Severe enterovirus 68 respiratory illness in children requiring intensive care management
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.
Journal of Clinical Virology
Acute respiratory tract infection, Asthma, Enterovirus, EV-D68, Intensive care unit, Respiratory virus
Schuster, J. E., Miller, J., Selvarangan, R., Weddle, G., Thompson, M., Hassan, F., Rogers, S. L., Oberste, M. S., Nix, W. A., Jackson, M. Severe enterovirus 68 respiratory illness in children requiring intensive care management Journal of Clinical Virology 70, 77-82 (2015).