Enterovirus 68 natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
Enterovirus produces mild upper respiratory symptoms and is most common in children. Enterovirus 68 is associated with a low mortality, but complications such as severe [[pneumonia]] and superimposed infections may occur in almost one-fifth of infected patients.
The [[Natural history of disease|natural history]] of [[Enterovirus 68]] is poorly understood due to scarcity of data. The [[virus]] may produce a spectrum of clinical disease, ranging from an [[asymptomatic]] course to severe [[respiratory]] and [[neurological illness]] necessitating hospitalization. [[Prognosis]] is generally good, but few reports of fatalities have been documented. Approximately 16-21% of patients suffer from [[enterovirus 68]]-associated [[complications]]. Common [[complications]], such as superimposed infections and severe [[pneumonia]] requiring [[mechanical ventilation]], are more likely to occur among patients with a history of [[pulmonary disease]].


==Natural History==
==Natural History==
*Enterovirus 68 enters the body through the oral and nasal cavity through respiratory droplets and colonizes the respiratory mucosa.
*[[Enterovirus 68]] colonizes the respiratory mucosa. It is believed to be transmitted through respiratory droplets and is often detected by [[nasopharyngeal]] swabs of patients presenting with respiratory illness. Nonetheless, the [[incubation period]] of the [[virus]] is unknown.
*Enterovirus 68 infection usually affects children, but can also cause mild respiratory symptoms in adult patients.<ref name="JacobsonRedd2012">{{cite journal|last1=Jacobson|first1=Lara M.|last2=Redd|first2=John T.|last3=Schneider|first3=Eileen|last4=Lu|first4=Xiaoyan|last5=Chern|first5=Shur-Wern W.|last6=Oberste|first6=M. Steven|last7=Erdman|first7=Dean D.|last8=Fischer|first8=Gayle E.|last9=Armstrong|first9=Gregory L.|last10=Kodani|first10=Maja|last11=Montoya|first11=Jennifer|last12=Magri|first12=Julie M.|last13=Cheek|first13=James E.|title=Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children|journal=The Pediatric Infectious Disease Journal|volume=31|issue=3|year=2012|pages=309–312|issn=0891-3668|doi=10.1097/INF.0b013e3182443eaf}}</ref>
*The [[virus]] has been isolated among patients of all age groups, ranging from 1 month to 72 years. Although 4 to 5-year-old children are believed to be the most susceptible hosts, accounting for approximately 80% of all reported cases, newer reports are currently noting more adult infections.<ref name="pmid21802981">{{cite journal| author=Rahamat-Langendoen J, Riezebos-Brilman A, Borger R, van der Heide R, Brandenburg A, Schölvinck E et al.| title=Upsurge of human enterovirus 68 infections in patients with severe respiratory tract infections. | journal=J Clin Virol | year= 2011 | volume= 52 | issue= 2 | pages= 103-6 | pmid=21802981 | doi=10.1016/j.jcv.2011.06.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21802981  }} </ref><ref name="pmid22694903">{{cite journal| author=Tokarz R, Firth C, Madhi SA, Howie SR, Wu W, Sall AA et al.| title=Worldwide emergence of multiple clades of enterovirus 68. | journal=J Gen Virol | year= 2012 | volume= 93 | issue= Pt 9 | pages= 1952-8 | pmid=22694903 | doi=10.1099/vir.0.043935-0 | pmc=PMC3542132 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22694903  }} </ref><ref name="JacobsonRedd2012">{{cite journal|last1=Jacobson|first1=Lara M.|last2=Redd|first2=John T.|last3=Schneider|first3=Eileen|last4=Lu|first4=Xiaoyan|last5=Chern|first5=Shur-Wern W.|last6=Oberste|first6=M. Steven|last7=Erdman|first7=Dean D.|last8=Fischer|first8=Gayle E.|last9=Armstrong|first9=Gregory L.|last10=Kodani|first10=Maja|last11=Montoya|first11=Jennifer|last12=Magri|first12=Julie M.|last13=Cheek|first13=James E.|title=Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children|journal=The Pediatric Infectious Disease Journal|volume=31|issue=3|year=2012|pages=309–312|issn=0891-3668|doi=10.1097/INF.0b013e3182443eaf}}</ref>
