History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include age <18 years old, history of asthma and/or wheezing, history of chronic lung disease, and onset of symptoms in late summer or autumn.
wheezing
Enterovirus D68 (EV-D68) infection can lead to asthma exacerbation in patients with a history of asthma. Patients with wheezing related to EV-D68 should be managed according to their asthma action plan. Sudden worsening requiring intensive care support may occur.
Patients with severe unexplained lower respiratory symptoms present typically with wheezing in EV-D68 infection.[38][39]
shortness of breath
Patients may present with shortness of breath, which may be related to an exacerbation of pre-existing asthma. Sudden worsening requiring intensive care support may occur.
uncommon
acute flaccid limb weakness
Mounting evidence suggests a causal relationship between enterovirus D68 and polio-like acute flaccid myelitis.[5][6][7][8][9][10][11][12] Specific findings may be observed on MRI involving the grey matter and often spanning more than one level of the spinal cord.[Figure caption and citation for the preceding image starts]: MRI of the spine showing a T2/STIR hyperintensity restricted to the ventral grey matter of the cervical and thoracic spinal cord in a child with acute flaccid myelitis.From the collection of Neil Friedman, MBChB, Center for Pediatric Neurology, Cleveland Clinic, Cleveland, Ohio [Citation ends].
A key component of the case definition for acute flaccid myelitis.[41]
Other diagnostic factors
common
rhinorrhoea
Most individuals infected have mild symptoms such as runny nose.
cough
Most individuals infected have mild symptoms such as cough.
sneezing
Most individuals infected have mild symptoms such as sneezing.
muscle aches
Many patients also report having muscle aches.
fever
Some patients present with fever. In one study, 48% of enterovirus D68 (EV-D68)-positive patients admitted to hospital had fever.[18]
Risk factors
strong
<18 years of age
Most patients requiring medical treatment are children.[1][2] During the large EV-D68 outbreak that occurred in the US during 2014, most hospitalised patients were children.[18]
Serological studies suggest that most adults have antibodies against EV-D68. This immunity probably affords protection against severe disease.[22]
history of asthma, wheezing
history of chronic lung disease
late summer or autumn
EV-D68 may have a seasonal occurrence, with outbreaks reported in the late summer and autumn.
Healthcare providers seeing an increase in patients with asthma exacerbation not caused by respiratory syncytial virus or influenza should consider EV-D68.
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