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| __NOTOC__ | | __NOTOC__ |
| {{CMG}}; {{AE}} {{chetan}} {{VB}} | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{Taxobox | | {{CMG}}; {{AE}} {{AL}}; {{JS}} {{HK}} |
| | name = ''Enterovirus 68''
| | {{Enterovirus 68}} |
| | virus_group = iv
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| | familia = ''[[Picornaviridae]]''
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| | genus = ''[[Enterovirus]]''
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| | species = ''[[Enterovirus D]]''
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| | subdivision_ranks = Subtype
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| | subdivision = ''Enterovirus 68''
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| | synonyms = Human rhinovirus 87<ref>{{cite doi|10.1159/000065866 }}</ref>
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| }} | |
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| ==Overview==
| | {{SK}} Enterovirus D-68, EV68, EV-68, EV-D68, EVD68, Acute flaccid paralysis with anterior myelitis, polio-like syndrome |
| '''Enterovirus 68''' ('''EV68''', '''EV-D68''') is a member of the ''[[Picornaviridae]]'' family, an [[enterovirus]]. It is a non-enveloped, positive sense ssRNA virus. It is distributed more in the pediatric age group, not just in USA but in other countries around the world as well. It can cause a wide range of symptoms ranging from mild febrile illness to fatal meningitis and encephalitis.
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| ==Origin and serotypes== | | ==[[Enterovirus 68 overview|Overview]]== |
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| Enteroviruses were divided into four subgroups based on the diseases they cause in humans. The Four subgroups were polioviruses, coxsackie A viruses, coxsackie B viruses, and echovirus. However, on further studies it was found and understood that, some coxsackie and echoviruses had overlapping antigenic properties with respect to the diseases they caused in mice. As a result, they were all later described as enteroviruses and numbered sequentially, beginning with enterovirus 68 (EV68). Current classifications systems are based on molecular, antigenic as well as biological properties of these viruses. The enterovirus family is presently subgrouped into 5 categories: Poliovirus, Human enterovirus A (HEV-A), HEV-B, HEV-C and HEV-D.
| | ==[[Enterovirus 68 historical perspective|Historical Perspective]]== |
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| EV68 first came into picture when it caused pneumonia and bronchiolitis in four children in California in 1962. Ten times EV68 has been isolated the most recent being 2014. The other isolations were in the years 1970, 1987, 1994, 1997, 2000 and 2003. Antigen typing reagents are not available in all facilities and hence EV68 involvement might be underestimated.
| | ==[[Enterovirus 68 pathophysiology|Pathophysiology]]== |
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| Human rhinovirus 87 was isolated at the same time as EV68. Corn is a prototype of HRV87 and is very unique in its receptor quality. Cross neutralization and partial capsid sequence studie shave revealed that HRV-87 Corn belongs to the same group as EV68.<ref name="Ishiko-2002">{{Cite journal | last1 = Ishiko | first1 = H. | last2 = Miura | first2 = R. | last3 = Shimada | first3 = Y. | last4 = Hayashi | first4 = A. | last5 = Nakajima | first5 = H. | last6 = Yamazaki | first6 = S. | last7 = Takeda | first7 = N. | title = Human rhinovirus 87 identified as human enterovirus 68 by VP4-based molecular diagnosis. | journal = Intervirology | volume = 45 | issue = 3 | pages = 136-41 | month = | year = 2002 | doi = 65866 | PMID = 12403917 }}</ref>
| | ==[[Enterovirus 68 causes|Causes]]== |
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| A study on 1962 isolates of EV68 have shown genome sequences of the 5′-non-translated (NTR) and 3D polymerase coding regions and complete VP1 capsid protein coding region sequence.
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| ==Epidemiology== | | ==[[Enterovirus 68 differential diagnosis|Differentiating Enterovirus 68 from Other Diseases]]== |
| Enterovirus 68 infection is an extremely rare condition, CDC found a total of 26 cases from 1987-2005, the most being 11 in the year 2003.<ref name="Khetsuriani-2006">{{Cite journal | last1 = Khetsuriani | first1 = N. | last2 = Lamonte-Fowlkes | first2 = A. | last3 = Oberst | first3 = S. | last4 = Pallansch | first4 = MA. | title = Enterovirus surveillance--United States, 1970-2005. | journal = MMWR Surveill Summ | volume = 55 | issue = 8 | pages = 1-20 | month = Sep | year = 2006 | doi = | PMID = 16971890 }}</ref> The first ever case was discovered in the year 1962 in California<ref name="Schieble-1967">{{Cite journal | last1 = Schieble | first1 = JH. | last2 = Fox | first2 = VL. | last3 = Lennette | first3 = EH. | title = A probable new human picornavirus associated with respiratory diseases. | journal = Am J Epidemiol | volume = 85 | issue = 2 | pages = 297-310 | month = Mar | year = 1967 | doi = | PMID = 4960233 }}</ref> and since then only a few cases have been discovered, however there have been recent outbreaks in other parts of the world as well.<ref name="Lauinger-2012">{{Cite journal | last1 = Lauinger | first1 = IL. | last2 = Bible | first2 = JM. | last3 = Halligan | first3 = EP. | last4 = Aarons | first4 = EJ. | last5 = MacMahon | first5 = E. | last6 = Tong | first6 = CY. | title = Lineages, sub-lineages and variants of enterovirus 68 in recent outbreaks. | journal = PLoS One | volume = 7 | issue = 4 | pages = e36005 | month = | year = 2012 | doi = 10.1371/journal.pone.0036005 | PMID = 22536453 }}</ref> | |
| <ref name="Oberste-2004">{{Cite journal | last1 = Oberste | first1 = MS. | last2 = Maher | first2 = K. | last3 = Schnurr | first3 = D. | last4 = Flemister | first4 = MR. | last5 = Lovchik | first5 = JC. | last6 = Peters | first6 = H. | last7 = Sessions | first7 = W. | last8 = Kirk | first8 = C. | last9 = Chatterjee | first9 = N. | title = Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinoviruses. | journal = J Gen Virol | volume = 85 | issue = Pt 9 | pages = 2577-84 | month = Sep | year = 2004 | doi = 10.1099/vir.0.79925-0 | PMID = 15302951 }}</ref>
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| <ref name="Tokarz-2012">{{Cite journal | last1 = Tokarz | first1 = R. | last2 = Firth | first2 = C. | last3 = Madhi | first3 = SA. | last4 = Howie | first4 = SR. | last5 = Wu | first5 = W. | last6 = Sall | first6 = AA. | last7 = Haq | first7 = S. | last8 = Briese | first8 = T. | last9 = Lipkin | first9 = WI. | title = Worldwide emergence of multiple clades of enterovirus 68. | journal = J Gen Virol | volume = 93 | issue = Pt 9 | pages = 1952-8 | month = Sep | year = 2012 | doi = 10.1099/vir.0.043935-0 | PMID = 22694903 }}</ref> Recently, five cases of unexplained paralysis were reported in California. In two of these enteroviruses were isolated.
