title: Type-specific clinical characteristics of adenovirus-associated influenza-like illness at five US military medical centers, 2009-2014.
abstract: Adenovirus is a recognized cause of influenza-like illness (ILI). The proportion of ILI attributable to adenovirus is not known. Moreover, knowledge gaps remain with respect to the epidemiologic, virologic, and clinical characteristics of adenovirus-associated ILI among otherwise healthy individuals.
  
  
  
  An observational, longitudinal study of <65-year-old patients with febrile ILI at five medical centers was conducted from 2009 to 2014. Nasopharyngeal specimens obtained at enrollment were first tested by single-reaction PCR for adenovirus, then further evaluated by a multiplex PCR assay for other respiratory viral pathogens. Symptoms over a 28-day period were collected.
  
  
  
  We enrolled 1536 individuals, among whom 43 (2·8%) were positive for adenovirus. The median age of cases was 3·4 years (range: 4 months to 41 years). Three were hospitalized. Species and serotype information was available for 33 (76·7%) cases. Species C (n = 21) was the most common, followed by B3 (n = 9) and one each of E4a, D46, and A. Species C infections were more frequent in children (P < 0·01). Half of the cases were positive for at least one other respiratory viral pathogen. Symptoms were generally mild and most commonly included cough (90%), fatigue (79%), rhinorrhea (74%), loss of appetite (71%), and sore throat (64%). Children with non-C adenovirus infection were more likely to report sore throat (P = 0·05) and hoarseness (P = 0·06) than those with species C infection.
  
  
  
  Adenovirus is frequently detected with other respiratory viruses. Persons with non-C adenovirus infections reported more severe symptoms, suggesting there may be species-specific differences in virulence and/or host response to infection.
authors.affiliation: Walter Reed National Military Medical Center, Washington, DC, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Koren
authors.affiliation: Naval Medical Center, San Diego, CA, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Arnold
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA.|Madigan Army Medical Center, Fort Lewis, WA, USA.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Fairchok
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA.|Naval Medical Center, Portsmouth, VA, USA.
authors.forename: Tahaniyat
authors.initials: T
authors.lastname: Lalani
authors.affiliation: San Antonio Military Health System, San Antonio, TX, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Danaher
authors.affiliation: Madigan Army Medical Center, Fort Lewis, WA, USA.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Schofield
authors.affiliation: Walter Reed National Military Medical Center, Washington, DC, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rajnik
authors.affiliation: Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA.|Naval Health Research Center, San Diego, CA, USA.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Hansen
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA.
authors.forename: Deepika
authors.initials: D
authors.lastname: Mor
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA.
authors.forename: Wei-Ju
authors.initials: WJ
authors.lastname: Chen
authors.affiliation: Children's National Medical Center, Washington, DC, USA.
authors.forename: Michelande
authors.initials: M
authors.lastname: Ridoré
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Burgess
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA.
authors.forename: Eugene V
authors.initials: EV
authors.lastname: Millar
mesh_terms: D000258:Adenovirus Infections, Human / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D000260:Adenoviruses, Human / Q000235:genetics / Q000302:isolation & purification*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000821:virology; D005260:Female; D005334:Fever / Q000821:virology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000453:epidemiology / Q000821:virology*; D008137:Longitudinal Studies; D008297:Male; D058749:Military Facilities; D060885:Multiplex Polymerase Chain Reaction; D009305:Nasopharynx / Q000821:virology; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000401:mortality / Q000821:virology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Adenovirus; influenza-like illness; military