Comparison of the Severity of Respiratory Disease in Children Testing Positive for Enterovirus D68 and Human Rhinovirus

Caylan, Esra; Weinblatt, Ezra; Welter, John; Dozor, Allen J.; Wang, Guiqing; Nolan, Sheila M.

doi:10.1016/j.jpeds.2018.02.027

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…In our study, RV-C was detected almost the whole year, similarly to others' results [33]. On the other hand, EV-D68, an EV type most frequently associated to respiratory diseases, has been described to be more pathogenic than most RV species [34], in addition to causing acute flaccid paralysis. The fact that no EV-D68 species was detected could be due to the epidemiologic circulation pattern of this EV type, which alternates years of high incidence with years of low circulation [35].…”

Section: Discussionsupporting

confidence: 90%

Lower Respiratory Tract Infection and Genus Enterovirus in Children Requiring Intensive Care: Clinical Manifestations and Impact of Viral Co-Infections

Penela‐Sánchez

González-de-Audicana

Armero

et al. 2021

Viruses

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Infection by rhinovirus (RV) and enterovirus (EV) in children ranges from asymptomatic infection to severe lower respiratory tract infection (LRTI). This cohort study evaluates the clinical impact of RV/EV species, alone or in codetection with other viruses, in young children with severe LRTI. Seventy-one patients aged less than 5 years and admitted to the Paediatric Intensive Care Unit (PICU) of a reference children’s hospital with RV or EV (RV/EV) LRTI were prospectively included from 1/2018 to 3/2020. A commercial PCR assay for multiple respiratory pathogens was performed in respiratory specimens. In 22/71, RV/EV + respiratory syncytial virus (RSV) was found, and 18/71 had RV/EV + multiple viral detections. Patients with single RV/EV detection required invasive mechanical ventilation (IMV) as frequently as those with RSV codetection, whereas none of those with multiple viral codetections required IMV. Species were determined in 60 samples, 58 being RV. No EV-A, EV-C, or EV-D68 were detected. RV-B and EV-B were only found in patients with other respiratory virus codetections. There were not any associations between RV/EV species and severity outcomes. To conclude, RV/EV detection alone was observed in young children with severe disease, while multiple viral codetections may result in reduced clinical severity. Differences in pathogenicity between RV and EV species could not be drawn.

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Section: Discussionsupporting

confidence: 90%

Lower Respiratory Tract Infection and Genus Enterovirus in Children Requiring Intensive Care: Clinical Manifestations and Impact of Viral Co-Infections

Penela‐Sánchez

González-de-Audicana

Armero

et al. 2021

Viruses

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“…Messacar et al found that pediatric patients admitted with the RV/EV complex had the same probability of requiring admission to the PICU or mechanical ventilation as those with influenza virus, which has historically been thought to produce more severe infections, with greater morbidity (20,21). In a previous publication by our group, the RV/EV complex was described as the most frequent etiological agent (30%), followed by RSV (19%), parainfluenza (7.4%), and adenovirus (5.7%).…”

Section: Discussionmentioning

confidence: 99%

“…However, when compared with RSV, we observed that the RV/EV behavior was more severe and had a more aggressive natural course. Additionally, the commercial brand of RT/PCR did not allow us to differentially evaluate the enterovirus and rhinovirus to understand the differences between these viruses from the same family (21). In general, they are analyzed together in most of the tests available commercially today.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Severe Acute Respiratory Infections Due to Rhinovirus/Enterovirus Complex in Children and Their Comparison with Those of Respiratory Syncytial Virus

