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Severe enterovirus 68 respiratory illness in children requiring intensive care management.
J Clin Virol. 2015 Sep; 70:77-82.JC

Abstract

BACKGROUND

Enterovirus 68 (EV-D68) causes acute respiratory tract illness in epidemic cycles, most recently in Fall 2014, but clinical characteristics of severe disease are not well reported.

OBJECTIVES

Children with EV-D68 severe respiratory disease requiring pediatric intensive care unit (PICU) management were compared with children with severe respiratory disease from other enteroviruses/rhinoviruses.

STUDY DESIGN

A retrospective review was performed of all children admitted to Children's Mercy Hospital PICU from August 1-September 15, 2014 with positive PCR testing for enterovirus/rhinovirus. Specimens were subsequently tested for the presence of EV-D68. We evaluated baseline characteristics, symptomatology, lab values, therapeutics, and outcomes of children with EV-D68 viral infection compared with enterovirus/rhinovirus-positive, EV-D68-negative children.

RESULTS

A total of 86 children with positive enterovirus/rhinovirus testing associated with respiratory symptoms were admitted to the PICU. Children with EV-D68 were older than their EV-D68-negative counterparts (7.1 vs. 3.5 years, P=0.01). They were more likely to have a history of asthma or recurrent wheeze (68% vs. 42%, P=0.03) and to present with cough (90% vs. 63%, P=0.009). EV-D68 children were significantly more likely to receive albuterol (95% vs. 79%, P=0.04), magnesium (75% vs. 42%, P=0.004), and aminophylline (25% vs. 4%, P=0.03). Other adjunctive medications used in EV-D68 children included corticosteroids, epinephrine, and heliox; 44% of EV-D68-positive children required non-invasive ventilatory support.

CONCLUSIONS

EV-D68 causes severe disease in the pediatric population, particularly in children with asthma and recurrent wheeze; children may require multiple adjunctive respiratory therapies.

Authors+Show Affiliations

Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, USA. Electronic address: jeschuster@cmh.edu.Division of Critical Care, Children's Mercy Hospital, Kansas City, MO, USA.Division of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, USA.Division of Critical Care, Children's Mercy Hospital, Kansas City, MO, USA.Division of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26305825

Citation

Schuster, Jennifer E., et al. "Severe Enterovirus 68 Respiratory Illness in Children Requiring Intensive Care Management." Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, vol. 70, 2015, pp. 77-82.
Schuster JE, Miller JO, Selvarangan R, et al. Severe enterovirus 68 respiratory illness in children requiring intensive care management. J Clin Virol. 2015;70:77-82.
Schuster, J. E., Miller, J. O., Selvarangan, R., Weddle, G., Thompson, M. T., Hassan, F., Rogers, S. L., Oberste, M. S., Nix, W. A., & Jackson, M. A. (2015). Severe enterovirus 68 respiratory illness in children requiring intensive care management. Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, 70, 77-82. https://doi.org/10.1016/j.jcv.2015.07.298
Schuster JE, et al. Severe Enterovirus 68 Respiratory Illness in Children Requiring Intensive Care Management. J Clin Virol. 2015;70:77-82. PubMed PMID: 26305825.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe enterovirus 68 respiratory illness in children requiring intensive care management. AU - Schuster,Jennifer E, AU - Miller,Jenna O, AU - Selvarangan,Rangaraj, AU - Weddle,Gina, AU - Thompson,Marita T, AU - Hassan,Ferdaus, AU - Rogers,Shannon L, AU - Oberste,M Steven, AU - Nix,W Allan, AU - Jackson,Mary Anne, Y1 - 2015/07/20/ PY - 2015/06/20/received PY - 2015/07/16/accepted PY - 2015/8/26/entrez PY - 2015/8/26/pubmed PY - 2016/5/25/medline KW - Acute respiratory tract infection KW - Asthma KW - EV-D68 KW - Enterovirus KW - Intensive care unit KW - Respiratory virus SP - 77 EP - 82 JF - Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology JO - J Clin Virol VL - 70 N2 - BACKGROUND: Enterovirus 68 (EV-D68) causes acute respiratory tract illness in epidemic cycles, most recently in Fall 2014, but clinical characteristics of severe disease are not well reported. OBJECTIVES: Children with EV-D68 severe respiratory disease requiring pediatric intensive care unit (PICU) management were compared with children with severe respiratory disease from other enteroviruses/rhinoviruses. STUDY DESIGN: A retrospective review was performed of all children admitted to Children's Mercy Hospital PICU from August 1-September 15, 2014 with positive PCR testing for enterovirus/rhinovirus. Specimens were subsequently tested for the presence of EV-D68. We evaluated baseline characteristics, symptomatology, lab values, therapeutics, and outcomes of children with EV-D68 viral infection compared with enterovirus/rhinovirus-positive, EV-D68-negative children. RESULTS: A total of 86 children with positive enterovirus/rhinovirus testing associated with respiratory symptoms were admitted to the PICU. Children with EV-D68 were older than their EV-D68-negative counterparts (7.1 vs. 3.5 years, P=0.01). They were more likely to have a history of asthma or recurrent wheeze (68% vs. 42%, P=0.03) and to present with cough (90% vs. 63%, P=0.009). EV-D68 children were significantly more likely to receive albuterol (95% vs. 79%, P=0.04), magnesium (75% vs. 42%, P=0.004), and aminophylline (25% vs. 4%, P=0.03). Other adjunctive medications used in EV-D68 children included corticosteroids, epinephrine, and heliox; 44% of EV-D68-positive children required non-invasive ventilatory support. CONCLUSIONS: EV-D68 causes severe disease in the pediatric population, particularly in children with asthma and recurrent wheeze; children may require multiple adjunctive respiratory therapies. SN - 1873-5967 UR - https://www.unboundmedicine.com/medline/citation/26305825/Severe_enterovirus_68_respiratory_illness_in_children_requiring_intensive_care_management_ DB - PRIME DP - Unbound Medicine ER -