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Tveten AK, Ørstenvik HL, Tolaas I. Loop-mediated isothermal amplification (LAMP) for detection of atypical enterovirus D68 strain VR-1197. J Virol Methods 2024; 330:115030. [PMID: 39236986 DOI: 10.1016/j.jviromet.2024.115030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/30/2024] [Accepted: 09/01/2024] [Indexed: 09/07/2024]
Abstract
A method that has rapidly evolved for detection of viral pathogens are loop-mediated isothermal amplification (LAMP) assays. The available LAMP assays usually target the most common viral strains, including enteroviruses, but for the atypical enterovirus D68 strain VR-1197 this method has not yet been developed. Enterovirus D68 are known for severe respiratory distress in children, and atypical strains are less likely to be detected by traditional methods. This study targets the atypical EVD68 strain VR-1197 and have developed a rapid detection method saving time when differentiating enterovirus strains. This study present method development and review the sensitivity and specificity compared to traditional RT-qPCR, and wet lab cross reactivity with other airway pathogens. The EVD68 VR-1197 assay can be a rapid POC (Point of care) test for atypical EVD68 VR-1197 and have the potential as reliable detection method with minimal technological requirements.
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Affiliation(s)
- Ann-Kristin Tveten
- Faculty of Natural Sciences, Department of Biological Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Larsgaardsveien 2, Aalesund NO-6009, Norway.
| | - Hanne Lillerovde Ørstenvik
- Faculty of Natural Sciences, Department of Biological Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Larsgaardsveien 2, Aalesund NO-6009, Norway
| | - Ingvill Tolaas
- Faculty of Natural Sciences, Department of Biological Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Larsgaardsveien 2, Aalesund NO-6009, Norway
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2
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Kimura H, Hayashi Y, Kitagawa M, Yoshizaki M, Saito K, Harada K, Okayama K, Miura Y, Kimura R, Shirai T, Fujita K, Machida S, Ito K, Kurosawa I. Pathogen Profiles in Outpatients with Non-COVID-19 during the 7th Prevalent Period of COVID-19 in Gunma, Japan. Microorganisms 2023; 11:2142. [PMID: 37763986 PMCID: PMC10536078 DOI: 10.3390/microorganisms11092142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/29/2023] Open
Abstract
The identification of pathogens associated with respiratory symptoms other than the novel coronavirus disease 2019 (COVID-19) can be challenging. However, the diagnosis of pathogens is crucial for assessing the clinical outcome of patients. We comprehensively profiled pathogens causing non-COVID-19 respiratory symptoms during the 7th prevalent period in Gunma, Japan, using deep sequencing combined with a next-generation sequencer (NGS) and advanced bioinformatics technologies. The study included nasopharyngeal swabs from 40 patients who tested negative for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) using immuno-chromatography and/or quantitative reverse transcription polymerase chain reaction (qRT-PCR) methods. Comprehensive pathogen sequencing was conducted through deep sequencing using NGS. Additionally, short reads obtained from NGS were analyzed for comprehensive pathogen estimation using MePIC (Metagenomic Pathogen Identification Pipeline for Clinical Specimens) and/or VirusTap. The results revealed the presence of various pathogens, including respiratory viruses and bacteria, in the present subjects. Notably, human adenovirus (HAdV) was the most frequently detected virus in 16 of the 40 cases (40.0%), followed by coryneforms, which were the most frequently detected bacteria in 21 of the 40 cases (52.5%). Seasonal human coronaviruses (NL63 type, 229E type, HKU1 type, and OC43 type), human bocaviruses, and human herpesviruses (human herpesvirus types 1-7) were not detected. Moreover, multiple pathogens were detected in 50% of the subjects. These results suggest that various respiratory pathogens may be associated with non-COVID-19 patients during the 7th prevalent period in Gunma Prefecture, Japan. Consequently, for an accurate diagnosis of pathogens causing respiratory infections, detailed pathogen analyses may be necessary. Furthermore, it is possible that various pathogens, excluding SARS-CoV-2, may be linked to fever and/or respiratory infections even during the COVID-19 pandemic.
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Affiliation(s)
- Hirokazu Kimura
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, Takasaki-shi 370-0006, Gunma, Japan; (Y.H.); (K.H.); (K.O.); (Y.M.); (K.F.)
