Enterovirus 68 overview: Difference between revisions
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Children and elderly patients have an increased risk of developing symptoms when infected with enterovirus 68. | |||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
Revision as of 13:54, 10 September 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]; João André Alves Silva, M.D. [3]
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Synonyms and keywords: Enterovirus D-68, EV68, EV-68, EV-D68
Overview
Enterovirus 68 (EV68) is a member of the Enterovirus genus of the Picornaviridae family. It is a non-enveloped, positive-sense, single-stranded RNA virus. It is detected more frequently among pediatric patients in the United States and other countries. While enteroviruses can cause a wide range of symptoms ranging from mild febrile illness to fatal meningitis and encephalitis, EV68 is mostly associated with acute respiratory symptoms.
Historical Perspective
Human enterovirus 68 (EV-D68) was initially detected in 1962 from samples of 4 children presenting for pneumonia and bronchiolitis at a hospital in California. It is a rare disease that has only become more evident in the past decade. The most recent outbreak occured in September 2014 at involved 10 states including Colorado, North Carolina, Georgia, Ohio, Iowa, Illinois, Missouri, Kansas, Oklahoma and Kentucky.
Pathophysiology
Causes
Differentiating Enterovirus 68 from other Diseases
Enterovirus 68 infection must be differentiated from other diseases that cause fever, cough, malaise, and rhinorrhea such as: respiratory syncytial virus, adenovirus, parainfluenza virus, seasonal influenza virus B, coronavirus, and rhinovirus.
Epidemiology and Demographics
Risk Factors
Children and elderly patients have an increased risk of developing symptoms when infected with enterovirus 68.
Natural History, Complications and Prognosis
Enterovirus produces mild upper respiratory symptoms and is most common in children. Enterovirus 68 is associated with a low mortality, but complications such as severe pneumonia and superimposed infections may occur in almost one-fifth of infected patients.
History and Symptoms
Enterovirus 68 infection presents with symptoms of an acute respiratory tract infection. The most common symptoms of this viral infection include fever, cough, dyspnea, rhinorrhea, and sneezing.
Physical Examination
Patients with enterovirus 68 infection develop signs and symptoms of respiratory illness. Findings in the physical exam include fever, tachypnea, skin rash, sore throat, and wheezing.
Laboratory Findings
Laboratory findings in an enterovirus 68 infection include a positive [[PCR] assay of a nasopharyngeal swab specimen or viral culture. Serology tests have a low specificity for the diagnosis of enterovirus 68.
Chest X Ray
Imaging studies is not commonly done in patients with enterovirus 68 infection. One-fourth of patient may develop lower respiratory complications and abnormal chest X-ray findings may include infiltration and consolidation.
Medical Therapy
There is no specific antiviral treatment for enterovirus 68 infection. Current management of these patients is based on supportive care towards symptom relief and prevention of complications.
Primary Prevention
There is no vaccine against enterovirus 68. Preventive measures such as hand washing, avoiding contact with sick people and disinfecting touched surfaces are recommended.
Future or Investigational Therapies
Even though the treatment for enterovirus infection is currently with supportive care, the development of other medical therapies has increased in the past years. Immune globulin has shown clinical and laboratory improvement among some patients with enterovirus infection. Antiviral medications against enterovirus, such as pleconaril, are currently under research, but have shown benefit in patients with severe infections caused by other subtypes of enteroviruses.