*The infection starts with symptoms such as [[cough]], [[fever]], [[difficulty breathing]], and [[wheezing]].<ref name="LuWo2013">{{cite journal|last1=Lu|first1=Q.-B.|last2=Wo|first2=Y.|last3=Wang|first3=H.-Y.|last4=Wei|first4=M.-T.|last5=Zhang|first5=L.|last6=Yang|first6=H.|last7=Liu|first7=E.-M.|last8=Li|first8=T.-Y.|last9=Zhao|first9=Z.-T.|last10=Liu|first10=W.|last11=Cao|first11=W.-C.|title=Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China|journal=Journal of Medical Microbiology|volume=63|issue=Pt_3|year=2013|pages=408–414|issn=0022-2615|doi=10.1099/jmm.0.068247-0}}</ref><ref name="ImamuraSuzuki2014">{{cite journal|last1=Imamura|first1=Tadatsugu|last2=Suzuki|first2=Akira|last3=Lupisan|first3=Socorro|last4=Kamigaki|first4=Taro|last5=Okamoto|first5=Michiko|last6=Roy|first6=Chandra Nath|last7=Olveda|first7=Remigio|last8=Oshitani|first8=Hitoshi|title=Detection of enterovirus 68 in serum from pediatric patients with pneumonia and their clinical outcomes|journal=Influenza and Other Respiratory Viruses|volume=8|issue=1|year=2014|pages=21–24|issn=17502640|doi=10.1111/irv.12206}}</ref><ref name="PirallaGirello2014">{{cite journal|last1=Piralla|first1=Antonio|last2=Girello|first2=Alessia|last3=Grignani|first3=Michela|last4=Gozalo-Margüello|first4=Monica|last5=Marchi|first5=Antonietta|last6=Marseglia|first6=Gianluigi|last7=Baldanti|first7=Fausto|title=Phylogenetic characterization of enterovirus 68 strains in patients with respiratory syndromes in Italy|journal=Journal of Medical Virology|volume=86|issue=9|year=2014|pages=1590–1593|issn=01466615|doi=10.1002/jmv.23821}}</ref>
*The clinical features of the [[virus]] are characterized by non-specific [[Signs and Symptoms|signs and symptoms]] including [[cough]], [[dyspnea]], [[wheezing]], and other [[symptoms]] of [[bronchitis]].<ref name="JacobsonRedd2012">{{cite journal|last1=Jacobson|first1=Lara M.|last2=Redd|first2=John T.|last3=Schneider|first3=Eileen|last4=Lu|first4=Xiaoyan|last5=Chern|first5=Shur-Wern W.|last6=Oberste|first6=M. Steven|last7=Erdman|first7=Dean D.|last8=Fischer|first8=Gayle E.|last9=Armstrong|first9=Gregory L.|last10=Kodani|first10=Maja|last11=Montoya|first11=Jennifer|last12=Magri|first12=Julie M.|last13=Cheek|first13=James E.|title=Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children|journal=The Pediatric Infectious Disease Journal|volume=31|issue=3|year=2012|pages=309–312|issn=0891-3668|doi=10.1097/INF.0b013e3182443eaf}}</ref><ref name="LuWo2013">{{cite journal|last1=Lu|first1=Q.-B.|last2=Wo|first2=Y.|last3=Wang|first3=H.-Y.|last4=Wei|first4=M.-T.|last5=Zhang|first5=L.|last6=Yang|first6=H.|last7=Liu|first7=E.-M.|last8=Li|first8=T.-Y.|last9=Zhao|first9=Z.-T.|last10=Liu|first10=W.|last11=Cao|first11=W.-C.|title=Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China|journal=Journal of Medical Microbiology|volume=63|issue=Pt_3|year=2013|pages=408–414|issn=0022-2615|doi=10.1099/jmm.0.068247-0}}</ref><ref name="ImamuraSuzuki2014">{{cite journal|last1=Imamura|first1=Tadatsugu|last2=Suzuki|first2=Akira|last3=Lupisan|first3=Socorro|last4=Kamigaki|first4=Taro|last5=Okamoto|first5=Michiko|last6=Roy|first6=Chandra Nath|last7=Olveda|first7=Remigio|last8=Oshitani|first8=Hitoshi|title=Detection of enterovirus 68 in serum from pediatric patients with pneumonia and their clinical outcomes|journal=Influenza and Other Respiratory Viruses|volume=8|issue=1|year=2014|pages=21–24|issn=17502640|doi=10.1111/irv.12206}}</ref><ref name="PirallaGirello2014">{{cite journal|last1=Piralla|first1=Antonio|last2=Girello|first2=Alessia|last3=Grignani|first3=Michela|last4=Gozalo-Margüello|first4=Monica|last5=Marchi|first5=Antonietta|last6=Marseglia|first6=Gianluigi|last7=Baldanti|first7=Fausto|title=Phylogenetic characterization of enterovirus 68 strains in patients with respiratory syndromes in Italy|journal=Journal of Medical Virology|volume=86|issue=9|year=2014|pages=1590–1593|issn=01466615|doi=10.1002/jmv.23821}}</ref>  
