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Influenza Other Respir Viruses. 2018 Jul;12(4):522-528. doi: 10.1111/irv.12551. Epub 2018 Mar 23.

Enterovirus D-68 in children presenting for acute care in the hospital setting.

Author information

1
Seattle Children's Hospital, Seattle, WA, USA.
2
University of Washington, Seattle, WA, USA.
3
Seattle Children's Research Institute, Seattle, WA, USA.
4
Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

Abstract

BACKGROUND:

Severe respiratory disease associated with enterovirus D68 (EV-D68) has been reported in hospitalized pediatric patients. Virologic and clinical characteristics of EV-D68 infections exclusively in patients presenting to a hospital Emergency Department (ED) or urgent care have not been well defined.

METHODS:

Mid-nasal swabs from pediatric patients with respiratory symptoms presenting to the ED or urgent care were evaluated using a commercial multiplex PCR platform. Specimens positive for rhinovirus/enterovirus (HRV/EV) were subsequently tested using real-time reverse-transcriptase PCR for EV-D68. The PCR cycle threshold (CT) was used as a viral load proxy. Clinical outcomes were compared between patients with EV-D68 and patients without EV-D68 who tested positive for HRV/EV.

RESULTS:

From August to December 2014, 511 swabs from patients with HRV/EV were available. EV-D68 was detected in 170 (33%) HRV/EV-positive samples. In multivariable models adjusted for age and underlying asthma, patients with EV-D68 were more likely to require hospitalization for respiratory reasons (odds ratio (OR): 3.11, CI: 1.85-5.25), require respiratory support (OR: 1.69, CI: 1.09-2.62), have confirmed/probable lower respiratory tract infection (LRTI; OR: 3.78, CI: 2.03-7.04), and require continuous albuterol or steroids (OR: 3.91, CI: 2.22-6.88 and OR: 4.73, CI: 2.65-8.46, respectively). Higher EV-D68 viral load was associated with need for respiratory support and LRTI in multivariate models.

CONCLUSIONS:

Among pediatric patients presenting to the ED or urgent care, EV-D68 causes more severe disease than non-EV-D68 HRV/EV independent of underlying asthma. High viral load was associated with worse clinical outcomes. Rapid and quantitative viral testing may help identify and risk stratify patients.

KEYWORDS:

enterovirus; enterovirus-D68; respiratory infection; rhinovirus

PMID:
29498483
PMCID:
PMC6005627
DOI:
10.1111/irv.12551
[Indexed for MEDLINE]
Free PMC Article

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