Enterovirus D-68 (EV-D68) is an important cause of viral lower respiratory tract illness in children. In 2014, the US experienced an outbreak of EV-D68, with numerous children requiring hospital admission due to severe lower respiratory illness and asthma.
Most people infected have mild symptoms such as runny nose, cough, sneezing, or muscle aches; some patients have fever. Often patients with more severe disease have a history of asthma or chronic lung disease.
A possible association exists between EV-D68 infection and polio-like acute flaccid myelitis.
Diagnosis is clinical. Most clinical tests for rhinovirus do not distinguish EV-D68 in the absence of specific testing.
Specific testing for EV-D68 should be considered in children with severe unexplained respiratory illness, even in the absence of fever. Although not routinely available, specific testing can be obtained on a case-by-case basis through state or local health departments, or the Centers for Disease Control and Prevention.
In patients with mild upper respiratory symptoms, the illness is typically self-limited and no specific therapy is indicated.
Patients with asthma exacerbation or severe unexplained respiratory illness should receive supportive care. Management should occur in a setting that can provide access to appropriate paediatric subspecialty and critical care support. Currently there is no specific antiviral therapy available for the treatment of any enterovirus.
Preventive measures to avoid transmission include avoiding close contact with sick persons, washing hands with soap and water, covering coughs and sneezes, staying home when sick, and cleaning and disinfecting contaminated surfaces. In the healthcare setting, healthcare providers should use standard, contact, and droplet precautions.
Enterovirus D-68 (EV-D68) is a member of the Picornaviridae family. It has emerged as an important cause of acute respiratory illness, especially in children. In 2014, the US experienced an outbreak, with numerous children requiring hospital admission due to severe lower respiratory illness and asthma. Emerging data also support a role for EV-D68 in polio-like acute flaccid myelitis. EV-D68 is closely related to rhinoviruses. Most clinical tests for rhinovirus do not distinguish EV-D68 in the absence of strain-specific typing.
History and exam
Key diagnostic factors
- presence of risk factors
- shortness of breath
- acute flaccid limb weakness
Other diagnostic factors
- muscle aches
- <18 years of age
- history of asthma, wheezing
- history of chronic lung disease
- late summer or autumn
1st investigations to order
- clinical diagnosis
Investigations to consider
- respiratory viral testing
- real-time reverse transcription (rRT) PCR assay or molecular sequencing
- pulse oximetry
- contrast MRI of the spine and brain
- lumbar puncture
with mild upper respiratory symptoms
with asthma exacerbation or severe unexplained lower respiratory illness
with acute flaccid myelitis
Charles Foster, MD
Center for Pediatric Infectious Diseases
CF declares that he has no competing interests.
Giovanni Piedimonte, MD, FAAP, FCCP
Professor & Chair
Cleveland Clinic Children’s Hospital
GP declares that he has no competing interests.
Neil R. Friedman, MD
Center for Pediatric Neurology
NRF declares that he has no competing interests.
Feras Khan, MD
Clinical Assistant Professor
Emergency Medicine Physician
Department of Emergency Medicine
University of Maryland School of Medicine
FK declares that he has no competing interests.
Samuel R. Dominguez, MD, PhD
Pediatric Infectious Disease
Children’s Hospital Colorado and University of Colorado School of Medicine
SRD declares that he has no competing interests.
- Rhinovirus infection
- Seasonal influenza infection
- Respiratory syncytial virus infection
- Acute Flaccid Myelitis (AFM): Initial Evaluation and Diagnostic Studies
- Acute Flaccid Myelitis (AFM): Clinical Guidance for the Acute Medical Treatment of AFM
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