*The disease can progress to severe [[respiratory distress]] and patients may require [[oxygen]] supplementation and hospital admission. Patients usually stay from 1 to 6 days in the hospital.<ref name="JacobsonRedd2012">{{cite journal|last1=Jacobson|first1=Lara M.|last2=Redd|first2=John T.|last3=Schneider|first3=Eileen|last4=Lu|first4=Xiaoyan|last5=Chern|first5=Shur-Wern W.|last6=Oberste|first6=M. Steven|last7=Erdman|first7=Dean D.|last8=Fischer|first8=Gayle E.|last9=Armstrong|first9=Gregory L.|last10=Kodani|first10=Maja|last11=Montoya|first11=Jennifer|last12=Magri|first12=Julie M.|last13=Cheek|first13=James E.|title=Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children|journal=The Pediatric Infectious Disease Journal|volume=31|issue=3|year=2012|pages=309–312|issn=0891-3668|doi=10.1097/INF.0b013e3182443eaf}}</ref> <ref name="PirallaGirello2014">{{cite journal|last1=Piralla|first1=Antonio|last2=Girello|first2=Alessia|last3=Grignani|first3=Michela|last4=Gozalo-Margüello|first4=Monica|last5=Marchi|first5=Antonietta|last6=Marseglia|first6=Gianluigi|last7=Baldanti|first7=Fausto|title=Phylogenetic characterization of enterovirus 68 strains in patients with respiratory syndromes in Italy|journal=Journal of Medical Virology|volume=86|issue=9|year=2014|pages=1590–1593|issn=01466615|doi=10.1002/jmv.23821}}</ref>
*Without treatment, [[symptoms]] generally self-resolve within 4-6 days of [[symptom]] onset.
*The disease may progress in the minority of untreated cases to [[pneumonia]], [[Asthma exacerbation resident survival guide|asthma exacerbations]], and severe respiratory distress. Patients may require hospitalization, [[oxygen]] supplementation, or less commonly [[mechanical ventilation]]. The majority of patients requiring intensive care hospitalization are those with a history of [[pulmonary disease]], such as [[asthma]], [[cystic fibrosis]], or [[lung transplantation]].<ref name="JacobsonRedd2012">{{cite journal|last1=Jacobson|first1=Lara M.|last2=Redd|first2=John T.|last3=Schneider|first3=Eileen|last4=Lu|first4=Xiaoyan|last5=Chern|first5=Shur-Wern W.|last6=Oberste|first6=M. Steven|last7=Erdman|first7=Dean D.|last8=Fischer|first8=Gayle E.|last9=Armstrong|first9=Gregory L.|last10=Kodani|first10=Maja|last11=Montoya|first11=Jennifer|last12=Magri|first12=Julie M.|last13=Cheek|first13=James E.|title=Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children|journal=The Pediatric Infectious Disease Journal|volume=31|issue=3|year=2012|pages=309–312|issn=0891-3668|doi=10.1097/INF.0b013e3182443eaf}}</ref><ref name="LuWo2013">{{cite journal|last1=Lu|first1=Q.-B.|last2=Wo|first2=Y.|last3=Wang|first3=H.-Y.|last4=Wei|first4=M.-T.|last5=Zhang|first5=L.|last6=Yang|first6=H.|last7=Liu|first7=E.-M.|last8=Li|first8=T.-Y.|last9=Zhao|first9=Z.-T.|last10=Liu|first10=W.|last11=Cao|first11=W.-C.|title=Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China|journal=Journal of Medical Microbiology|volume=63|issue=Pt_3|year=2013|pages=408–414|issn=0022-2615|doi=10.1099/jmm.0.068247-0}}</ref><ref name="ImamuraSuzuki2014">{{cite journal|last1=Imamura|first1=Tadatsugu|last2=Suzuki|first2=Akira|last3=Lupisan|first3=Socorro|last4=Kamigaki|first4=Taro|last5=Okamoto|first5=Michiko|last6=Roy|first6=Chandra Nath|last7=Olveda|first7=Remigio|last8=Oshitani|first8=Hitoshi|title=Detection of enterovirus 68 in serum from pediatric patients with pneumonia and their clinical outcomes|journal=Influenza and Other Respiratory Viruses|volume=8|issue=1|year=2014|pages=21–24|issn=17502640|doi=10.1111/irv.12206}}</ref><ref name="PirallaGirello2014">{{cite journal|last1=Piralla|first1=Antonio|last2=Girello|first2=Alessia|last3=Grignani|first3=Michela|last4=Gozalo-Margüello|first4=Monica|last5=Marchi|first5=Antonietta|last6=Marseglia|first6=Gianluigi|last7=Baldanti|first7=Fausto|title=Phylogenetic characterization of enterovirus 68 strains in patients with respiratory syndromes in Italy|journal=Journal of Medical Virology|volume=86|issue=9|year=2014|pages=1590–1593|issn=01466615|doi=10.1002/jmv.23821}}</ref>


