Enterovirus 68 pathophysiology
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Pathophysiology
The clinical manifestation of EV68 infection is not well defined. A number of cases of EV68 infection with pulmonary involvement have been identified in different parts of the world. The clinical signs and symptoms of EV68 range from a mild illness to more severe complications requiring hospitalization and in rare cases leading to death. Major symptoms associated with enterovirus infection include pharyngeal congestion, headache, myalgia, chills, and sore throat but not increased respiratory rate or difficulty breathing. In a few cases associated EV68 infection, respiratory difficulty was noted. Most symptomatic cases were among the younger age groups. The possible role of EV68 in polio like flaccid paralysis requires further research.
EV68 rearranged itself in the spacer region of 5' UTR between the IRES and polyprotein ORF. All the EVD68 strains that were examined after that rearrangement had a 24 nucleotide deletion. In the 1990's, a large change in the virus lead to its division into subgroups A to C. The subgroup C underwent more changes and resulted in 11 nucleotides deletion in the spacer region. This spacer change has lead to a very high impact on the initiation of translation. A variation in IRES is believed to affect the virulence.