=978-0-7020-7870-5 |page=947 |edition=10th |chapter-url=https://books.google.com/books?id=sl3sDwAAQBAJ&pg=PA947 |language=en |chapter=28.Respiratory disease}}</ref> Illness is more likely to be severe in people with weakened immune systems, particularly children who have had a hematopoietic stem cell transplantation.<ref name=Arnold2021>{{cite journal |last1=Arnold |first1=Amber |last2=MacMahon |first2=Eithne |title=Adenovirus infections |journal=Medicine |date=1 December 2021 |volume=49 |issue=12 |pages=790–793 |doi=10.1016/j.mpmed.2021.09.013 |s2cid=240127201 |url=https://www.sciencedirect.com/science/article/abs/pii/S1357303921002607 |language=en |issn=1357-3039 |url-access=subscription }}</ref> Sometimes there is a skin rash.<ref name=Shieh2021/>

===Respiratory tract=== Preschool children with adenovirus colds tend to present with a nasal congestion, runny nose and abdominal pain.<ref name=Shieh2021/> There may be a harsh barking cough.<ref name=Shieh2021/> It is frequently associated with a fever and a sore throat.<ref name=Shieh2021/> Up to one in five infants with bronchiolitis will have adenovirus infection, which can be severe.<ref name=Shieh2021/> Bronchiolitis obliterans is uncommon, but can occur if adenovirus causes pneumonia with prolonged fever, and can result in difficulty breathing.<ref name=Shieh2021/> It presents with a hyperinflated chest, expiratory wheeze and low oxygen.<ref name=Shieh2021/> Severe pneumonia is most common in very young children age three to 18 months and presents with sudden illness, ongoing cough, high fever, shortness of breath and a fast rate of breathing.<ref name=Shieh2021/> There are frequently wheezes and crackles on breathing in and out.<ref name=Shieh2021/>

===Eyes=== Adenovirus eye infection may present as a pinkish-red eye.<ref name=Shieh2021/> Six to nine days following exposure to adenovirus, one or both eyes, typically in children, may be affected in association with fever, pharyngitis and lymphadenopathy (pharyngoconjunctival fever (PCF)).<ref name=Goldman2019/> The onset is usually sudden, and there is often rhinitis.<ref name=Shieh2021/> Adenovirus infection can also cause adenoviral keratoconjunctivitis.<ref name=Shieh2021/> Typically one eye is affected after an incubation period of up to a week.<ref name=Shieh2021/> The eye becomes itchy, painful, burning and reddish and lymphadenopathy may be felt by the ear nearest the affected eye.<ref name=Shieh2021/> The symptoms may last around 10 days to three weeks.<ref name=Shieh2021/> It may be is associated with blurred vision, photophobia and swelling of the conjunctiva.<ref name=Shieh2021/><ref name=Labib2020>{{cite journal |last1=Labib |first1=Bisant A |last2=Minhas |first2=Bhawanjot K |last3=Chigbu |first3=DeGaulle I |title=Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions |journal=Clinical Ophthalmology |date=17 March 2020 |volume=14 |pages=837–852 |doi=10.2147/OPTH.S207976 |pmid=32256043 |pmc=7094151 |issn=1177-5467 |doi-access=free }}</ref> A sore throat and nasal congestion may or may not be present.<ref name=Shieh2021/> This tends to occur in epidemics, affecting predominantly adults.<ref name=Shieh2021/> In very young children, it may be associated with high fever, sore throat, otitis media, diarrhoea, and vomiting.<ref name=Shieh2021/>

===Gastrointestinal tract=== Adenovirus infection can cause a gastroenteritis when it may present with diarrhea, vomiting, and abdominal pain, with or without respiratory or general symptoms.<ref name=Shieh2021/> Children under the age of one-year appear particularly vulnerable.<ref name=Lee2020/> However, it usually resolves within three-days.<ref name=Shieh2021/> It appears similar to diarrhoea diseases caused by other infections.<ref name=Lee2020>{{cite journal |last1=Lee |first1=B |last2=Damon |first2=CF |last3=Platts-Mills |first3=JA |title=Pediatric acute gastroenteritis associated with adenovirus 40/41 in low-income and middle-income countries. |journal=Current Opinion in Infectious Diseases |date=October 2020 |volume=33 |issue=5 |pages=398–403 |doi=10.1097/QCO.0000000000000663 |pmid=32773498 |pmc=8286627 }}</ref>

