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A comparison of hospitalized children with enterovirus D68 to those with rhinovirus

Charles B Foster1, Ritika Coelho1, Paul M Brown2

  • 1Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, Ohio.

Pediatric Pulmonology
|January 31, 2017
PubMed

Insights

Enterovirus D68 (EV-D68) was frequently misidentified as rhinovirus in hospitalized children, leading to underappreciation of its role in triggering asthma. This study highlights the need for accurate diagnostic assays to understand EV-D68

Area of Science:

  • Pediatric respiratory infections
  • Virology
  • Asthma research

Background:

  • Enterovirus D68 (EV-D68) outbreaks in 2014 led to hospitalizations for pediatric respiratory distress.
  • Many initial diagnoses incorrectly identified EV-D68 as rhinovirus due to cross-reactivity in common diagnostic panels.
  • Existing assays lacked the specificity to differentiate between EV-D68 and rhinovirus, impacting accurate diagnosis.

Purpose of the Study:

  • To compare clinical presentation and outcomes of children diagnosed with rhinovirus versus EV-D68.
  • To investigate the association between EV-D68 infection and asthma exacerbations.
  • To evaluate the diagnostic limitations of multiplex respiratory viral panels during EV-D68 outbreaks.

Main Methods:

  • Retrospective analysis of 103 nasopharyngeal swabs from hospitalized children initially testing positive for rhinovirus.
  • Specific retesting for EV-D68 to compare patient cohorts.
  • Clinical data review including medical history, presenting symptoms, and treatment regimens.

Main Results:

  • EV-D68 positive patients were significantly more likely to have a history of asthma (33.3% vs. 11.0%) and present with status asthmaticus (47.6% vs. 2.4%).
  • Patients with EV-D68 exhibited increased wheezing, respiratory distress, and lower respiratory tract involvement.
  • EV-D68 infections were associated with higher rates of steroid treatment and discharge on asthma medications, with less frequent viral coinfections.

Conclusions:

  • EV-D68 is strongly associated with severe asthma exacerbations in children, often presenting as status asthmaticus.
  • Diagnostic assay limitations in distinguishing EV-D68 from rhinovirus may have led to underestimation of EV-D68's role in asthma.
  • Accurate viral diagnostics are crucial for understanding and managing pediatric respiratory illnesses, particularly in relation to asthma triggers.
Abstract

Keywords:
asthmachildrenenterovirus D68respiratory virusrhinovirus

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