*The symptoms typically develop 1 week after exposure to an ill contact.<ref name="JacobsonRedd2012">{{cite journal|last1=Jacobson|first1=Lara M.|last2=Redd|first2=John T.|last3=Schneider|first3=Eileen|last4=Lu|first4=Xiaoyan|last5=Chern|first5=Shur-Wern W.|last6=Oberste|first6=M. Steven|last7=Erdman|first7=Dean D.|last8=Fischer|first8=Gayle E.|last9=Armstrong|first9=Gregory L.|last10=Kodani|first10=Maja|last11=Montoya|first11=Jennifer|last12=Magri|first12=Julie M.|last13=Cheek|first13=James E.|title=Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children|journal=The Pediatric Infectious Disease Journal|volume=31|issue=3|year=2012|pages=309–312|issn=0891-3668|doi=10.1097/INF.0b013e3182443eaf}}</ref>
==Complications==
Complications are observed among 16-21% of patients diagnosed with [[enterovirus 68]]. The majority of patients with complications have a history of [[pulmonary]] or [[systemic]] co-morbidities.<ref name="Meijervan der Sanden2012">{{cite journal|last1=Meijer|first1=Adam|last2=van der Sanden|first2=Sabine|last3=Snijders|first3=Bianca E.P.|last4=Jaramillo-Gutierrez|first4=Giovanna|last5=Bont|first5=Louis|last6=van der Ent|first6=Cornelis K.|last7=Overduin|first7=Pieter|last8=Jenny|first8=Shireen L.|last9=Jusic|first9=Edin|last10=van der Avoort|first10=Harrie G.A.M.|last11=Smith|first11=Gavin J.D.|last12=Donker|first12=Gé A.|last13=Koopmans|first13=Marion P.G.|title=Emergence and epidemic occurrence of enterovirus 68 respiratory infections in The Netherlands in 2010|journal=Virology|volume=423|issue=1|year=2012|pages=49–57|issn=00426822|doi=10.1016/j.virol.2011.11.021}}</ref> [[Complications]] that can develop as a result of infection with [[enterovirus 68]] are:
*[[Lower respiratory infections]]<ref name="pmid21802981">{{cite journal| author=Rahamat-Langendoen J, Riezebos-Brilman A, Borger R, van der Heide R, Brandenburg A, Schölvinck E et al.| title=Upsurge of human enterovirus 68 infections in patients with severe respiratory tract infections. | journal=J Clin Virol | year= 2011 | volume= 52 | issue= 2 | pages= 103-6 | pmid=21802981 | doi=10.1016/j.jcv.2011.06.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21802981  }} </ref>
 