- Advanced Medical Science Research Center, Gunma Paz University Research Institute, Shibukawa-shi 377-0008, Gunma, Japan; (R.K.); (T.S.); (K.I.)
| | - Yuriko Hayashi
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, Takasaki-shi 370-0006, Gunma, Japan; (Y.H.); (K.H.); (K.O.); (Y.M.); (K.F.)
| | - Masanari Kitagawa
- Project Department, Takara Bio Inc., Kusatsu-shi 525-0058, Shiga, Japan; (M.K.); (M.Y.); (K.S.)
| | - Miwa Yoshizaki
- Project Department, Takara Bio Inc., Kusatsu-shi 525-0058, Shiga, Japan; (M.K.); (M.Y.); (K.S.)
| | - Kensuke Saito
- Project Department, Takara Bio Inc., Kusatsu-shi 525-0058, Shiga, Japan; (M.K.); (M.Y.); (K.S.)
| | - Kazuhiko Harada
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, Takasaki-shi 370-0006, Gunma, Japan; (Y.H.); (K.H.); (K.O.); (Y.M.); (K.F.)
- Kurosawa Hospital, Takasaki-shi 370-1203, Gunma, Japan; (S.M.); (I.K.)
| | - Kaori Okayama
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, Takasaki-shi 370-0006, Gunma, Japan; (Y.H.); (K.H.); (K.O.); (Y.M.); (K.F.)
| | - Yusuke Miura
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, Takasaki-shi 370-0006, Gunma, Japan; (Y.H.); (K.H.); (K.O.); (Y.M.); (K.F.)
| | - Ryusuke Kimura
- Advanced Medical Science Research Center, Gunma Paz University Research Institute, Shibukawa-shi 377-0008, Gunma, Japan; (R.K.); (T.S.); (K.I.)
- Department of Bacteriology, Graduate School of Medicine, Gunma University, Maebashi-shi 371-8514, Gunma, Japan
| | - Tatsuya Shirai
- Advanced Medical Science Research Center, Gunma Paz University Research Institute, Shibukawa-shi 377-0008, Gunma, Japan; (R.K.); (T.S.); (K.I.)
| | - Kiyotaka Fujita
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, Takasaki-shi 370-0006, Gunma, Japan; (Y.H.); (K.H.); (K.O.); (Y.M.); (K.F.)
| | - Suguru Machida
- Kurosawa Hospital, Takasaki-shi 370-1203, Gunma, Japan; (S.M.); (I.K.)
| | - Kazuto Ito
- Advanced Medical Science Research Center, Gunma Paz University Research Institute, Shibukawa-shi 377-0008, Gunma, Japan; (R.K.); (T.S.); (K.I.)
- Kurosawa Hospital, Takasaki-shi 370-1203, Gunma, Japan; (S.M.); (I.K.)
| | - Isao Kurosawa
- Kurosawa Hospital, Takasaki-shi 370-1203, Gunma, Japan; (S.M.); (I.K.)
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3
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Fall A, Kenmoe S, Ebogo-Belobo JT, Mbaga DS, Bowo-Ngandji A, Foe-Essomba JR, Tchatchouang S, Amougou Atsama M, Yéngué JF, Kenfack-Momo R, Feudjio AF, Nka AD, Mbongue Mikangue CA, Taya-Fokou JB, Magoudjou-Pekam JN, Noura EA, Zemnou-Tepap C, Meta-Djomsi D, Maïdadi-Foudi M, Kame-Ngasse GI, Nyebe I, Djukouo LG, Kengne Gounmadje L, Tchami Ngongang D, Oyono MG, Demeni Emoh CP, Tazokong HR, Mahamat G, Kengne-Ndé C, Sadeuh-Mba SA, Dia N, La Rosa G, Ndip L, Njouom R. Global prevalence and case fatality rate of Enterovirus D68 infections, a systematic review and meta-analysis. PLoS Negl Trop Dis 2022; 16:e0010073. [PMID: 35134062 PMCID: PMC8824346 DOI: 10.1371/journal.pntd.0010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
A substantial amount of epidemiological data has been reported on Enterovirus D68 (EV-D68) infections after the 2014 outbreak. Our goal was to map the case fatality rate (CFR) and prevalence of current and past EV-D68 infections. We conducted a systematic review (PROSPERO, CRD42021229255) with published articles on EV-68 infections in PubMed, Embase, Web of Science and Global Index Medicus up to January 2021. We determined prevalences using a model random effect. Of the 4,329 articles retrieved from the databases, 89 studies that met the inclusion criteria were from 39 different countries with apparently healthy individuals and patients with acute respiratory infections, acute flaccid myelitis and asthma-related diseases. The CFR estimate revealed occasional deaths (7/1353) related to EV-D68 infections in patients with severe acute respiratory infections. Analyses showed that the combined prevalence of current and past EV-D68 infections was 4% (95% CI = 3.1-5.0) and 66.3% (95% CI = 40.0-88.2), respectively. The highest prevalences were in hospital outbreaks, developed countries, children under 5, after 2014, and in patients with acute flaccid myelitis and asthma-related diseases. The present study shows sporadic deaths linked to severe respiratory EV-D68 infections. The study also highlights a low prevalence of current EV-D68 infections as opposed to the existence of EV-D68 antibodies in almost all participants of the included studies. These findings therefore highlight the need to implement and/or strengthen continuous surveillance of EV-D68 infections in hospitals and in the community for the anticipation of the response to future epidemics.
