1066. Clinical severity among cases with Coxsackievirus/Enterovirus: A case series
Session: Poster Abstract Session: Herpesviruses, HPV, and Other Viruses
Friday, October 9, 2015
Room: Poster Hall
Background: Coxsackieviruses, part of the enterovirus family, are a cause of influenza-like illness (ILI) in adults and children.  Descriptions of coxsackievirus/enterovirus (CVEV) infection may identify risk factors for severe disease, and inform prevention strategies.

Methods: A multi-center clinical research consortium for the natural history of ILI has been conducted across five US military treatment facilities since 2009. Otherwise healthy individuals, birth to ≤65y, with ILI <72h were enrolled in an observational study. Clinical symptoms were collected over 28d. Nasal/throat swabs were collected at baseline and analyzed by target-enriched multiplex PCR (Diatherix Laboratories, Inc).


From 11/2009-5/2014, 898 participants were enrolled and tested by end-point multiplex PCR. Of these, 87 (9.5%) were positive for CVEV. Two (0.2%) were co-infected with CVEV and influenza. Cases of CVEV were identified throughout the year, with the highest numbers of cases occurring between January and May, peaking in March. Patients with CVEV were younger (p=0.006) with a mean age of 17.4y (range 1m-58y). When compared to those with influenza, children attending daycare (p=0.002) and adults who reported being a current smoker (p<0.001) were more likely to have CVEV. Over 80% with CVEV reported cough, sore throat, and runny nose. In adults, over 75% reported myalgia. Adults with CVEV reported more severe upper respiratory symptoms at illness onset (median score: 5 vs. 4, p=0.03) and through 7d, but lower systemic scores (p=0.01), when compared to those with influenza.  Among children with CVEV, systemic symptom scores (0.0 vs. 5.0, p=0.014) and total respiratory symptom scores (4 vs.13, p=0.031) were lower than those of children with influenza.  


CVEV represents a small but significant viral cause of ILI. CVEV appears to cause more severe upper respiratory symptoms in adults than influenza.  By contrast, children with CVEV reported less severe symptoms than those with influenza. Studies of severe ILI among adults should assess the contribution of CVEV, especially in the post-influenza season.

Jacqueline Owens, M.S.1, John Arnold, MD2, Wei-Ju Chen, PhD3, Mary Fairchok, MD4, Christina Schofield, MD FACP, FIDSA5, Tahaniyat Lalani, MD6, Patrick Danaher, MD, FIDSA7, Michael Rajnik, MD8, Leslie Malone, MS, MB(ASCP)CM9, Elena Grigorenko, PhD10, Donald Stalons, PhD, D(ABMM), MPH9, Erin Mcdonough, BS11, Deepika Mor, MS3, Michelande Ridore, MS3, Timothy Burgess, MD, MPH8, Eugene Millar, PhD1 and Henry M. Jackson Foundation for the Advancement in Military Medicine, (1)Infectious Disease Clinical Research Program, Rockville, MD, (2)Naval Medical Center San Diego, San Diego, CA, (3)Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, (4)Pediatrics, Madigan Army Medical Center, Tacoma, WA, (5)Madigan Army Medical Center, Tacoma, WA, (6)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (7)San Antonio Military Health System, Fort Sam Houston, TX, (8)Walter Reed National Military Medical Center, Bethesda, MD, (9)Diatherix Laboratories, Inc., Huntsville, AL, (10)Diatherix Laboratories, Inc, Huntsville, AL, (11)Naval Health Research Center, San Diego, CA


J. Owens, None

J. Arnold, None

W. J. Chen, None

M. Fairchok, None

C. Schofield, None

T. Lalani, None

P. Danaher, None

M. Rajnik, None

L. Malone, Diatherix Lab: Investigator , Salary

E. Grigorenko, Diatherix lab: Investigator , Salary

D. Stalons, Diatherix Lab: Investigator , Salary

E. Mcdonough, None

D. Mor, None

M. Ridore, None

T. Burgess, None

E. Millar, None

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