**[[Pneumonia]] is considered the most common [[Complication (medicine)|complication]] of [[enterovirus 68]]
**[[Bacterial]] [[super-infection]] is reported with organisms that are commonly associated with [[lower respiratory infections]], such as ''[[Streptococcus pneumoniae]]'', ''[[Hemophilus influenzae]]'', ''[[Mycoplasma pneumoniae|Mycoplasma pnuemoniae]]'', and ''Chlamydia pneumniae''
**[[Viral]] co-infection with [[RSV]] and [[CMV]] has been described
*[[Respiratory failure]]<ref name="pmid21801632">{{cite journal| author=Kaida A, Kubo H, Sekiguchi J, Kohdera U, Togawa M, Shiomi M et al.| title=Enterovirus 68 in children with acute respiratory tract infections, Osaka, Japan. | journal=Emerg Infect Dis | year= 2011 | volume= 17 | issue= 8 | pages= 1494-7 | pmid=21801632 | doi=10.3201/eid1708.110028 | pmc=PMC3381549 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21801632  }} </ref>
 
*[[Asthma exacerbation resident survival guide|Asthma exacerbation]]<ref name="pmid21801632">{{cite journal| author=Kaida A, Kubo H, Sekiguchi J, Kohdera U, Togawa M, Shiomi M et al.| title=Enterovirus 68 in children with acute respiratory tract infections, Osaka, Japan. | journal=Emerg Infect Dis | year= 2011 | volume= 17 | issue= 8 | pages= 1494-7 | pmid=21801632 | doi=10.3201/eid1708.110028 | pmc=PMC3381549 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21801632  }} </ref>


==Complications==
*[[Febrile convulsions]]<ref name="pmid21801632">{{cite journal| author=Kaida A, Kubo H, Sekiguchi J, Kohdera U, Togawa M, Shiomi M et al.| title=Enterovirus 68 in children with acute respiratory tract infections, Osaka, Japan. | journal=Emerg Infect Dis | year= 2011 | volume= 17 | issue= 8 | pages= 1494-7 | pmid=21801632 | doi=10.3201/eid1708.110028 | pmc=PMC3381549 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21801632  }} </ref>
*Infection with EV-68 may be asymptomatic, or frequently cause cold-like symptoms.
 