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Affiliation(s)
- Amary Fall
- Virology Department, Institute Pasteur of Dakar, Dakar, Senegal
| | - Sebastien Kenmoe
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | | | - Marie Amougou Atsama
- Centre de Recherche sur les Maladies Émergentes et Re-Emergentes, Institut de Recherches Médicales et d’Etudes des Plantes Médicinales, Yaounde, Cameroon
| | | | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon
| | | | - Alex Durand Nka
- Virology Laboratory, Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
| | | | | | | | - Efietngab Atembeh Noura
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | - Dowbiss Meta-Djomsi
- Centre de Recherche sur les Maladies Émergentes et Re-Emergentes, Institut de Recherches Médicales et d’Etudes des Plantes Médicinales, Yaounde, Cameroon
| | - Martin Maïdadi-Foudi
- Centre de Recherche sur les Maladies Émergentes et Re-Emergentes, Institut de Recherches Médicales et d’Etudes des Plantes Médicinales, Yaounde, Cameroon
| | - Ginette Irma Kame-Ngasse
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Inès Nyebe
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | | | | | - Martin Gael Oyono
- Department of Animals Biology and Physiology, The University of Yaounde I, Yaounde, Cameroon
| | | | | | - Gadji Mahamat
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Research Monitoring and Planning Unit, National Aids Control Committee, Douala, Cameroon
| | | | - Ndongo Dia
- Virology Department, Institute Pasteur of Dakar, Dakar, Senegal
| | - Giuseppina La Rosa
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Lucy Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Richard Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
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4
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Development of an experimental inactivated vaccine from Vero cell adapted Enterovirus D68. Virus Res 2021; 304:198528. [PMID: 34339771 DOI: 10.1016/j.virusres.2021.198528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/10/2021] [Accepted: 07/22/2021] [Indexed: 11/24/2022]
Abstract
Enterovirus D68 is an emerging respiratory disease pathogen causing multiple outbreaks worldwide. Enterovirus D68 strain US/KY/14-18953 was adapted to propagate in Vero cells resulting alteration of seven amino acids. The Vero cell adapted virus was inactivated with Formalin and immunized in mice. Formalin inactivated vaccine elicited high virus specific IgG antibody titer and neutralization titer. Avidity of the IgG antibodies elicited by two different doses of formalin inactivated vaccine is moderately high which got augmented by alum adjuvanted formulations. Formalin inactivated unadjuvanted vaccine elicited a balanced IgG1 type and IgG2a type antibody indicating a more balanced Th2/Th1 type immune response while alum formulated formalin inactivated antigen elicited significantly high IgG1 antibody in immunized sera and Th2 cytokines in mice splenocytes denoting Th2 type T cell immune response. Additionally, the formalin inactivated vaccine formulations has displayed excellent serum mediated invivo protective efficacy. These data suggested that formalin inactivated Enterovirus D68 is a promising vaccine candidate.
