Enterovirus D68 Causing Acute Respiratory Infection: Clinical Characteristics and Differences With Acute Respiratory Infections Associated With Enterovirus Non-D68

Abstract

Background: Enterovirus (EV) D68 is mainly associated with acute respiratory infection (ARI). Since 2014, when outbreaks in different countries were observed, this emerging virus was considered a potential threat to public health. Methods: During 2015–2017, the presence of enterovirus RNA was investigated in all respiratory samples of children younger than 15 years of age with ARI, obtained for virologic studies in the Pediatric Emergency Care Units and wards of 2 hospitals in Gipuzkoa (Spain), using a commercial multiplex real-time polymerase chain reaction. When enterovirus was detected, a polymerase chain reaction to amplify a specific viral polyprotein (VP1) gene region of EV-D68 was performed. Results: In 2016, EV-D68 circulation was associated to ARI, with the highest incidence in the spring months. EV-D68 was detected in 44 children, mean age 30.1 ± 31.7 months old, 23 (52.3%) of them females and 17 (38.6%) with underlying respiratory medical conditions. Thirty-two patients (72%) required hospital admission, receiving the discharge diagnosis of recurrent wheezing (37.5%), asthmatic crisis (37.5%) or bronchiolitis (12.5%). Seven children (15.9%) needed the support of the pediatric intensive care unit. When coinfections were excluded, children with EV-D68 infection presented with increased work of breathing, recurrent wheezing or asthmatic crisis, more frequently than those with ARI associated with EV non-D68. Moreover, clinical outcomes (hospitalization, respiratory support) were more severe. All 44 EV-D68 strains detected belonged to lineage B3. Conclusions: EV-D68 circulated widely in Gipuzkoa during 2016 and was associated with severe ARI. In children with severe ARI of unknown etiology, the presence of EV-D68 should be considered.

Enteroviruses in Respiratory Samples from Paediatric Patients of a Tertiary Care Hospital in Germany

“…In 2016, most of the sequences clustered to clade B3, whereby in 2014, clade B1 and B2 viruses were predominantly circulating. This shift from B1 and B2 clades and less frequently detected A1 and A2 clades in 2014 to clade B3 in 2016 was also reported during and after the emerging North American outbreak as well as by pan-European surveillance data [17,22,23,26,31].…”

“…In recent years, EV-D68 infections were associated with acute respiratory infections and neurological complications such as AFP [ 17 , 22 , 25 , 26 , 31 ]. Most of these investigations were based on the analysis of samples from hospitalised patients, and therefore, data on associated symptoms and pre-existing conditions are potentially biased towards higher severity.…”

“…These results could be limited by increased collection of samples in chronically ill infants, or EV infections in those without pre-existing conditions more often stayed sub-clinical. Nevertheless, there is some evidence that pre-existing conditions in general have an impact on hospitalisation rate and disease severity in EV infection [ 13 , 17 ]. Asthma was not a significant risk factor for higher disease severity in the present study cohort.…”

“…The global emergence of EV-D68 and EV-A71 shows the importance of strengthening and continuing epidemiological research on respiratory EVs [ 5 , 10 , 16 , 17 ]. Therefore, the present study aims to investigate the molecular epidemiology and clinical presentations of EV infections in infants and children from a German medical university centre over a 4-year period.…”

Isolation of the Human Cytomegalovirus from bodily fluids

“…Due to the slow viral cycle (48 h), the CPE appear after 10 days of inoculation in the form of foci in large round cells with cluster aggregation (Hematian et al, 2016). We discarded the possibility of the presence of adventitious viruses such as the adenoviruses or enteroviruses which are frequently shed in the lung fluids of children (Jain et al, 2015;Montes et al, 2019), thereby confirming that the observed CPE after the inoculation of BAL52 was not related to the effects of the adventitious viruses but with that of the HCMV.…”