title: Severe enterovirus 68 respiratory illness in children requiring intensive care management.
abstract: BACKGROUND
  Enterovirus 68 (EV-D68) causes acute respiratory tract illness in epidemic cycles, most recently in Fall 2014, but clinical characteristics of severe disease are not well reported.
  
  
  OBJECTIVE
  Children with EV-D68 severe respiratory disease requiring pediatric intensive care unit (PICU) management were compared with children with severe respiratory disease from other enteroviruses/rhinoviruses.
  
  
  METHODS
  A retrospective review was performed of all children admitted to Children's Mercy Hospital PICU from August 1-September 15, 2014 with positive PCR testing for enterovirus/rhinovirus. Specimens were subsequently tested for the presence of EV-D68. We evaluated baseline characteristics, symptomatology, lab values, therapeutics, and outcomes of children with EV-D68 viral infection compared with enterovirus/rhinovirus-positive, EV-D68-negative children.
  
  
  RESULTS
  A total of 86 children with positive enterovirus/rhinovirus testing associated with respiratory symptoms were admitted to the PICU. Children with EV-D68 were older than their EV-D68-negative counterparts (7.1 vs. 3.5 years, P=0.01). They were more likely to have a history of asthma or recurrent wheeze (68% vs. 42%, P=0.03) and to present with cough (90% vs. 63%, P=0.009). EV-D68 children were significantly more likely to receive albuterol (95% vs. 79%, P=0.04), magnesium (75% vs. 42%, P=0.004), and aminophylline (25% vs. 4%, P=0.03). Other adjunctive medications used in EV-D68 children included corticosteroids, epinephrine, and heliox; 44% of EV-D68-positive children required non-invasive ventilatory support.
  
  
  CONCLUSIONS
  EV-D68 causes severe disease in the pediatric population, particularly in children with asthma and recurrent wheeze; children may require multiple adjunctive respiratory therapies.
authors: Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, USA. Electronic address: jeschuster@cmh.edu.
authors: Jennifer E
authors: JE
authors: Schuster
authors: Division of Critical Care, Children's Mercy Hospital, Kansas City, MO, USA.
authors: Jenna O
authors: JO
authors: Miller
authors: Division of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.
authors: Rangaraj
authors: R
authors: Selvarangan
authors: Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, USA.
authors: Gina
authors: G
authors: Weddle
authors: Division of Critical Care, Children's Mercy Hospital, Kansas City, MO, USA.
authors: Marita T
authors: MT
authors: Thompson
authors: Division of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.
authors: Ferdaus
authors: F
authors: Hassan
authors: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Shannon L
authors: SL
authors: Rogers
authors: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: M Steven
authors: MS
authors: Oberste
authors: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: W Allan
authors: WA
authors: Nix
authors: Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, USA.
authors: Mary Anne
authors: MA
authors: Jackson
mesh_terms: D000367:Age Factors; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D019468:Disease Management; D030016:Enterovirus D, Human / Q000145:classification* / Q000235:genetics*; D004769:Enterovirus Infections / Q000175:diagnosis* / Q000628:therapy / Q000821:virology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000628:therapy / Q000821:virology*; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: Acute respiratory tract infection; Asthma; EV-D68; Enterovirus; Intensive care unit; Respiratory virus