Enterovirus D-68

Last reviewed: 6 Jan 2023
Last updated: 17 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • wheezing
  • shortness of breath
  • acute flaccid limb weakness
More key diagnostic factors

Other diagnostic factors

  • rhinorrhoea
  • cough
  • sneezing
  • muscle aches
  • fever
Other diagnostic factors

Risk factors

  • <18 years of age
  • history of asthma, wheezing
  • history of chronic lung disease
  • late summer or autumn
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

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
  • electromyography
  • testing for poliovirus
More investigations to consider

Treatment algorithm

ONGOING

with mild upper respiratory symptoms

with asthma exacerbation or severe unexplained lower respiratory illness

with acute flaccid myelitis

Contributors

Authors

Charles B. Foster, MD
Charles B. Foster

Professor of Pediatrics

Medical Director of Pediatric Infection Prevention

Center for Pediatric Infectious Diseases

Cleveland Clinic Children’s

Cleveland Clinic

Cleveland

OH

Disclosures

CF declares that he has no competing interests.

Giovanni Piedimonte, MD, FAAP, FCCP
Giovanni Piedimonte

Vice-President for Research and Institutional Official

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

Tulane University

New Orleans

LA

Disclosures

GP declares that he has no competing interests.

Neil R. Friedman, MD
Neil R. Friedman

Interim Director, Barrow Neurological Institute at Phoenix Children’s

Director of Clinical Transformation

Barrow Neurological Institute at Phoenix Children’s

Phoenix

AZ

Disclosures

NRF declares that he has no competing interests.

Peer reviewers

Feras Khan, MD

Clinical Assistant Professor

Emergency Medicine Physician

Department of Emergency Medicine

University of Maryland School of Medicine

Baltimore

MD

Disclosures

FK declares that he has no competing interests.

Samuel R. Dominguez, MD, PhD

Associate Professor

Pediatric Infectious Disease

Children’s Hospital Colorado and University of Colorado School of Medicine

Aurora

CO

Disclosures

SRD declares that he has no competing interests.

  • Enterovirus D-68 images
  • Differentials

    • Rhinovirus infection
    • Seasonal influenza infection
    • Respiratory syncytial virus infection
    More Differentials
  • Guidelines

    • Acute flaccid myelitis (AFM): clinical guidance for the acute medical treatment of AFM
    • Acute flaccid myelitis (AFM): initial evaluation and diagnostic studies
    More Guidelines
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