===Other organs=== Uncommonly the bladder may be affected, presenting with a sudden onset of burning on passing urine and increased frequency of passing urine, followed by seeing blood in the urine a day or two later.<ref name=Shieh2021/> Meningism may occur in adenovirus associated meningoencephalitis, which may occur in people with weakened immune systems such as with AIDS or lymphoma.<ref name=Shieh2021/> Adenovirus infection may result in symptoms of myocarditis, dilated cardiomyopathy, and pericarditis.<ref name=Shieh2021/> Other signs and symptoms depend on other complications such as dark urine, itching and jaundice in hepatitis, generally in people who have a weakened immune system.<ref name=Shieh2021/> Adenovirus is a rare cause of urethritis in men, when it may present with burning on passing urine associated with red eyes and feeling unwell.<ref name=Young2022>{{cite journal |last1=Young |first1=Ashley |last2=Toncar |first2=Alicia |last3=Wray |first3=Anton A. |title=Urethritis |journal=StatPearls |date=2022 |url=https://www.ncbi.nlm.nih.gov/books/NBK537282/ |publisher=StatPearls Publishing|pmid=30725967 }}</ref>

==Cause and mechanism== Adenovirus infection in humans are generally caused by ''Adenoviruses'' types B, C, E and F.<ref name=Flint2017/>

Although epidemiologic characteristics of the adenoviruses vary by type, all are transmitted by direct contact, fecal-oral transmission, and occasionally waterborne transmission. Some types are capable of establishing persistent asymptomatic infections in tonsils, adenoids, and intestines of infected hosts, and shedding can occur for months or years. Some adenoviruses (e.g., serotypes 1, 2, 5, and 6) have been shown to be endemic in parts of the world where they have been studied, and infection is usually acquired during childhood. Other types cause sporadic infection and occasional outbreaks; for example, epidemic keratoconjunctivitis is associated with adenovirus serotypes 8, 19, and 37. Epidemics of febrile disease with conjunctivitis are associated with waterborne transmission of some adenovirus types, often centering on inadequately chlorinated swimming pools and small lakes. ARD is most often associated with adenovirus types 4 and 7 in the United States. Enteric adenoviruses 40 and 41 cause gastroenteritis, usually in children. For some adenovirus serotypes, the clinical spectrum of disease associated with infection varies depending on the site of infection; for example, infection with adenovirus 7 acquired by inhalation is associated with severe lower respiratory tract disease, whereas oral transmission of the virus typically causes no or mild disease. Outbreaks of adenovirus-associated respiratory disease have been more common in the late winter, spring, and early summer; however, adenovirus infections can occur throughout the year.<ref name=gov.US>{{USGovernment|url=https://www.cdc.gov/ncidod/dvrd/revb/respiratory/eadfeat.htm|agency=Centers for Disease Control and Prevention|title=Respiratory and Enteric Viruses Branch |access-date=2007-07-03 |url-status=dead |archive-url=https://web.archive.org/web/20070703180449/http://www.cdc.gov/ncidod/dvrd/revb/respiratory/eadfeat.htm |archive-date=July 3, 2007 }}</ref>

Several adenoviruses, including Ad5, Ad9, Ad31, Ad36, Ad37, and SMAM1, have at least some evidence of causation of obesity in animals, adipogenesis in cells, or association with human obesity.<ref>{{cite journal |vauthors=Voss JD, Atkinson RL, Dhurandhar NV |date=November 2015 |title=Role of adenoviruses in obesity |journal=Rev Med Virol |volume=25 |issue=6 |pages=379–387 |doi=10.1002/rmv.1852 |pmid=26352001 |s2cid=5370331}}</ref>

