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enterovirus-D68 infection

Epidemiology: - 20-25 cases of polio-like syndrome reported in Califormia 2014 - 2 of 5 initial cases tested positive for enterovirus-68 - cases confirmed in 472 people across 41 states & Washington, D.C. (Sepember 30, 2014) [7] - at least 4 deaths (Oct 2, 2014) [8] - children diagnosed with enterovirus D68 in late 2014 were not at greater risk for death or critical care admission, relative to children with other respiratory viruses [13] - outbreak in children in Colorado, Sept-Oct 2014 [10] - pediatric cases of enterovirus D68 spiked in 2018, mirroring cases of acute flaccid myelitis [14] Pathology: - cause of lower respiratory tract infection - severity variable, mild to fatal - associated with polio-like symptoms [2] - may be cause of acute neurologic illness with focal limb weakness & spinal cord gray matter abnormalities on MRI [6] - may be a cause of acute neurologic illness with limb paralysis (acute flaccid myelitis) - may be especially risky to those with asthma [3] Genetics: - paralysis associated with B1 strain of enterovirus-D68 [12] - not all children with enterovirus-D68 B1 strain infection develop paralysis [12] Clinical manifestations: - limb weakness or paralysis may occur - acute flaccid paralysis [10] - cranial nerve palsy [10] - most patients have very mild symptoms - all but a very few recover quickly & completely [7] Laboratory: - enterovirus D68 RNA by rt-PCR [10] - laboratories now able to process 140 specimens/day Radiology: - magnetic resonance imaging of spinal cord - spinal cord gray matter abnormalities on MRI [6] Complications: - bacterial superinfection Differential diagnosis: - asthma, wheezing [4]

Related

acute neurologic illness with limb paralysis; acute flaccid myelitis (AFM)

General

enteroviral infection

References

  1. Centers for Disease Control and Prevention Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 --- Asia, Europe, and United States, 2008--2010 MMWR September 30, 2011 / 60(38);1301-1304 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6038a1.htm
  2. Physician's First Watch, Feb 24, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Seroka R, Uher M A Polio-like Syndrome in California: Clinical, Radiologic, and Serologic Evaluation of Five Children Identified by a Statewide Laboratory over a Twelve-month Period. American Academy of Neurology 66th Annual Meeting https://www.aan.com/PressRoom/Home/GetDigitalAsset/11171 - American Academy of Neurology. News Release. Feb 23, 2014 Mysterious Polio-Like Illness Found in Five California Children. https://www.aan.com/PressRoom/Home/PressRelease/1246
  3. Orciari Herman A, Sadoughi S, Sofair A Enterovirus-68-like Respiratory Virus Sickening Children Across the U.S. Physician's First Watch, Sept 8, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Missouri Department of Health & Senior Services. Health Alert. August 29, 2014 FROM: GAIL VASTERLING DITECTOR SUBJECT: Respiratory Illnesses D ue to Enterovirus D68 (EVD68) in Missouri http://health.mo.gov/emergencies/ert/alertsadvisories/pdf/HA82914.pdf
  4. Midgley CM et al Severe Respiratory Illness Associated with Enterovirus D68 - Missouri and Illinois, 2014 MMWR. September 8, 2014 / 63(Early Release);1-2 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0908a1.htm
  5. Centers for Disease Control and Prevention (CDC) States with Lab-confirmed Enterovirus D68. September 2014. http://www.cdc.gov/non-polio-enterovirus/about/EV-D68-states.html
  6. CDC HEALTH ADVISORY. September 26, 2014, Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children. http://emergency.cdc.gov/han/han00370.asp
  7. Orciari Herman A, Sadoughi S, Saitz R Child Dies from Enterovirus D68 Complications; Neurologic Symptoms Increasingly Reported Physician's First Watch, Oct 2, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Press Releases. Oct 1,2014 Recent Child Death Resulting from Staphylococcus Aureus Sepsis Associated with Enteroviral Infection (EV-D68). http://www.ri.gov/press/view/23044
  8. NEJM Journal Watch Editors Health Departments Investigating 4 Deaths Linked to Enterovirus D68 Physician's First Watch, Oct 3, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  9. Pastula DM et al Acute Neurologic Illness of Unknown Etiology in Children - Colorado, August-September 2014 MMWR. October 3, 2014 / 63(Early Release);1-2 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e1003a1.htm - Ayscue P et al Acute Flaccid Paralysis with Anterior Myelitis - California, June 2012-June 2014 MMWR. October 3, 2014 / 63(Early Release);1-4 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e1003a2.htm
  10. Messacar K et al A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA. Lancet. Jan 28, 2015 PMID: 25638662 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2962457-0/abstract
  11. Centers for Disease Control and Prevention (CDC). Press Release. October 14, 2014 CDC Develops a New, Faster Lab Test for Enterovirus D68 http://www.cdc.gov/media/releases/2014/p1014-test-enterovirus-D68.html
  12. Greninger AL et al A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012-14): a retrospective cohort study. The Lancet Infectious Diseases. Published Online: 30 March 2015 PMID: 25837569 http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2815%2970093-9/fulltext - Norder H, Magnius L Can sequence data predict enterovirus D68 infection outcome? The Lancet Infectious Diseases. Published Online: 30 March 2015 PMID: 25837570 http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2815%2970107-6/abstract
  13. Young K, Fairchild DG, Di Francesco L Enterovirus D68 Not Tied to Elevated Risk for Death in Kids During 2014 Outbreak Physician's First Watch, Oct 14, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org http://www.cmaj.ca/content/early/2015/10/13/cmaj.150619
  14. Kujawski SA, Midgley CM, Rha B, et al. Enterovirus D68-Associated Acute Respiratory Illness - New Vaccine Surveillance Network, United States, July-October, 2017 and 2018. MMWR Morb Mortal Wkly Rep 2019;68:277-280 https://www.cdc.gov/mmwr/volumes/68/wr/mm6812a1.htm
  15. Centers for Disease Control and Prevention (CDC) Enterovirus D68. Questions and answers. http://www.ncbi.nlm.nih.gov/pubmed/?term=Schifano+ED