*However, complications may be observed in 17% of cases<ref name="Meijervan der Sanden2012">{{cite journal|last1=Meijer|first1=Adam|last2=van der Sanden|first2=Sabine|last3=Snijders|first3=Bianca E.P.|last4=Jaramillo-Gutierrez|first4=Giovanna|last5=Bont|first5=Louis|last6=van der Ent|first6=Cornelis K.|last7=Overduin|first7=Pieter|last8=Jenny|first8=Shireen L.|last9=Jusic|first9=Edin|last10=van der Avoort|first10=Harrie G.A.M.|last11=Smith|first11=Gavin J.D.|last12=Donker|first12=Gé A.|last13=Koopmans|first13=Marion P.G.|title=Emergence and epidemic occurrence of enterovirus 68 respiratory infections in The Netherlands in 2010|journal=Virology|volume=423|issue=1|year=2012|pages=49–57|issn=00426822|doi=10.1016/j.virol.2011.11.021}}</ref>, including severe [[pneumonia]] or co-infections with other pathogens, such as [[RSV]], [[S. pneumoniae]], [[CMV]], [[Chlamydia pneumoniae]], or [[Mycoplasma pneumoniae]].<ref name="LuWo2013">{{cite journal|last1=Lu|first1=Q.-B.|last2=Wo|first2=Y.|last3=Wang|first3=H.-Y.|last4=Wei|first4=M.-T.|last5=Zhang|first5=L.|last6=Yang|first6=H.|last7=Liu|first7=E.-M.|last8=Li|first8=T.-Y.|last9=Zhao|first9=Z.-T.|last10=Liu|first10=W.|last11=Cao|first11=W.-C.|title=Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China|journal=Journal of Medical Microbiology|volume=63|issue=Pt_3|year=2013|pages=408–414|issn=0022-2615|doi=10.1099/jmm.0.068247-0}}</ref>
*[[CNS]] sequelae<ref name="pmid21631275">{{cite journal| author=Kreuter JD, Barnes A, McCarthy JE, Schwartzman JD, Oberste MS, Rhodes CH et al.| title=A fatal central nervous system enterovirus 68 infection. | journal=Arch Pathol Lab Med | year= 2011 | volume= 135 | issue= 6 | pages= 793-6 | pmid=21631275 | doi=10.1043/2010-0174-CR.1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21631275  }} </ref>
*In rare cases, EV-68 causes disease of the [[CNS]].<ref name="pmid24324030">{{cite journal| author=Lu QB, Wo Y, Wang HY, Wei MT, Zhang L, Yang H et al.| title=Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China. | journal=J Med Microbiol | year= 2014 | volume= 63 | issue= Pt 3 | pages= 408-14 | pmid=24324030 | doi=10.1099/jmm.0.068247-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24324030 }} </ref><ref>{{Cite journal
 
| author = [[Justin D. Kreuter]], [[Arti Barnes]], [[James E. McCarthy]], [[Joseph D. Schwartzman]], [[M. Steven Oberste]], [[C. Harker Rhodes]], [[John F. Modlin]] & [[Peter F. Wright]]
**Lymphocytic meningomyelitis and [[encephalitis]] were both reported in only 1 case of a previously healthy 5-year-old boy
| title = A fatal central nervous system enterovirus 68 infection
*Death<ref name="pmid24073203">{{cite journal| author=Imamura T, Suzuki A, Lupisan S, Okamoto M, Aniceto R, Egos RJ et al.| title=Molecular evolution of enterovirus 68 detected in the Philippines. | journal=PLoS One | year= 2013 | volume= 8 | issue= 9 | pages= e74221 | pmid=24073203 | doi=10.1371/journal.pone.0074221 | pmc=PMC3779236 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24073203 }} </ref>
| journal = [[Archives of pathology & laboratory medicine]]
 
| volume = 135
**Death due to [[enterovirus 68]]-associated complications is documented among both children and adults, but is considered a very rare event
| issue = 6
| pages = 793–796
| year = 2011
| month = June
| doi = 10.1043/2010-0174-CR.1
| pmid = 21631275
}}</ref>