==Diagnosis== Diagnosis is by signs and symptoms, and a laboratory test is not usually required.<ref name=MSD2022/> In some circumstances such as severe disease, when a diagnosis needs to be confirmed, a PCR test on blood or respiratory secretions may detect adenovirus DNA.<ref name=MSD2022/><ref name=Arnold2021/> Adenovirus can be isolated by growing in cell cultures in a laboratory.<ref name=ATS2019>{{cite journal |title=Adenovirus Infection and Outbreaks: What You Need to Know |journal=Am J Respir Crit Care Med |date=2019 |volume=199 |pages=13–14 |url=https://www.thoracic.org/patients/patient-resources/resources/adenovirus.pdf |publisher=American Thoracic Society |access-date=7 May 2022 }}</ref> Other conditions that appear similar include whooping cough, influenza, parainfluenza, and respiratory syncytial virus (RSV).<ref name=Goldman2019/> Since adenovirus can be excreted for prolonged periods, the presence of virus does not necessarily mean it is associated with disease.<ref name=CDCdiagnosis>{{cite web |title=Clinical Diagnosis of Adenovirus |url=https://www.cdc.gov/adenovirus/hcp/diagnosis.html |website=www.cdc.gov |access-date=7 May 2022 |language=en-us |date=29 November 2021 }}</ref>

==Prevention== {{See also|Adenovirus vaccine}} Infection by adenovirus may be prevented by washing hands, avoiding touching own eyes, mouth and nose before washing hands and avoiding being near sick people.<ref name=CDCtreat/> Strict attention to good infection-control practices is effective for stopping transmission in hospitals of adenovirus-associated disease, such as epidemic keratoconjunctivitis.<ref name=gov.US/> Maintaining adequate levels of chlorination is necessary for preventing swimming pool-associated outbreaks of adenovirus conjunctivitis.<ref name=CDCtreat/> A live adenovirus vaccine to protect against types 4 and 7 adenoviruses has been used in some military personnel.<ref name=CDCtreat/> Rates of adenovirus disease fell among military recruits following the introduction a live oral vaccine against types 4 and 7.<ref name=Goldman2019/> Stocks of the vaccine ran out in 1999 and rates of disease increased until 2011 when the vaccine was re-introduced.<ref name=Goldman2019/>

==Treatment== Treatment is generally symptomatic and supportive.<ref name=CDCtreat/> Medicines to ease pain and reduce fever can be bought over the counter.<ref name=CDCtreat/> For adenoviral conjunctivitis, a cold compress and lubricants may provide some relief of discomfort.<ref name=Kumar2020/> Steroid eye drops may be required if the cornea is involved.<ref name=Kumar2020/> Most adenovirus infections get better without any treatment.<ref name=CDCtreat/>

== Prognosis == After recovery from adenovirus infection, the virus can be carried for weeks or months.<ref name=Lynch2016/>

Adenovirus can cause severe necrotizing pneumonia in which all or part of a lung has increased translucency radiographically, which is called Swyer-James Syndrome.<ref name="isbn0-8089-2325-0">{{cite book | author = Kliegman, Robert | author2 = Richard M Kliegman | title = Nelson essentials of pediatrics | publisher = Elsevier Saunders | location = St. Louis, Mo | year = 2006 | isbn = 978-0-8089-2325-1 }}</ref> Severe adenovirus pneumonia also may result in bronchiolitis obliterans, a subacute inflammatory process in which the small airways are replaced by scar tissue, resulting in a reduction in lung volume and lung compliance.<ref name="isbn0-8089-2325-0" />

==Epidemiology== Adenovirus infections occur sporadically throughout the year, and outbreaks can occur particularly in winter and spring.<ref name=Lynch2016/> Epidemics may spread more quickly in closed populations such as in hospitals, nurseries, long-term care facilities, boarding schools, orphanages and swimming pools.<ref name=Lynch2016/> Severe disease is rare in people who are usually healthy.<ref name=Lynch2016/> Around 10% of respiratory infections in children are caused by adenoviruses.<ref name=Lynch2016/> Most are mild and by the age of 10-years, most children have had at least one adenovirus infection.<ref name=Shieh2021/>

