Open AccessEnterovirus D‐68 in children presenting for acute care in the hospital setting
Author(s) -
Savage Timothy J.,
Kuypers Jane,
Chu Helen Y.,
Bradford Miranda C.,
Buccat Anne Marie,
Qin Xuan,
Klein Eileen J.,
Jerome Keith R.,
Englund Janet A.,
Waghmare Alpana
Publication year - 2018
Publication title -
influenza and other respiratory viruses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.743
H-Index - 57
eISSN - 1750-2659
pISSN - 1750-2640
DOI - 10.1111/irv.12551
Subject(s) - medicine , rhinovirus , emergency department , odds ratio , respiratory tract infections , pediatrics , respiratory system , enterovirus , asthma , emergency medicine , immunology , virus , psychiatry
Background Severe respiratory disease associated with enterovirus D68 ( EV ‐D68) has been reported in hospitalized pediatric patients. Virologic and clinical characteristics of EV ‐D68 infections exclusively in patients presenting to a hospital Emergency Department ( ED ) or urgent care have not been well defined. Methods Mid‐nasal swabs from pediatric patients with respiratory symptoms presenting to the ED or urgent care were evaluated using a commercial multiplex PCR platform. Specimens positive for rhinovirus/enterovirus ( HRV / EV ) were subsequently tested using real‐time reverse‐transcriptase PCR for EV ‐D68. The PCR cycle threshold ( CT ) was used as a viral load proxy. Clinical outcomes were compared between patients with EV ‐D68 and patients without EV ‐D68 who tested positive for HRV / EV . Results From August to December 2014, 511 swabs from patients with HRV / EV were available. EV ‐D68 was detected in 170 (33%) HRV / EV ‐positive samples. In multivariable models adjusted for age and underlying asthma, patients with EV ‐D68 were more likely to require hospitalization for respiratory reasons (odds ratio ( OR ): 3.11, CI : 1.85‐5.25), require respiratory support ( OR : 1.69, CI : 1.09‐2.62), have confirmed/probable lower respiratory tract infection ( LRTI ; OR : 3.78, CI : 2.03‐7.04), and require continuous albuterol or steroids ( OR : 3.91, CI : 2.22‐6.88 and OR : 4.73, CI : 2.65‐8.46, respectively). Higher EV ‐D68 viral load was associated with need for respiratory support and LRTI in multivariate models. Conclusions Among pediatric patients presenting to the ED or urgent care, EV ‐D68 causes more severe disease than non‐ EV ‐D68 HRV / EV independent of underlying asthma. High viral load was associated with worse clinical outcomes. Rapid and quantitative viral testing may help identify and risk stratify patients.