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| '''Philippines:''' During October 2008-March 2009, an outbreak of HEV68 was detected in the Eastern Visayas region of the Philippines among pediatric patients hospitalized with pneumonia.<ref name="Imamura-2011">{{Cite journal | last1 = Imamura | first1 = T. | last2 = Fuji | first2 = N. | last3 = Suzuki | first3 = A. | last4 = Tamaki | first4 = R. | last5 = Saito | first5 = M. | last6 = Aniceto | first6 = R. | last7 = Galang | first7 = H. | last8 = Sombrero | first8 = L. | last9 = Lupisan | first9 = S. | title = Enterovirus 68 among children with severe acute respiratory infection, the Philippines. | journal = Emerg Infect Dis | volume = 17 | issue = 8 | pages = 1430-5 | month = Aug | year = 2011 | doi = 10.3201/eid1708.101328 | PMID = 21801620 }}</ref>
| | ==[[Enterovirus 68 epidemiology and demographics|Epidemiology and Demographics]]== |
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| '''Japan:''' In Japan, first cases were picked up in the year 2005. Since 2005 to 2010 < 10 cases were discovered almost every year, till 2010 where almost 120 cases occurred. Most of these presented with an acute respiratory illness with cough, breathing difficulty, wheezing etc.<ref name="-2011">{{Cite journal | title = Clusters of acute respiratory illness associated with human enterovirus 68--Asia, Europe, and United States, 2008-2010. | journal = MMWR Morb Mortal Wkly Rep | volume = 60 | issue = 38 | pages = 1301-4 | month = Sep | year = 2011 | doi = | PMID = 21956405 }}</ref>
| | ==[[Enterovirus 68 risk factors|Risk Factors]]== |
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| '''Netherlands:''' In 2010, all patients with pneumonia and pneumonia like symptoms were prospectively studied and their samples were sequenced. A total of 24 of these were found to be due to enterovirus 68. 50% of them being in the age group < 20 years.
| | ==[[Enterovirus 68 natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Identification of Isolates== | | ==Diagnosis== |
| Oberste etal used rabbit antisera for typing of isolates. To the isolates, serotype specific rabbit antisera was added. Other method used for sequencing was partial sequencing of VP1 capsid gene, using primer 292 (5'-MIGCIGYIGARACNGG-3') and 222 (5'-CICCIGGIGGIAYRWACAT-3'). The serotype was determined by comparing partial sequence of isolates with a database containing partial sequences of all known enterovirus serotypes as described previously by the same group.
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| Two commercially available, FDA approved multipathogen detection systems - Luminex xTAG RVP and Idaho Technologies (Salt Lake City, Utah) Film array respiratory panel are currently being used in the united states. Both use broadly reactive primers that can pick up both enterovirus as well as human rhinovirus.
| | [[Enterovirus 68 history and symptoms|History and Symptoms]] | [[Enterovirus 68 physical examination|Physical Examination]] | [[Enterovirus 68 laboratory findings|Laboratory Findings]] | [[Enterovirus 68 chest x ray|Chest X Ray]] |
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| ==Life cycle== | | ==Treatment== |
| Enterovirus 68 is acid labile and prefers a lower temperature, whereas rhinoviruses are more acid stable and can survive at higher temperatures. In a study to predict the effect of acidity and temperature on viral growth, 5 clinical isolates were tested for acid stability versus EV-68 FERMON strain. It was shown that all strains showed 100-1000 fold reduction in infectivity titres, after incubation for 1 hour in pH 3 buffer. The results were in agreement with a similar study done by Blomqvist et al. Also, in the study each of EV 68 strains also grew to a lower titre at 37 °C than at 33 °C.
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| ==Pathogenesis==
| | [[Enterovirus 68 medical therapy|Medical Therapy]] | [[Enterovirus 68 primary prevention|Primary Prevention]] | [[Enterovirus 68 future or investigational therapies|Future or Investigational Therapies]] |
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| | ==Case Studies== |
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| | | [[Enterovirus 68 case study one|Case #1]] |
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| == Immune system avoidance ==
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| == Cloning and synthesis ==
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| == References ==
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| {{Reflist|2}}
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| [[Category:Picornaviruses]]
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| [[Category:Enterovirus]] | |
| [[Category:Poliomyelitis]]
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