Tests
1st tests to order
clinical diagnosis
Test
The illness may be suspected based on epidemiologic considerations.
Enterovirus D68 (EV-D68) infection appears to occur seasonally, typically in the late summer and fall. Outbreaks within schools or communities are common.
Healthcare providers seeing an increase in patients with asthma exacerbation not caused by respiratory syncytial virus or influenza should consider EV-D68.
Patients with mild illness do not require any tests. Investigations should be considered for patients with severe respiratory illness or acute flaccid myelitis.
Result
condition features
Tests to consider
respiratory viral testing
Test
The initial approach is to test respiratory specimens for rhinovirus or enterovirus. If positive, more specific testing can be pursued.
Specific testing for enterovirus D68 should be considered in children with severe unexplained respiratory illness, even in the absence of fever.[35]
Result
positive for enterovirus or rhinovirus
real-time reverse transcription (rRT) PCR assay or molecular sequencing
Test
Specific testing for enterovirus D68 (EV-D68) is performed with rRT-PCR assay or molecular sequencing.[35] The test is ideally performed on nasopharyngeal or oropharyngeal specimens.[38] The assay is not routinely available through clinical laboratories. In the US, specific testing can be obtained on a case-by-case basis through state or local health departments, or the Centers for Disease Control and Prevention (CDC).[35] If acute flaccid myelitis is suspected, PCR for enterovirus should also be performed on cerebrospinal fluid, nasopharyngeal or oropharyngeal specimens, stool or rectal swab, and serum.[42]
Result
positive for EV-D68
pulse oximetry
Test
Often patients with more severe disease have a history of asthma or chronic lung disease. In these cases, monitoring of oxyhemoglobin saturation and close observation of clinical indicators of respiratory distress are indicated.
Result
may be normal; arterial oxygen saturation levels <94% may indicate increased severity of an asthma exacerbation
contrast MRI of the spine and brain
Test
Acute flaccid myelitis (AFM) should be suspected in children presenting with sudden onset of weakness in one or more extremity.[39] During the 2014 outbreak in the US, most children had a febrile respiratory illness in the 2 weeks preceding the onset of the neurologic symptoms, which often included flaccid limb weakness and paralysis, and acute cranial nerve dysfunction.[8][Figure caption and citation for the preceding image starts]: MRI of the spine showing a T2/STIR hyperintensity restricted to the ventral gray 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].
Increasing evidence indicates that enterovirus D68 infection might cause AFM.[5][6][7][8][9][10][11][12]
Result
may show inflammation of the gray matter in the spinal cord
lumbar puncture
Test
Acute flaccid myelitis (AFM) should be suspected in children presenting with sudden onset of weakness in one or more extremity.[39] During the 2014 outbreak in the US, most children had a febrile respiratory illness in the 2 weeks preceding the onset of the neurologic symptoms, which often included flaccid limb weakness and paralysis, and acute cranial nerve dysfunction.[8] Increasing evidence indicates that EV-D68 infection might cause AFM.[5][6][7][8][9][10][11][12]
Result
may show mild to moderate lymphocytic pleocytosis, normal or mildly elevated protein, normal glucose
electromyography
Test
Acute flaccid myelitis (AFM) should be suspected in children presenting with sudden onset of weakness in one or more extremity.[39] Most children had a febrile respiratory illness in the 2 weeks preceding the onset of the neurologic symptoms, which often included flaccid limb weakness and paralysis, and acute cranial nerve dysfunction.[8] Increasing evidence indicates that enterovirus D68 infection might cause AFM.[5][6][7][8][9][10][11][12]
Result
acute spinal motor neuron injury
testing for poliovirus
Test
Given the clinical similarity between acute flaccid myelitis (AFM) and acute flaccid limb paralysis caused by poliovirus, patients suspected of having AFM should also be tested for poliovirus infection.[45]
Result
negative for poliovirus
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