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5
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González-Sanz R, Taravillo I, Reina J, Navascués A, Moreno-Docón A, Aranzamendi M, Romero MP, Del Cuerpo M, Pérez-González C, Pérez-Castro S, Otero A, Cabrerizo M. Enterovirus D68-associated respiratory and neurological illness in Spain, 2014-2018. Emerg Microbes Infect 2020; 8:1438-1444. [PMID: 31571527 PMCID: PMC6781473 DOI: 10.1080/22221751.2019.1668243] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
During 2014, enterovirus D68 (EV-D68) outbreaks were described globally, causing severe respiratory diseases in children and, in some cases, subsequent paralysis. In this study, the type characterization of enterovirus (EV) detected in respiratory illnesses and the epidemiology and clinical association of EV-D68 infections in Spain over a five-year period were described. A total of 546 EV-positive samples from hospitalized patients with respiratory infections were included. EV-D68 was the most frequently detected type (46.6%, 191/410 typed EV). Other EV from species A (25.1%), B (27.8%) and C (0.5%) were also identified. EV-D68 infections were more associated with bronchitis while EV-A/B types were more frequent in upper respiratory illness (p < 0.01). EV-D68 was also detected in patients with neurological symptoms (nine meningitis/meningoencephalitis and eight acute flaccid paralysis cases). Phylogenetic analysis of 3′-VP1 region showed most Spanish EV-D68 sequences from 2014 to 2016 belonged to subclades B2/B3, as other American and European strains circulating during the same period. However, those detected in 2017 and 2018 clustered to the emerged subclade D1. In summary, different EV can cause respiratory infections but EV-D68 was the most prevalent, with several strains circulating in Spain at least since 2014. Association between EV-D68 infection and neurological disease was also described.
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Affiliation(s)
- Rubén González-Sanz
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III , Madrid , Spain
| | - Irene Taravillo
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III , Madrid , Spain
| | - Jordi Reina
- Hospital Son Espases , Palma de Mallorca , Spain
| | | | | | - Maitane Aranzamendi
- Hospital Universitario Cruces, Biocruces Bizkaia Health Research Institute , Bilbao , Spain
| | | | | | | | - Sonia Pérez-Castro
- Servicio de Microbiología, Complexo Hospitalario Universitario de Vigo (CHUVI) , Sergas, Vigo , Spain
| | - Almudena Otero
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III , Madrid , Spain
| | - María Cabrerizo
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III , Madrid , Spain
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6
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Enterovirus D68 Causing Acute Respiratory Infection: Clinical Characteristics and Differences With Acute Respiratory Infections Associated With Enterovirus Non-D68. Pediatr Infect Dis J 2019; 38:687-691. [PMID: 30985516 DOI: 10.1097/inf.0000000000002289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Enterovirus (EV) D68 is mainly associated with acute respiratory infection (ARI). Since 2014, when outbreaks in different countries were observed, this emerging virus was considered a potential threat to public health. METHODS During 2015-2017, the presence of enterovirus RNA was investigated in all respiratory samples of children younger than 15 years of age with ARI, obtained for virologic studies in the Pediatric Emergency Care Units and wards of 2 hospitals in Gipuzkoa (Spain), using a commercial multiplex real-time polymerase chain reaction. When enterovirus was detected, a polymerase chain reaction to amplify a specific viral polyprotein (VP1) gene region of EV-D68 was performed. RESULTS In 2016, EV-D68 circulation was associated to ARI, with the highest incidence in the spring months. EV-D68 was detected in 44 children, mean age 30.1 ± 31.7 months old, 23 (52.3%) of them females and 17 (38.6%) with underlying respiratory medical conditions. Thirty-two patients (72%) required hospital admission, receiving the discharge diagnosis of recurrent wheezing (37.5%), asthmatic crisis (37.5%) or bronchiolitis (12.5%). Seven children (15.9%) needed the support of the pediatric intensive care unit. When coinfections were excluded, children with EV-D68 infection presented with increased work of breathing, recurrent wheezing or asthmatic crisis, more frequently than those with ARI associated with EV non-D68. Moreover, clinical outcomes (hospitalization, respiratory support) were more severe. All 44 EV-D68 strains detected belonged to lineage B3. CONCLUSIONS EV-D68 circulated widely in Gipuzkoa during 2016 and was associated with severe ARI. In children with severe ARI of unknown etiology, the presence of EV-D68 should be considered.
