Clinical Features and Severity Predictors of Pediatric Enterovirus D68 Pneumonia in Southern China

Enterovirus D68 (EV-D68) has re-emerged globally as an important cause of pediatric respiratory illness, frequently associated with severe pneumonia in hospitalized children. Data describing the clinical spectrum and severity-associated features of EV-D68 infection in mainland China remain limited.

We retrospectively analyzed children hospitalized with EV-D68-associated community-acquired pneumonia between January 2022 and September 2024 at a tertiary pediatric center in southern China. EV-D68 was identified using targeted next-generation sequencing. Clinical characteristics, laboratory findings obtained at admission, treatment and outcomes were compared between severe and nonsevere cases. Exploratory receiver operating characteristic analyses were performed to evaluate the discriminatory performance of selected clinical and laboratory features.

Forty children met the inclusion criteria, of whom 33 (82.5%) were classified as having severe pneumonia. Children with severe disease more frequently had a history of atopic conditions and developed wheezing during hospitalization. At admission, severe cases demonstrated higher neutrophil proportions and lower lymphocyte proportions. Median C-reactive protein levels were higher in severe cases but did not reach statistical significance. Exploratory receiver operating characteristic analyses showed moderate discrimination for severe disease using neutrophil proportion and a combined model incorporating atopic history and serum immunoglobulin E levels. Despite frequent intensive care unit admissions, all children recovered.

EV-D68-associated pneumonia in hospitalized children in southern China was frequently severe, particularly among those with an atopic background. Routine clinical and laboratory features demonstrated exploratory discriminatory value for disease severity. These findings may assist clinicians in early risk stratification and highlight the need for further multicenter studies.