Enterovirus D68

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 22 Sep 2025

最后更新： 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.

定义

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]

病史和体格检查

关键诊断因素

wheezing
shortness of breath
acute flaccid limb weakness

完整详情

其他诊断因素

rhinorrhea
cough
sneezing
muscle aches
fever

完整详情

危险因素

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

完整详情

诊断性检查

首要检查

clinical diagnosis

完整详情

需考虑的检查

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

完整详情

治疗流程

持续性治疗

with mild upper respiratory symptoms

with asthma exacerbation or severe unexplained lower respiratory illness

with acute flaccid myelitis

撰稿人

作者

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

利益声明

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

利益声明

ETL declares that she has no competing interests.

鸣谢

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.

同行评议者

Megan Culler Freeman, MD, PhD

Assistant Professor of Pediatrics

Division of Pediatric Infectious Diseases

UPMC Children’s Hospital of Pittsburgh

Pittsburgh

利益声明

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.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

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. 摘要

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.全文摘要

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. 摘要

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

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

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Rhinovirus infection
- Seasonal influenza infection
- Respiratory syncytial virus infection
更多鉴别诊断
指南
- Clinical overview of Enterovirus D68
- Acute flaccid myelitis (AFM): clinical guidance for the acute medical treatment of AFM
更多指南
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Enterovirus D68

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

with mild upper respiratory symptoms

with asthma exacerbation or severe unexplained lower respiratory illness

with acute flaccid myelitis

撰稿人

作者

Giovanni Piedimonte, MD, FAAP, FCCP

利益声明

Elisabeth Toverud Landaas, MD, PhD

利益声明

鸣谢

同行评议者

Megan Culler Freeman, MD, PhD

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

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