Enterovirus D68

Visão geral 
Teoria 
Diagnóstico 
Tratamento 
ACOMPANHAMENTO 
Recursos 

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Última revisão: 19 Aug 2025

Última atualização: 01 Apr 2025

Enterovirus D68 (EV-D68) is an important cause of viral lower respiratory tract illness in children.

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.

EV-D68 infection is associated with the polio-like disease acute flaccid myelitis, and there is increasing evidence for a causal connection between the virus and this serious neurologic complication.

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 (CDC).

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 pediatric subspecialty and critical care support. Currently there is no specific antiviral therapy available for the treatment of any enterovirus.

Definição

Enterovirus D68 (EV-D68) is a member of the Picornaviridae family. It has emerged as an important cause of acute respiratory illness, especially in children.[1][2][3] In 2014, the US experienced an outbreak, with numerous children requiring hospital admission due to severe lower respiratory illness and asthma. Further outbreaks occurred in 2016 and 2018.[4]

Mounting evidence also supports a causal role of EV-D68 for the polio-like illness acute flaccid myelitis.[5][6][7][8][9][10][11][12] EV-D68 is closely related to rhinoviruses. Most clinical tests for rhinovirus do not distinguish EV-D68 in the absence of strain-specific typing.[13]

História e exame físico

Principais fatores diagnósticos

wheezing
shortness of breath
acute flaccid limb weakness

Detalhes completos

Outros fatores diagnósticos

rhinorrhea
cough
sneezing
muscle aches
fever

Detalhes completos

Fatores de risco

<18 years of age
history of asthma, wheezing
history of chronic lung disease
late summer or fall

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

clinical diagnosis

Detalhes completos

Investigações a serem consideradas

respiratory viral testing
real-time reverse transcription (rRT) PCR assay or molecular sequencing
pulse oximetry
contrast MRI of the spine and brain
lumbar puncture
electromyography
testing for poliovirus

Detalhes completos

Algoritmo de tratamento

CONTÍNUA

with mild upper respiratory symptoms

with asthma exacerbation or severe unexplained lower respiratory illness

with acute flaccid myelitis

Colaboradores

Autores

Giovanni Piedimonte, MD, FAAP, FCCP

Vice-President for Research and Institutional Official

Office of Research; Departments of Pediatrics, Biochemistry & Molecular Biology

Tulane University

New Orleans

Declarações

GP declares that he has no competing interests.

Elisabeth Toverud Landaas, MD, PhD

Senior Medical Officer and Associate Professor in Medical Microbiology

Department of Microbiology

Oslo University Hospital and University of Oslo

Oslo

Norway

Declarações

ETL declares that she has no competing interests.

Agradecimentos

Dr Giovanni Piedimonte and Dr Elisabeth T. Landaas would like to gratefully acknowledge Dr Charles B. Foster and Dr Neil R. Friedman, both previous co-contributors of this topic. CBF and NRF declare that they have no competing interests.

Revisores

Megan Culler Freeman, MD, PhD

Assistant Professor of Pediatrics

Division of Pediatric Infectious Diseases

UPMC Children’s Hospital of Pittsburgh

Pittsburgh

Declarações

MCF declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Oermann CM, Schuster JE, Conners GP, et al. Enterovirus D68: a focused review and clinical highlights from the 2014 United States outbreak. Ann Am Thorac Soc. 2015 May;12(5):775-81. Resumo

Midgley CM, Jackson MA, Selvarangan R, et al. Severe respiratory illness associated with enterovirus d68 - missouri and illinois, 2014. MMWR Morb Mortal Wkly Rep. 2014 Sep 12;63(36):798-9.Texto completo Resumo

Greninger AL, Naccache SN, Messacar K, et al. A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012-14): a retrospective cohort study. Lancet Infect Dis. 2015 Jun;15(6):671-82. Resumo

Centers for Disease Control and Prevention. Non-polio enterovirus: clinical overview of enterovirus D68. Apr 2024 [internet publication].Texto completo

Centers for Disease Control and Prevention. Acute flaccid myelitis (AFM): clinical guidance for the acute medical treatment of AFM. Jun 2024 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Rhinovirus infection
- Seasonal influenza infection
- Respiratory syncytial virus infection
Mais Diagnósticos diferenciais
Diretrizes
- Clinical overview of Enterovirus D68
- Acute flaccid myelitis (AFM): clinical guidance for the acute medical treatment of AFM
Mais Diretrizes
Conectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal

Enterovirus D68

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

with mild upper respiratory symptoms

with asthma exacerbation or severe unexplained lower respiratory illness

with acute flaccid myelitis

Colaboradores

Autores

Giovanni Piedimonte, MD, FAAP, FCCP

Declarações

Elisabeth Toverud Landaas, MD, PhD

Declarações

Agradecimentos

Revisores

Megan Culler Freeman, MD, PhD

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice