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Enterovirus D-68 in children presenting for acute care in the hospital setting
Timothy J Savage1,2, Jane Kuypers2, Helen Y Chu2
1Seattle Children's Hospital, Seattle, WA, USA.
Insights
Enterovirus D68 (EV-D68) in children presenting to emergency departments causes more severe respiratory illness than other common viruses. Higher viral loads correlate with worse outcomes, suggesting a need for rapid diagnostic testing.
Area of Science:
- Pediatric infectious diseases
- Virology
- Respiratory medicine
Background:
- Enterovirus D68 (EV-D68) is associated with severe respiratory disease in hospitalized children.
- Limited data exists on the virologic and clinical characteristics of EV-D68 in emergency department (ED) settings.
Purpose of the Study:
- To define the virologic and clinical features of EV-D68 infections in pediatric patients presenting to EDs or urgent care.
- To compare clinical outcomes between EV-D68 and non-EV-D68 rhinovirus/enterovirus (HRV/EV) infections.
Main Methods:
- Mid-nasal swabs from pediatric patients with respiratory symptoms were tested for HRV/EV using multiplex PCR.
- EV-D68 was identified using real-time reverse-transcriptase PCR, with cycle threshold (CT) values serving as a viral load proxy.
- Clinical outcomes were compared between EV-D68 positive and negative HRV/EV positive patients.
Main Results:
- EV-D68 was detected in 33% of HRV/EV-positive samples.
- EV-D68 infection was associated with increased likelihood of hospitalization (OR: 3.11), respiratory support (OR: 1.69), lower respiratory tract infection (LRTI; OR: 3.78), and continuous albuterol/steroid use.
- Higher EV-D68 viral load correlated with the need for respiratory support and LRTI.
Conclusions:
- EV-D68 causes more severe respiratory disease than other HRV/EV in pediatric ED patients, irrespective of asthma.
- High viral load is linked to adverse clinical outcomes.
- Rapid, quantitative viral testing can aid in patient identification and risk stratification.
Background:
Severe respiratory disease associated with enterovirus D68 (EV-D68) has been reported in hospitalized pediatric patients. Virologic and clinical characteristics of EV-D68 infections exclusively in patients presenting to a hospital Emergency Department (ED) or urgent care have not been well defined.
Methods:
Mid-nasal swabs from pediatric patients with respiratory symptoms presenting to the ED or urgent care were evaluated using a commercial multiplex PCR platform. Specimens positive for rhinovirus/enterovirus (HRV/EV) were subsequently tested using real-time reverse-transcriptase PCR for EV-D68. The PCR cycle threshold (CT) was used as a viral load proxy. Clinical outcomes were compared between patients with EV-D68 and patients without EV-D68 who tested positive for HRV/EV.
Results:
From August to December 2014, 511 swabs from patients with HRV/EV were available. EV-D68 was detected in 170 (33%) HRV/EV-positive samples. In multivariable models adjusted for age and underlying asthma, patients with EV-D68 were more likely to require hospitalization for respiratory reasons (odds ratio (OR): 3.11, CI: 1.85-5.25), require respiratory support (OR: 1.69, CI: 1.09-2.62), have confirmed/probable lower respiratory tract infection (LRTI; OR: 3.78, CI: 2.03-7.04), and require continuous albuterol or steroids (OR: 3.91, CI: 2.22-6.88 and OR: 4.73, CI: 2.65-8.46, respectively). Higher EV-D68 viral load was associated with need for respiratory support and LRTI in multivariate models.
Conclusions:
Among pediatric patients presenting to the ED or urgent care, EV-D68 causes more severe disease than non-EV-D68 HRV/EV independent of underlying asthma. High viral load was associated with worse clinical outcomes. Rapid and quantitative viral testing may help identify and risk stratify patients.
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