Adenoviruses are the most common viruses causing an inflamed throat.<ref name=Kumar2020/> 75% of conjunctivitis cases are due to adenovirus infection.<ref name=Labib2020/> Under two-year olds are particularly susceptible to adenovirus gastroenteritis by types 40 and 41, with type 41 being more common than type 40.<ref name=Lee2020/> Some large studies have revealed type 40/41 adenovirus as one of the second most common causes of diarrhea in children in low and middle income countries; the most common being rotavirus.<ref name=Lee2020/> In 2016, the Global Burden of Disease Study estimated that globally, around 75 million episodes of diarrhea among children under the age of five-years, were attributable to adenovirus infection, with a mortality of near 12%.<ref name=Lee2020/>

Research in adenovirus infection has generally been limited relative to other respiratory disease viruses.<ref name=Lee2020/> The impact of type-40/41 adenovirus diarrhoea is possibly underestimated.<ref name=Lee2020/>

==History== The first adenoviral strains were isolated from adenoids in 1953 by Rowe et al.<ref name=Kimpen2004/> Later, during studies on rotavirus diarrhoea, the wider use of electron microscopy resulted in detecting previously unrecognized adenoviruses types 40 and 41, subsequently found to be important in causing gastrointestinal illness in children.<ref name=Shieh2021/>

The illness made headlines in Texas in September 2007, when a so-called "boot camp flu" sickened hundreds at Lackland Air Force Base in San Antonio.<ref>[https://www.nytimes.com/2007/11/16/us/16brfs-VIRUS.html ''New York Times''] {{Webarchive|url=https://web.archive.org/web/20150611023007/http://www.nytimes.com/2007/11/16/us/16brfs-VIRUS.html?ref=us |date=2015-06-11 }} article ''New Form of Virus Has Caused 10 Deaths in 18 Months'' published November 16, 2007</ref> In 2018, outbreaks occurred in an adult nursing home in New Jersey, and a college campus in Maryland.<ref name=ATS2019/> In 2020, as a result of infection control measures during the COVID-19 pandemic, rates of adenovirus diarrhoea declined significantly in China.<ref name=Zhang202>{{cite journal |last1=Zhang |first1=Junfeng |last2=Cao |first2=JiaJia |last3=Ye |first3=Qing |title=Nonpharmaceutical interventions against the COVID-19 pandemic significantly decreased the spread of enterovirus in children |journal=Journal of Medical Virology |date=26 April 2022 |volume=94 |issue=8 |pages=3581–3588 |doi=10.1002/jmv.27806 |pmid=35474224 |pmc=9088497 |issn=1096-9071 }}</ref>

==Other animals== Dogs can be affected by adenovirus infection.<ref name=Drobatz2019>{{cite book |last1=Gonzales |first1=Anthony L. |last2=King |first2=Lesley G. |editor1-last=Drobatz |editor1-first=Kenneth J. |editor2-last=Hopper |editor2-first=Kate |editor3-last=Rozanski |editor3-first=Elizabeth A. |editor4-last=Silverstein |editor4-first=Deborah C. |title=Textbook of Small Animal Emergency Medicine |date=2019 |publisher=Wiley Blackwell |location=Hoboken |isbn=978-1-119-02893-2 |page=234 |chapter-url=https://books.google.com/books?id=U6NuDwAAQBAJ&pg=PA234 |language=en |chapter=37. Bronchopneumonia }}</ref> Severe liver damage is a classical infectious disease seen in unvaccinated dogs.<ref name=De2020>{{cite journal |last1=De Jonge |first1=Bert |last2=Van Brantegem |first2=Leen |last3=Chiers |first3=Koen |title=Infectious canine hepatitis, not only in the textbooks : a brief review and three case reports |journal=Vlaams Diergeneeskundig Tijdschrift |date=2020 |volume=89 |issue=5 |pages=284–291 |doi=10.21825/vdt.v89i5.16956 |s2cid=228935463 |url=https://biblio.ugent.be/publication/8689537 |issn=0303-9021 |doi-access=free }}</ref>

==References== {{Reflist|2}}

== External links ==

{{Medical resources | DiseasesDB = | ICD10 = {{ICD10|B|97|0|b|95}} | ICD9 = | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D000257 }} {{Viral diseases}} {{Authority control}}

{{DEFAULTSORT:Adenovirus Infection}} Category:Adenoviridae Category:Atypical pneumonias Category:Viral respiratory tract infections