==Prognosis==
==Prognosis==
*Most patients recover uneventfully.
*Most patients recover uneventfully.
*Asthmatic patient have an increased risk of developing severe disease.<ref name="HasegawaHirano2011">{{cite journal|last1=Hasegawa|first1=S.|last2=Hirano|first2=R.|last3=Okamoto-Nakagawa|first3=R.|last4=Ichiyama|first4=T.|last5=Shirabe|first5=K.|title=Enterovirus 68 infection in children with asthma attacks: virus-induced asthma in Japanese children|journal=Allergy|volume=66|issue=12|year=2011|pages=1618–1620|issn=01054538|doi=10.1111/j.1398-9995.2011.02725.x}}</ref>
*[[Asthmatic]] patient shave an increased risk of developing severe disease.<ref name="HasegawaHirano2011">{{cite journal|last1=Hasegawa|first1=S.|last2=Hirano|first2=R.|last3=Okamoto-Nakagawa|first3=R.|last4=Ichiyama|first4=T.|last5=Shirabe|first5=K.|title=Enterovirus 68 infection in children with asthma attacks: virus-induced asthma in Japanese children|journal=Allergy|volume=66|issue=12|year=2011|pages=1618–1620|issn=01054538|doi=10.1111/j.1398-9995.2011.02725.x}}</ref>
*One case report describes a fatal case of enterovirus 68 infection associated with [[pneumonia]], [[flaccid paralysis]] and neurologic impairment. <ref>{{Cite journal
*One case report describes a fatal case of [[enterovirus 68]] infection associated with [[pneumonia]], [[flaccid paralysis]] and [[Neurological|neurologic]] impairment. <ref>{{Cite journal
  | author = [[Justin D. Kreuter]], [[Arti Barnes]], [[James E. McCarthy]], [[Joseph D. Schwartzman]], [[M. Steven Oberste]], [[C. Harker Rhodes]], [[John F. Modlin]] & [[Peter F. Wright]]
  | author = [[Justin D. Kreuter]], [[Arti Barnes]], [[James E. McCarthy]], [[Joseph D. Schwartzman]], [[M. Steven Oberste]], [[C. Harker Rhodes]], [[John F. Modlin]] & [[Peter F. Wright]]
  | title = A fatal central nervous system enterovirus 68 infection
  | title = A fatal central nervous system enterovirus 68 infection

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Alejandro Lemor, M.D. [3]

Overview

The natural history of Enterovirus 68 is poorly understood due to scarcity of data. The virus may produce a spectrum of clinical disease, ranging from an asymptomatic course to severe respiratory and neurological illness necessitating hospitalization. Prognosis is generally good, but few reports of fatalities have been documented. Approximately 16-21% of patients suffer from enterovirus 68-associated complications. Common complications, such as superimposed infections and severe pneumonia requiring mechanical ventilation, are more likely to occur among patients with a history of pulmonary disease.

Natural History

Complications

Complications are observed among 16-21% of patients diagnosed with enterovirus 68. The majority of patients with complications have a history of pulmonary or systemic co-morbidities.[7] Complications that can develop as a result of infection with enterovirus 68 are:

    • Lymphocytic meningomyelitis and encephalitis were both reported in only 1 case of a previously healthy 5-year-old boy
  • Death[10]
    • Death due to enterovirus 68-associated complications is documented among both children and adults, but is considered a very rare event

