First Cases of Severe Flaccid Paralysis Associated With Enterovirus D68 Infection in Spain, 2015–2016

Cabrerizo, María; Íñiguez, J.P. García; Munell, Francina; Amado, Alfonso; Madurga-Revilla, P.; Rodrigo, Carlos; Pérez, Sonia González; Martínez-Sapiña, Ana; Antón, Andrés; Suárez, Gerardo; Rabella, N; Campo, Víctor del; Otero, Almudena; Masa-Calles, Josefa

doi:10.1097/inf.0000000000001668

Cited by 33 publications

(33 citation statements)

References 10 publications

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“…Regarding the clinical manifestations, most of EV-D68 detected were associated with LRTI, highlighting its possible association with severe respiratory illnesses [20]. Similarly to other European cases [21,22], only one case, a 2-year-old girl, developed AFP in February 2016 [15]. EV-D68 usually causes more severe disease in patients with asthma or reactive airway, as previously reported [23,24], but herein only one case was reported.…”

Section: Discussionsupporting

confidence: 72%

“…Before the neurologic complications, 5/25 (20%) of cases began with EV-A71-related HFMD, 3/25 (12%) with herpangina (2 EV-A71 and 1 CV-A10) and 6/25 (24%) with exanthema (5 EV-A71 and 1 EV-C109). Only one patient developed permanent neurologic disabilities due to cardiorespiratory failure and hypoxic-ischemic encephalopathy, in addition to one AFP case, but associated with EV-D68 infection [15].…”

Section: Neurological Complicationsmentioning

confidence: 95%

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Surveillance of enteroviruses from paediatric patients attended at a tertiary hospital in Catalonia from 2014 to 2017

Andrés

Vila

Gimferrer

et al. 2019

Journal of Clinical Virology

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A B S T R A C TBackground: Enterovirus (EV) infections are usually asymptomatic or mild, but symptomatic infections can evolve to severe complications. Outbreaks of EV-A71 and EV-D68 have been recently reported worldwide, sometimes related to severe clinical outcomes. Objective: To describe EV genetic diversity and the clinical outcomes from paediatric patients attended at a tertiary university hospital in Barcelona (Catalonia, Spain) from 2014 to 2017. Study design: Specimens were collected from paediatric (< 17 years old) cases with suspicion of respiratory tract infection or EV infection. EV laboratory-confirmation was performed by specific real-time multiplex RT-PCR assay. Partial viral VP1 protein was sequenced for genetic characterisation by phylogenetic analyses. Results: A total of 376 (7%) from 5703 cases were EV laboratory-confirmed. Phylogenetic analyses of VP1 (210; 81%) sequences distinguished up to 27 different EV types distributed within EV-A (82; 40%), EV-B (90; 42%), EV-C (5; 2%), and EV-D (33; 15%), in addition to 50 (19%) rhinoviruses. The most predominant were EV-A71 (37; 45%) and EV-D68 (32; 99%). EV-A71 was highly related to neurological complications (25/39, 63%), of which 20/39 were rhombencephalitis, and most EV-D68 (28/32, 88%) were associated with lower respiratory tract infections (LRTI), and exceptionally one (3%) with acute flaccid paralysis. Conclusions: EV-A71 and EV-D68 were the most detected EV in respiratory specimens. EV-A71 was highly related to neurological disease and EV-D68 was often associated with LRTI. However, both potential relatedness to neurological diseases makes the monitoring of EV circulation obligatory.

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Section: Discussionsupporting

confidence: 72%

Section: Neurological Complicationsmentioning

confidence: 95%

Surveillance of enteroviruses from paediatric patients attended at a tertiary hospital in Catalonia from 2014 to 2017

Andrés

Vila

Gimferrer

et al. 2019

Journal of Clinical Virology

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“…In addition to respiratory infections, EV-D68 has been associated with neurological complications in recent years [11,[17][18][19][20][21]. During our study-period, this virus was identified in 16 children and one adult with neurological symptoms.…”

Section: Discussionmentioning

confidence: 75%

“…Since 2014, an increasing number of EV-D68 outbreaks associated with severe respiratory diseases, mainly in children, have been occurring in different countries, first in the US and Canada, followed by Europe and Asia. Concurrently, clusters of cases with neurological complications such as myelitis or acute flaccid paralysis were reported in the same geographical areas [9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 88%

“…Since 2014, surveillance of EV-D68 infections is recommended and several studies have been published in Europe and other parts of the world regarding EV-D68 circulation, some reflecting an increase in detection in recent years [12][13][14][15][16]. Additionally, cases of paralysis or severe myelitis in children, in which EV-D68 was the only etiologic agent detected, were reported in different countries, including Spain [17][18][19][20][21]. Regarding respiratory diseases, in our country most of detected EV were not usually characterized, and the first reports of EV-D68 detection were published in 2015 [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Enterovirus D68-associated respiratory and neurological illness in Spain, 2014–2018

González-Sanz

Taravillo

Reina

et al. 2019

Emerging Microbes & Infections

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During 2014, enterovirus D68 (EV-D68) outbreaks were described globally, causing severe respiratory diseases in children and, in some cases, subsequent paralysis. In this study, the type characterization of enterovirus (EV) detected in respiratory illnesses and the epidemiology and clinical association of EV-D68 infections in Spain over a five-year period were described. A total of 546 EV-positive samples from hospitalized patients with respiratory infections were included. EV-D68 was the most frequently detected type (46.6%, 191/410 typed EV). Other EV from species A (25.1%), B (27.8%) and C (0.5%) were also identified. EV-D68 infections were more associated with bronchitis while EV-A/B types were more frequent in upper respiratory illness (p < 0.01). EV-D68 was also detected in patients with neurological symptoms (nine meningitis/meningoencephalitis and eight acute flaccid paralysis cases). Phylogenetic analysis of 3′-VP1 region showed most Spanish EV-D68 sequences from 2014 to 2016 belonged to subclades B2/B3, as other American and European strains circulating during the same period. However, those detected in 2017 and 2018 clustered to the emerged subclade D1. In summary, different EV can cause respiratory infections but EV-D68 was the most prevalent, with several strains circulating in Spain at least since 2014. Association between EV-D68 infection and neurological disease was also described.

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Neurologische Komplikationen bei Infektionen mit (neuen) Enteroviren

2018

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First Cases of Severe Flaccid Paralysis Associated With Enterovirus D68 Infection in Spain, 2015–2016

Cited by 33 publications

References 10 publications

Surveillance of enteroviruses from paediatric patients attended at a tertiary hospital in Catalonia from 2014 to 2017

Surveillance of enteroviruses from paediatric patients attended at a tertiary hospital in Catalonia from 2014 to 2017

Enterovirus D68-associated respiratory and neurological illness in Spain, 2014–2018

Neurologische Komplikationen bei Infektionen mit (neuen) Enteroviren

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