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Kubi JA, Mutocheluh M, Bonney JHK, Ampofo WK, Odoom JK. Molecular detection of enterovirus D68 among children with acute respiratory tract infection in Ghana. Afr J Lab Med 2019; 8:732. [PMID: 31309045 PMCID: PMC6620485 DOI: 10.4102/ajlm.v8i1.732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 11/02/2018] [Indexed: 01/08/2023] Open
Abstract
Background Acute respiratory tract infections of viral origin remain a leading cause of morbidity, mortality and economic loss regardless of age or gender. A small number of acute respiratory tract infection cases caused by enterovirus D68 (EV-D68) have been reported regularly to Centers for Disease Control and Prevention since 1987 by countries in North America, Europe and Asia. However, in 2014 and 2015, the number of reported confirmed EV-D68 infections was much greater than in previous years. The National Influenza Centre (NIC), Ghana carries out surveillance of respiratory infections, focusing on those caused by influenza virus; however, there is inadequate information on other viruses causing respiratory infections in Ghana, including EV-D68. Objectives To investigate the association of EV-D68 with Severe Acute Respiratory Infections (SARI) and Influenza-Like Illness (ILI) in Ghana. Methods This was a retrospective cross-sectional study which involved archived human respiratory specimens stored at –80 °C at the NIC from 2014 to 2015. Using a random sampling method, oropharyngeal and nasopharyngeal swabs from patients with SARI and ILI that were negative by real-time PCR for human influenza viruses were screened for EV-D68 using real-time reverse transcription-polymerase chain reaction (rRT-PCR). Results Enterovirus D68 was detected in 4 (2.2%) out of 182 SARI samples tested. EV-D68 was detected in children younger than 5 years (4 – 100% of positives) and was not detected in children older than 5 years. Enterovirus D68 was detected more frequently in SARI cases (3%) than in ILI cases (1.2%). Conclusion This study has shown for the first time the presence of EV-D68 in acute respiratory infections in Ghana. The results confirmed minimal EV-D68 circulation in the Ghanaian population.
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Affiliation(s)
- Joyce A Kubi
- Department of Clinical Microbiology, School of Medical Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Mohamed Mutocheluh
- Department of Clinical Microbiology, School of Medical Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph H K Bonney
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - William K Ampofo
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - John K Odoom
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Harun A, Beyza E. Viral and Atypical Bacterial Respiratory Infections in a University Teaching Hospital. Jpn J Infect Dis 2019; 72:318-322. [DOI: 10.7883/yoken.jjid.2018.510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Agca Harun
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludag University
| | - Ener Beyza
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludag University
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Savage TJ, Kuypers J, Chu HY, Bradford MC, Buccat AM, Qin X, Klein EJ, Jerome KR, Englund JA, Waghmare A. Enterovirus D-68 in children presenting for acute care in the hospital setting. Influenza Other Respir Viruses 2018; 12:522-528. [PMID: 29498483 PMCID: PMC6005627 DOI: 10.1111/irv.12551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Severe respiratory disease associated with enterovirus D68 (EV-D68) has been reported in hospitalized pediatric patients. Virologic and clinical characteristics of EV-D68 infections exclusively in patients presenting to a hospital Emergency Department (ED) or urgent care have not been well defined. METHODS Mid-nasal swabs from pediatric patients with respiratory symptoms presenting to the ED or urgent care were evaluated using a commercial multiplex PCR platform. Specimens positive for rhinovirus/enterovirus (HRV/EV) were subsequently tested using real-time reverse-transcriptase PCR for EV-D68. The PCR cycle threshold (CT) was used as a viral load proxy. Clinical outcomes were compared between patients with EV-D68 and patients without EV-D68 who tested positive for HRV/EV. RESULTS From August to December 2014, 511 swabs from patients with HRV/EV were available. EV-D68 was detected in 170 (33%) HRV/EV-positive samples. In multivariable models adjusted for age and underlying asthma, patients with EV-D68 were more likely to require hospitalization for respiratory reasons (odds ratio (OR): 3.11, CI: 1.85-5.25), require respiratory support (OR: 1.69, CI: 1.09-2.62), have confirmed/probable lower respiratory tract infection (LRTI; OR: 3.78, CI: 2.03-7.04), and require continuous albuterol or steroids (OR: 3.91, CI: 2.22-6.88 and OR: 4.73, CI: 2.65-8.46, respectively). Higher EV-D68 viral load was associated with need for respiratory support and LRTI in multivariate models. CONCLUSIONS Among pediatric patients presenting to the ED or urgent care, EV-D68 causes more severe disease than non-EV-D68 HRV/EV independent of underlying asthma. High viral load was associated with worse clinical outcomes. Rapid and quantitative viral testing may help identify and risk stratify patients.