Prognosis

References

  1. ↑ 1.0 1.1 Rahamat-Langendoen J, Riezebos-Brilman A, Borger R, van der Heide R, Brandenburg A, Schölvinck E; et al. (2011). "Upsurge of human enterovirus 68 infections in patients with severe respiratory tract infections". J Clin Virol. 52 (2): 103–6. doi:10.1016/j.jcv.2011.06.019. PMID 21802981.
  2. ↑ Tokarz R, Firth C, Madhi SA, Howie SR, Wu W, Sall AA; et al. (2012). "Worldwide emergence of multiple clades of enterovirus 68". J Gen Virol. 93 (Pt 9): 1952–8. doi:10.1099/vir.0.043935-0. PMC 3542132. PMID 22694903.
  3. ↑ 3.0 3.1 3.2 Jacobson, Lara M.; Redd, John T.; Schneider, Eileen; Lu, Xiaoyan; Chern, Shur-Wern W.; Oberste, M. Steven; Erdman, Dean D.; Fischer, Gayle E.; Armstrong, Gregory L.; Kodani, Maja; Montoya, Jennifer; Magri, Julie M.; Cheek, James E. (2012). "Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children". The Pediatric Infectious Disease Journal. 31 (3): 309–312. doi:10.1097/INF.0b013e3182443eaf. ISSN 0891-3668.
  4. ↑ 4.0 4.1 Lu, Q.-B.; Wo, Y.; Wang, H.-Y.; Wei, M.-T.; Zhang, L.; Yang, H.; Liu, E.-M.; Li, T.-Y.; Zhao, Z.-T.; Liu, W.; Cao, W.-C. (2013). "Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China". Journal of Medical Microbiology. 63 (Pt_3): 408–414. doi:10.1099/jmm.0.068247-0. ISSN 0022-2615.
  5. ↑ 5.0 5.1 Imamura, Tadatsugu; Suzuki, Akira; Lupisan, Socorro; Kamigaki, Taro; Okamoto, Michiko; Roy, Chandra Nath; Olveda, Remigio; Oshitani, Hitoshi (2014). "Detection of enterovirus 68 in serum from pediatric patients with pneumonia and their clinical outcomes". Influenza and Other Respiratory Viruses. 8 (1): 21–24. doi:10.1111/irv.12206. ISSN 1750-2640.
  6. ↑ 6.0 6.1 Piralla, Antonio; Girello, Alessia; Grignani, Michela; Gozalo-Margüello, Monica; Marchi, Antonietta; Marseglia, Gianluigi; Baldanti, Fausto (2014). "Phylogenetic characterization of enterovirus 68 strains in patients with respiratory syndromes in Italy". Journal of Medical Virology. 86 (9): 1590–1593. doi:10.1002/jmv.23821. ISSN 0146-6615.
  7. ↑ Meijer, Adam; van der Sanden, Sabine; Snijders, Bianca E.P.; Jaramillo-Gutierrez, Giovanna; Bont, Louis; van der Ent, Cornelis K.; Overduin, Pieter; Jenny, Shireen L.; Jusic, Edin; van der Avoort, Harrie G.A.M.; Smith, Gavin J.D.; Donker, Gé A.; Koopmans, Marion P.G. (2012). "Emergence and epidemic occurrence of enterovirus 68 respiratory infections in The Netherlands in 2010". Virology. 423 (1): 49–57. doi:10.1016/j.virol.2011.11.021. ISSN 0042-6822.
  8. ↑ 8.0 8.1 8.2 Kaida A, Kubo H, Sekiguchi J, Kohdera U, Togawa M, Shiomi M; et al. (2011). "Enterovirus 68 in children with acute respiratory tract infections, Osaka, Japan". Emerg Infect Dis. 17 (8): 1494–7. doi:10.3201/eid1708.110028. PMC 3381549. PMID 21801632.
  9. ↑ Kreuter JD, Barnes A, McCarthy JE, Schwartzman JD, Oberste MS, Rhodes CH; et al. (2011). "A fatal central nervous system enterovirus 68 infection". Arch Pathol Lab Med. 135 (6): 793–6. doi:10.1043/2010-0174-CR.1. PMID 21631275.
  10. ↑ Imamura T, Suzuki A, Lupisan S, Okamoto M, Aniceto R, Egos RJ; et al. (2013). "Molecular evolution of enterovirus 68 detected in the Philippines". PLoS One. 8 (9): e74221. doi:10.1371/journal.pone.0074221. PMC 3779236. PMID 24073203.
  11. ↑ Hasegawa, S.; Hirano, R.; Okamoto-Nakagawa, R.; Ichiyama, T.; Shirabe, K. (2011). "Enterovirus 68 infection in children with asthma attacks: virus-induced asthma in Japanese children". Allergy. 66 (12): 1618–1620. doi:10.1111/j.1398-9995.2011.02725.x. ISSN 0105-4538.
  12. ↑ Justin D. Kreuter, Arti Barnes, James E. McCarthy, Joseph D. Schwartzman, M. Steven Oberste, C. Harker Rhodes, John F. Modlin & Peter F. Wright (2011). "A fatal central nervous system enterovirus 68 infection". Archives of pathology & laboratory medicine. 135 (6): 793–796. doi:10.1043/2010-0174-CR.1. PMID 21631275. Unknown parameter |month= ignored (help)
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