Clinical Course of Enterovirus D68 in Hospitalized Children
Jennifer E Schuster1, Rangaraj Selvarangan, Ferdaus Hassan
1From the *Department of Pediatrics, Children's Mercy Hospital, †Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, and ‡University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri.
Insights
Enterovirus D68 (EV-D68) causes severe respiratory illness in children, especially those with asthma. EV-D68 patients require more intensive treatments for breathing difficulties and may need intensive care.
Area of Science:
- Virology
- Pediatric Infectious Diseases
- Respiratory Medicine
Background:
- Enterovirus D68 (EV-D68) is a known cause of respiratory tract infections.
- A significant international outbreak in 2014 highlighted EV-D68's potential to cause severe respiratory disease in children.
Purpose of the Study:
- To compare clinical characteristics and treatment needs of pediatric patients with EV-D68 versus other enterovirus/rhinovirus (EV/RV) infections during the 2014 outbreak.
- To identify risk factors for severe outcomes in children infected with EV-D68.
Main Methods:
- Retrospective chart review of children admitted between August 1 and September 15, 2014.
- Multiplex polymerase chain reaction (PCR) testing for EV/RV, with subsequent specific testing for EV-D68.
- Comparison of clinical data between EV-D68 positive and other EV/RV positive children.
Main Results:
- Children with EV-D68 were older (4.6 vs. 2.2 years) and more likely to have a history of asthma or recurrent wheezing.
- EV-D68 patients required more supplemental oxygen, albuterol, and corticosteroids.
- Age 5 years or older was a risk factor for intensive care unit (ICU) admission in EV-D68 cases.
- Asthmatic children with EV-D68 had higher rates of oxygen, magnesium, and continuous albuterol use.
Conclusions:
- EV-D68 causes severe respiratory disease in pediatric populations, particularly in those with pre-existing asthma or recurrent wheezing.
- EV-D68-infected children frequently require interventions for severe bronchospasm and may necessitate ICU care.
Background:
Enterovirus D68 (EV-D68) has been sporadically reported as a cause of respiratory tract infections. In 2014, an international outbreak of EV-D68 occurred and caused severe respiratory disease in the pediatric population.
Methods:
A retrospective chart review was performed of children admitted to Children's Mercy Hospital from August 1, 2014, to September 15, 2014, with positive multiplex polymerase chain reaction testing for EV/rhinovirus (RV). Specimens were subsequently tested for EV-D68, and clinical data were obtained from the medical records. Patients with EV-D68 were compared with children presenting simultaneously with other EV/RV.
Results:
Of 542 eligible specimens, children with EV-D68 were significantly older than children with other EV/RV (4.6 vs. 2.2 years, P < 0.001). Children with EV-D68 were more likely to have a history of asthma (38.6% vs. 30.0%, P = 0.04) or recurrent wheezing (22.1% vs. 14.8%, P = 0.04). EV-D68-positive children more commonly received supplemental oxygen (86.7% vs. 65.0%, P < 0.001), albuterol (91.2% vs. 65.5%, P < 0.001) and corticosteroids (82.9% vs. 58.6%, P < 0.001). Age ≥5 years was an independent risk factor for intensive care unit management in EV-D68-infected children. Children with a history of asthma or recurrent wheezing and EV-D68 received supplemental oxygen (92.7% vs. 82.4%, P = 0.007) and magnesium (42.7% vs. 29.7%, P = 0.03) at higher rates and more continuous albuterol (3 vs. 2 hours, P = 0.03) than those with other EV/RV.
Conclusions:
EV-D68 causes severe disease in the pediatric population, particularly in children with a history of asthma or recurrent wheezing. EV-D68-positive children are more likely to require therapy for refractory bronchospasm and may need intensive care unit- level care.
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