Methods: Specimens collected from hospitalized patients, aged 0-17 years, with positive enterovirus/rhinovirus (EV/RV) testing by multiplex PCR assay, admitted from August 1-September 15, 2014, were retrospectively tested for EV-D68 by sequencing or PCR. Specific viral typing was not available to practitioners during admission. Clinical data was obtained from the medical chart.
Results: 570 patients were positive for EV/RV. 20 patients were excluded because the condition necessitating admission was unrelated to the positive test or an alternate primary diagnosis was identified, and 8 had no specimen for further testing. Of the remaining 542 patients, 339 (63%) were EV-D68 positive and 203 (37%) were EV-D68 negative. EV-D68 positive patients were older (4.6 vs 2.2 years, P<0.001) and more likely to have a history of asthma (39% vs 30%, P=0.04) or recurrent wheezing (22% vs 15%, P=0.04). EV-D68 positive patients were more likely to be hypoxic (56% vs 46%, P=0.04) and have retractions (74% vs 53%, P<0.001) or wheezing (72% vs 47%, P<0.001) on initial examination. For patients with a history of bronchospasm, children with EV-D68 were more likely to require supplemental oxygen (93% vs 82%, P=0.007), albuterol (99% vs 92%, P=0.004), more hours of continuous albuterol (3 vs 2, P=0.03), magnesium (43% vs 30%, P=0.03), and aminophylline (7% vs 0%, P=0.007) compared to children with other EV/RV. Sixty (18%) EV-D68 positive patients required intensive care unit (ICU) management, and age ≥5 years was a risk factor. There were no differences in length of stay or ICU admission between patients with EV-D68 and other EV/RV. No EV-D68 positive subjects died or had acute flaccid myelitis.
Conclusion: EV-D68 is more likely to cause respiratory disease in school-aged children. EV-D68 patients with a history of asthma or recurrent wheeze require more aggressive management of bronchospasm than those with other EV/RV. Rapid laboratory testing would assist in patient management.
K. Briggs, None
F. Hassan, None
L. Hays, None
B. Pahud, GSK: Research Contractor , Research support
ROCHE: Research Contractor , Research support
CDC: Grant Investigator , Grant recipient
NIH: Grant Investigator , Research support
Pfizer: Scientific Advisor , Consulting fee
G. Weddle, None
J. Miller, None
M. Thompson, None
H. Puls, None
M. A. Queen, None
M. A. Jackson, None