Clinical and laboratory profile of acute adenoviral infections in children in a tertiary care centre in India

Background: Adenoviral infections have very dramatic presentation with high grade fever, prolonged course and high inflammatory markers, causing much alarm among caretakers and health care workers. Being very common in pediatric age group, it leads to rampant use of antibiotics and hospitalization. This study attempts to characterize acute adenoviral infections and those related to swimming pools. Methods: A study was conducted among children, aged 2 months to 14 years, who presented with fever and clinical features of adenoviral infection. Diagnosis was confirmed by nasopharyngeal swab and clinical and laboratory data were analyzed statistically. Results: Fever was the commonest presentation (100%), with >80% experiencing high-grade fever and 7.3% lasting≥10 days. Respiratory symptoms were most common (75%), followed by gastrointestinal (51%), ophthalmic (41%) and neurological (19%). Multisystem involvement occurred in 78%. Elevated inflammatory markers were frequent: CRP>50 mg/L in 70%, ESR>50 mm/hour in 53% and leukocyte count>15,000/mm³ in 65%. Neither higher inflammatory markers nor fever severity correlated with longer fever duration or hospital stay. Swimming pool-related cases showed a higher incidence of conjunctivitis. Post COVID era saw in surge of adenoviral infections. Conclusions: Adenoviral infections cause prolonged fever, multisystem involvement and high inflammatory markers despite being viral. Elevated inflammatory markers do not predict prolonged illness or hospitalization and should not alone guide antibiotic use in clinically stable children. Early diagnosis can prevent unnecessary antibiotics. A global surge in adenoviral infections has been observed post-COVID.