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Affiliation(s)
- Timothy J. Savage
- Seattle Children's HospitalSeattleWAUSA
- University of WashingtonSeattleWAUSA
| | | | | | | | | | - Xuan Qin
- Seattle Children's HospitalSeattleWAUSA
| | - Eileen J. Klein
- Seattle Children's HospitalSeattleWAUSA
- University of WashingtonSeattleWAUSA
- Seattle Children's Research InstituteSeattleWAUSA
| | - Keith R. Jerome
- University of WashingtonSeattleWAUSA
- Fred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Janet A. Englund
- Seattle Children's HospitalSeattleWAUSA
- University of WashingtonSeattleWAUSA
- Seattle Children's Research InstituteSeattleWAUSA
| | - Alpana Waghmare
- Seattle Children's HospitalSeattleWAUSA
- University of WashingtonSeattleWAUSA
- Seattle Children's Research InstituteSeattleWAUSA
- Fred Hutchinson Cancer Research CenterSeattleWAUSA
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Caylan E, Weinblatt E, Welter J, Dozor A, Wang G, Nolan SM. Comparison of the Severity of Respiratory Disease in Children Testing Positive for Enterovirus D68 and Human Rhinovirus. J Pediatr 2018; 197:147-153.e1. [PMID: 29655864 DOI: 10.1016/j.jpeds.2018.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 02/05/2018] [Accepted: 02/12/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To compare the characteristics and severity of respiratory disease in children testing positive for enterovirus D68 (EV-D68) and for human rhinovirus (RhV). STUDY DESIGN A retrospective single center study of children presenting with acute respiratory symptoms and positive polymerase chain reaction for RhV/EV from September 1, 2014 through October 31, 2014 was performed. Specimens were subsequently tested specifically for EV-D68 and specimens identified as RhV were subtyped when possible into RhV-A, RhV-B, and RhV-C species. Clinical manifestations in patients with EV-D68 were compared with those with non-EV-D68, RhV, and RhV-C. RESULTS Of the 173 patients included in the analysis, 72 tested positive for EV-D68, 61 for RhV, and 30 for RhV-C. There were significantly fewer infants in the EV-D68 group. Patients with EV-D68 were more likely than those without EV-D68, and specifically with RhV-C, to have fever and wheezing. Patients with EV-D68 received more magnesium sulfate for respiratory distress not responding adequately to repeated doses of inhaled albuterol. Hospitalized patients with EV-D68 received more bronchodilator therapy than patients with RhV. Patients with EV-D68 were more likely to be admitted to the intensive care unit and were older than patients without EV-D68. There was no difference in length of overall hospitalization or time in the pediatric intensive care unit. CONCLUSIONS Children with EV-D68 appeared to have more severe respiratory disease on admission than children with RhV as evidenced by higher rates of fever, wheezing, bronchodilator use and pediatric intensive care unit admission. Despite the initial difference in severity, no significant difference in length of stay was found suggesting that patients with EV-D68 recovered as quickly as other groups.
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Affiliation(s)
- Esra Caylan
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, New York Medical College, Valhalla, NY
| | | | - John Welter
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, New York Medical College, Valhalla, NY.
