title: A comparison of hospitalized children with enterovirus D68 to those with rhinovirus.
abstract: During the Fall of 2014, numerous children were hospitalized with asthma or respiratory distress related to Enterovirus D68 (EV-D68). A large proportion initially tested positive for rhinovirus. During this period our laboratory noted a cross-reactivity between EV-D68 and the rhinovirus component of the GenMark multiplex respiratory viral panel. Many other laboratories used assays not designed to distinguish these Picornoviridae.
  
  
  
  To compare the presentation and outcomes of patients with rhinovirus and EV-D68, 103 GenMark rhinovirus positive nasopharyngeal swabs from hospitalized children were retested for EV-D68.
  
  
  
  EV-D68 positive patients versus EV-D68 negative patients were more likely to have a history of asthma (33.3% vs. 11.0%, P = 0.02) and to present with acute respiratory illness (66.7% vs. 40.2%, P = 0.048), especially status asthmaticus (47.6% vs. 2.4%, P < 0.001). On admission they had more wheezing, respiratory distress, and lower respiratory tract involvement, and were more likely to be treated with steroids and discharged home on asthma medications. Respiratory viral coinfection was less common in EV-D68 positive vs EV-D68 negative patients. In patients without a respiratory viral coinfection the overall findings were similar.
  
  
  
  Patients with EV-D68 versus rhinovirus were more likely to have a history of asthma, to present with status asthmaticus, to wheeze on admission, and to receive treatment with asthma medications in hospital and at discharge. The inability of common assays to distinguish EV-D68 from rhinoviruses raises the possibility that the role of EV-D68 as a viral trigger of asthma has been under appreciated. Pediatr Pulmonol. 2017;52:827-832. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, Ohio.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Foster
authors.affiliation: Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, Ohio.
authors.forename: Ritika
authors.initials: R
authors.lastname: Coelho
authors.affiliation: Center for Pediatric Research, Cleveland Clinic Children's, Cleveland, Ohio.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Brown
authors.affiliation: Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, Ohio.
authors.forename: Aman
authors.initials: A
authors.lastname: Wadhwa
authors.affiliation: Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, Ohio.
authors.forename: Amena
authors.initials: A
authors.lastname: Dossul
authors.affiliation: Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, Ohio.
authors.forename: Blanca E
authors.initials: BE
authors.lastname: Gonzalez
authors.affiliation: Center for Pediatric Pulmonary Medicine, Cleveland Clinic Children's, Cleveland, Ohio.
authors.forename: Silvia
authors.initials: S
authors.lastname: Cardenas
authors.affiliation: Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, Ohio.
authors.forename: Camille
authors.initials: C
authors.lastname: Sabella
authors.affiliation: Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Debbie
authors.initials: D
authors.lastname: Kohn
authors.affiliation: Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Sherilynn
authors.initials: S
authors.lastname: Vogel
authors.affiliation: Center for Pediatric Research, Cleveland Clinic Children's, Cleveland, Ohio.|Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Belinda
authors.initials: B
authors.lastname: Yen-Lieberman
authors.affiliation: Center for Pediatric Research, Cleveland Clinic Children's, Cleveland, Ohio.|Center for Pediatric Pulmonary Medicine, Cleveland Clinic Children's, Cleveland, Ohio.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Piedimonte
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000453:epidemiology; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004417:Dyspnea / Q000453:epidemiology; D030016:Enterovirus D, Human; D004769:Enterovirus Infections / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010850:Picornaviridae Infections / Q000453:epidemiology*; D012135:Respiratory Sounds; D012229:Rhinovirus; D012621:Seasons
keywords: asthma; children; enterovirus D68; respiratory virus; rhinovirus