Foster Charles B, Coelho Ritika, Brown Paul M, Wadhwa Aman, Dossul Amena, Gonzalez Blanca E, Cardenas Silvia, Sabella Camille, Kohn Debbie, Vogel Sherilynn, Yen-Lieberman Belinda, Piedimonte Giovanni
Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, Ohio.
Center for Pediatric Research, Cleveland Clinic Children's, Cleveland, Ohio.
Pediatr Pulmonol. 2017 Jun;52(6):827-832. doi: 10.1002/ppul.23661. Epub 2017 Jan 30.
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.
2014年秋季，大量儿童因与肠道病毒D68（EV - D68）相关的哮喘或呼吸窘迫住院。很大一部分儿童最初检测出鼻病毒呈阳性。在此期间，我们实验室注意到EV - D68与GenMark多重呼吸道病毒检测板中的鼻病毒成分之间存在交叉反应。许多其他实验室使用的检测方法并非用于区分这些小RNA病毒科病毒。
为比较鼻病毒和EV - D68患者的临床表现及转归，对103份来自住院儿童且GenMark检测鼻病毒呈阳性的鼻咽拭子重新检测EV - D68。
与EV - D68阴性患者相比，EV - D68阳性患者更有可能有哮喘病史（33.3%对11.0%，P = 0.02），并表现为急性呼吸道疾病（66.7%对40.2%，P = 0.048），尤其是哮喘持续状态（47.6%对2.4%，P < 0.001）。入院时，他们有更多的喘息、呼吸窘迫及下呼吸道受累情况，更有可能接受类固醇治疗并在出院时携带哮喘药物回家。与EV - D68阴性患者相比，EV - D68阳性患者呼吸道病毒合并感染较少见。在无呼吸道病毒合并感染的患者中，总体结果相似。
与鼻病毒患者相比，EV - D68患者更有可能有哮喘病史、表现为哮喘持续状态、入院时喘息，并在住院和出院时接受哮喘药物治疗。常用检测方法无法区分EV - D68和鼻病毒，这增加了EV - D68作为哮喘病毒触发因素的作用未得到充分认识的可能性。《儿科肺脏病学》。2017年；52:827 - 832。©2017威利期刊公司。