| | - Allen Dozor
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, New York Medical College, Valhalla, NY
| | - Guiqing Wang
- Pathology and Clinical Laboratories, New York Medical College/ Westchester Medical Center, Valhalla, NY
| | - Sheila M Nolan
- Pediatric Infectious Diseases, New York Medical College, Valhalla, NY
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Biggs HM, McNeal M, Nix WA, Kercsmar C, Curns AT, Connelly B, Rice M, Chern SWW, Prill MM, Back N, Oberste MS, Gerber SI, Staat MA. Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July-October 2014. Clin Infect Dis 2018; 65:315-323. [PMID: 28379349 DOI: 10.1093/cid/cix314] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/31/2017] [Indexed: 12/19/2022] Open
Abstract
Background Enterovirus D68 (EV-D68) caused a widespread outbreak of respiratory illness in the United States in 2014, predominantly affecting children. We describe EV-D68 rates, spectrum of illness, and risk factors from prospective, population-based acute respiratory illness (ARI) surveillance at a large US pediatric hospital. Methods Children <13 years of age with ARI and residence in Hamilton County, Ohio were enrolled from the inpatient and emergency department (ED) settings at a children's hospital in Cincinnati, Ohio, from 1 July to 31 October 2014. For each participant, we interviewed parents, reviewed medical records, and tested nasal and throat swabs for EV-D68 using real-time reverse- transcription polymerase chain reaction assay. Results EV-D68 infection was detected in 51 of 207 (25%) inpatients and 58 of 505 (11%) ED patients. Rates of EV-D68 hospitalization and ED visit were 1.3 (95% confidence interval [CI], 1.0-1.6) and 8.4 per 1000 children <13 years of age, respectively. Preexisting asthma was associated with EV-D68 infection (adjusted odds ratio, 3.2; 95% CI, 2.0-5.1). Compared with other ARI, children with EV-D68 were more likely to be admitted from the ED (P ≤ .001), receive supplemental oxygen (P = .001), and require intensive care unit admission (P = .04); however, mechanical ventilation was uncommon (2/51 inpatients; P = .64), and no deaths occurred. Conclusions During the 2014 EV-D68 epidemic, high rates of pediatric hospitalizations and ED visits were observed. Children with asthma were at increased risk for medically attended EV-D68 illness. Preparedness planning for a high-activity EV-D68 season in the United States should take into account increased healthcare utilization, particularly among children with asthma, during the late summer and early fall.
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Affiliation(s)
- Holly M Biggs
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - W Allan Nix
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolyn Kercsmar
- Pulmonology, Cincinnati Children's Hospital Medical Center, Ohio
| | - Aaron T Curns
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Shur-Wern Wang Chern
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mila M Prill
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - M Steven Oberste
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan I Gerber
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Iroh Tam PY, Zhang L, Cohen Z. Clinical characteristics and outcomes of human rhinovirus positivity in hospitalized children. Ann Thorac Med 2018; 13:230-236. [PMID: 30416595 PMCID: PMC6196663 DOI: 10.4103/atm.atm_291_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND: The clinical relevance of positive human rhinovirus (HRV) in hospitalized patients is unclear. Our objective was to describe the clinical characteristics and outcomes of HRV positivity in a heterogeneous population of hospitalized children, compared to those positive for another respiratory virus and those where no respiratory virus was detected. METHODS: A retrospective case–control study of children hospitalized between January 2014 to April 2015 who had a respiratory viral specimen collected. Clinical and laboratory data were collected, and baseline characteristics and clinical variables were compared. RESULTS: During the study period, there were 671 specimens obtained from 577 patients that were processed for the respiratory viral polymerase chain reaction assay, of which 198 were positive for HRV, 167 positive for another respiratory virus, and 306 where no respiratory virus was detected. A history of asthma was significantly associated with HRV-positive patients (odds ratio [OR] 3.71; P < 0.001). On multivariate analysis, HRV-positive patients had a higher requirement for mechanical ventilation (OR 1.44), lower rates of readmission (OR 0.53), and lower mortality (OR 0.35) compared to patients with no respiratory virus isolated; however, none were statistically significant. HRV-positive patients did have a significantly shorter length of stay (LOS) compared with patients with no respiratory virus isolated (difference–0.35; P = 0.001). Similar outcomes were seen in patients positive for other respiratory viruses. CONCLUSIONS: HRV-positive hospitalized pediatric patients with a heterogeneous set of clinical diagnoses had higher association with asthma compared to patients who had another, or no, respiratory virus isolated. HRV-positive patients had shorter LOS compared to patients who had no respiratory viruses isolated. These findings suggest that HRV positivity in hospitalized pediatric patients may not lead to adverse clinical outcomes, although asthma is a risk factor regardless of clinical comorbidities and diagnoses. Further research is warranted to understand the predisposition of asthma to HRV positivity.
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Affiliation(s)
- Pui-Ying Iroh Tam
- Division of Pediatric Infectious Diseases, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.,Paediatric and Child Health Research Group, Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Lei Zhang
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Zohara Cohen
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
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13
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Reina J, Cabrerizo M, Ferrés F. Community acquired acute respiratory infections caused by enterovirus D68 (EV-D68). ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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14
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Infecciones respiratorias agudas comunitarias causadas por enterovirus D68 (EV-D68). An Pediatr (Barc) 2017; 86:158-159. [DOI: 10.1016/j.anpedi.2016.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/09/2016] [Accepted: 05/12/2016] [Indexed: 11/18/2022] Open
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