Fernández‐Sarmiento

Corrales

Obando

et al. 2021

Arch Pediatr Infect Dis

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Background: Acute respiratory tract infections (ARTIs) are one of the main causes of morbidity and mortality in children under the age of five worldwide. Objectives: The objective of this research was to describe the main characteristics of hospitalized patients with ARTI caused by the rhinovirus/enterovirus (RV/EV) complex and the risk factors associated with severe infection. Methods: This was a retrospective descriptive study in patients from one month to 18-years-old who had been hospitalized for ARTI between October 2015 and December 2019 at Fundación Cardioinfantil in Bogotá, Colombia, and had had an RT-PCR viral panel during their hospitalization. Rhinovirus/enterovirus infection was characterized to identify factors associated with disease severity as compared to respiratory syncytial virus (RSV). A multivariate analysis was performed, controlling for confounding factors, to identify groups at risk of developing associated acute respiratory distress syndrome (ARDS). Results: During the study period, 645 RT-PCRs were performed, with the two main etiological agents identified being RV/EV (n = 224) and RSV (n = 68). The median age of patients with the RV/EV complex was 27 months (IQR: 8 - 70), and seven months for those with RSV (IQR: 2 - 11). Severe RV/EV complex infections required more transfers to intensive care (47% vs. 11%), showed more viral coinfection (OR: 2.13, 95% CI: 1.42 - 4.64), and had less bacterial coinfection (OR: 0.55, 95% CI: 0.31 - 0.98) than RSV infections. The RV/EV group had a higher risk of developing ARDS (OR: 3.6, 95% CI: 1.07 - 12:18), especially in premature infants (P: 0.05; exp(B), 2.99; 95% CI = 1.01 - 8.82), those with heart disease (P: 0.047; exp(B), 2.99; 95% CI = 1.01 - 8.82), and those with inborn errors of metabolism (P: 0.032; exp(B), 5 - 01; 95% CI = 1.15 - 21.81). A total of 13 patients from both study groups died (4.5%), with no differences found between the groups (RV/EV 54% vs. RSV 46%; P = 0.3). Conclusions: Respiratory infection due to RV/EV in children can frequently be severe, requiring management with intensive care therapy. When compared to RSV, this complex is more frequently associated with the development of ARDS, especially in risk groups such as those with prematurity, heart disease, or inborn errors of metabolism.

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“…However, when compared with RSV, we observed that the RV / EV behavior is more severe and has a more aggressive natural course. Additionally, the commercial brand of RT/PCR did not allow us to differentially evaluate the enterovirus and rhinovirus to understand the differences between these viruses from the same family [24]. In general, they are analyzed together in most of the tests available commercially today.…”

Section: Discussionmentioning

confidence: 99%

Characterization of rhinovirus/enterovirus complex infection in children living at high altitudes: A cross sectional study

Jaime

Catalina

Obando

et al. 2021

Preprint

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Background: Respiratory tract infections caused by the rhinovirus/enterovirus (RV/EV) complex have traditionally been considered to be minor, self-limited infections in children, with few complications. There are no previous studies of patients living at high altitudes that characterize severe cases of this infection.Methods: This was a cross-sectional study including patients from 1 month to 18 years old who had been hospitalized for acute respiratory tract infections between October 2015 and December 2019, and had had a viral panel with RT-PCR during their hospitalization.Results: During the study period, 645 RT-PCRs were performed, with the two main etiological agents identified being RV/EV (224) and respiratory syncytial virus (68). The median age of patients with RV/EV complex was 27 months (IQR: 8-70), 55.8% were boys and the average length of hospital stay was 12 days (IQR: 6-24). Severe RV/EV complex infections required more transfers to intensive care (11% vs 47%), showed more viral coinfection (OR: 2.13,95%, 95%CI: 1.42-4.64) and had less bacterial coinfection (OR: 0.55, 95%CI: 0.31-0.98) than RSV infections, with no difference in mortality ( 2.4% vs. 2.1%, P:0.09). Post-transplant patients (OR: 3.35, 95%CI: 1.10-11.34) and those with comorbidities (OR: 3.97, 95%CI: 2.23-7.08) had the highest risk of RV/EV infection. The RV/EV group had a higher risk of presenting acute respiratory distress syndrome (ARDS) (OR: 3.6, 95%CI: 1.07-12:18), especially in premature infants (p: 0.05; exp (B), 2.99; 95%CI= 1.01-8.82), those with heart disease (p: 0.047; exp(B), 2.99; 95%CI = 1.01-8.82) and those with inborn errors of metabolism (p: 0.032; exp (B), 5-01; 95%CI= 1.15-21.81). Conclusions: Respiratory infection due to RV/EV in children who live at high altitudes can frequently be severe, requiring management with intensive care therapy. When compared to RSV, this complex is more frequently associated with viral coinfection and the development of ARDS, especially in risk groups such as those with prematurity, heart disease or inborn errors of metabolism. It is important to see RV / EV as a virus that can have an unsatisfactory course as or more severe than that of other viruses that affect the respiratory tract in children.

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Comparison of the Severity of Respiratory Disease in Children Testing Positive for Enterovirus D68 and Human Rhinovirus

Cited by 7 publications

References 25 publications

Lower Respiratory Tract Infection and Genus Enterovirus in Children Requiring Intensive Care: Clinical Manifestations and Impact of Viral Co-Infections

Lower Respiratory Tract Infection and Genus Enterovirus in Children Requiring Intensive Care: Clinical Manifestations and Impact of Viral Co-Infections

Factors Associated with Severe Acute Respiratory Infections Due to Rhinovirus/Enterovirus Complex in Children and Their Comparison with Those of Respiratory Syncytial Virus

Characterization of rhinovirus/enterovirus complex infection in children living at high altitudes: A cross sectional study

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