Comment: This report provides updated information on EV-D68 prevalence in children through active surveillance of pediatric children at 7 US medical centers throught the New Vaccine Surveillance Network. EV-D68 testing occurred in all patients who visited the emergency department (ED) or were hospitalized with acute respiratory illness (ARI) at all NVSN sites during July 1–October 31, 2017, and the same period in 2018. Among patients with ARI who were tested, EV-D68 was detected in two patients (0.8%) in 2017 and 358 (13.9%) in 2018. Detections in 2018 oeaked in September.
Comment: Autopsy study of 15 cases of confirmed E-A71 infection. Most cases had death ascribed to neurogenic pulmonary edema. Brainstem involvement seen in most (11/15) with inflammation and clastmodendrosis but no viral antigen present. Lungs and hearts lacked evidence of any viral induced inflammation or pathology. For 11 of the 15 cases, reduction in lung aquaporin-4 staining possibly may play a role in the development of fatal pulmonary oedema.
Comment: As of August 2015, 16 HPeV and 118 EV (4 EV species infect humans: A, B, C, and D) identified through surveillance in an effort to follow trends in these virus which usually cause mild infection (URI, herpangina, HFM disease) but can cause acute flaccid paralysis, myocarditis, meningoencephalitis.
Most commonly reported types of EV and HPeV were coxsackievirus (CV) A6 and HPeV3 with results promoted likely by increased testing in response to outbreaks in 2011 & 2012.
Comment: Rash in child (2 yrs) and pregnant mother was suspected to be varicella. Enterovirus instead detected by RT-PCR, Coxsackie A6.
Comment: Outbreak of previously known but not widely circulated strain of enterovirus (first noted in 1962), noted due to emergence of NAAT-multiplex PCR of respiratory secretions. THis appears to cause os severe respiratory illness in children with fatalities. Only 79 EV-D68 reports during 2009–2013, current numbers unclear but thought to be vastly higher. Strain has been reported in Asia, Europe in older MMWR report, and associated with CNS dysfunction.
Comment: Cases of a polio-like paralysis are described. No clear etiology was identified to explain these reported cases, although EV-D68 was recovered from upper respiratory tract specimens of two patients. EV infection, including poliovirus infection, should be considered in the differential diagnosis in cases of AFP with anterior myelitis and testing performed per CDC guidelines.
Comment: Analysis done given increase in severe HFM disease ascribed to enterovirus 71 mostly. Risks for severity include: fever ≥ 3 days, T ≥ 37.5°C, lethargy, hyperglycemia, vomiting, increased neutrophil count, EV71 infection, and young age.
Comment: Since E71 has caused epidemics of severe neurological infection especially in children now for many years in SE Asia and Taiwan especially, there has been interest in a protective vaccine. This large trial showed about 90% vaccine efficacy with only a small percent of serious ADRs not significantly different than placebo
Comment: Small study of severe E71 infections in Vietnam in patients all receiving dopamine or dobutamine and intravenous immunoglobulin, with the milrinone arm with lower mortality and less time spent on ventilator. Milrinone is a phosphodiesterase 3 inhibitor that was developed to treat heart failure patients.
Comment: Review of a growing body of evidence regarding the link of enteroviral infection and the development of insulin dependent diabetes mellitus. Authors suggest an overall odds ratio of 3.7, 95% CI 2.1-6.8)
Comment: Study suggests that use of RT-PCR to hasten enterovirus diagnosis, with institution of IVIG if positive, may shorten duration of illness. It should be noted that number in study was 75, but no RT-PCR positive patient receiving IVIG had any sequelae, whereas one patient randomized to viral cx isolation had seizures.
Comment: Seminal case series found that 4.6% of 1571 patients with encephalitis had enterovirus infection (45 confirmed cases, 28 possible). Only four cases were fatal, with 2 due to EV71. Most cases correlated with the prevalent circulating enteroviruses for that year.
Comment: Study examined neurological sequelae of EV71 infection. A total of 142 children were studied for an average of ~ 3yrs. 56% of pts with a poliomyelitis-like syndrome and 20% with encephalomyelitis experienced limb weakness and atrophy. For pts with cardiopulmonary failure and CNS involvement, about two-thirds had limb weakness and atrophy, while 61% needed tube feeding and 57% underwent ventilator support. Most strikingly, delayed neurodevelopment was found in only 1/20 patients (5%) with severe CNS involvement alone but in 21/28 pts (75%) with co-existent cardiopulmonary failure (P<0.001).
Comment: The drug failed (for other reasons), but use of pleconaril early in the course of enteroviral meningitis appeared to shorten illness, although impact was more modest in the severely ill group.
Comment: Cochrane study states that evidence from only one RCT trial of 62 patients is insufficient to recommend IVIG for presumed viral myocarditis in adults.
Comment: Several epidemics of EV71 in Taiwan have caused hand, foot and mouth disease in children, but some were afflicted with great severity, including cases of neurological and cardiopulmonary illness resulting in death.
Comment: Main serious complication in this EV 71 outbreak was rhomboencephalitis among children (mean age 2.5 y) with two-thirds first presenting with hand-foot-mouth disease. Mortality rate was 14%.
Comment: Open label trial using high-dose IVIG (2 gm/kg) vs. historical controls suggested benefit, as 21 patients receiving IVIG had improved LV function at 3 to 6 months.
Comment: Data are mixed on whether IVIG is helpful, with multiple reports of successes but also failures.
Comment: Employment of enterovirus PCR resulted in faster hospital discharge, fewer tests, and less antibiotic use.
Pt with non-specific febrile syndrome that defervesced once maculopapular rash developed.
Lesions may be seen on palate or buccal mucosa.
maculopapular lesions on palms and soles characteristic
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