Archive for October 17, 2016

Respiratory Presentation of Pediatric Patients in the 2014 Enterovirus D68 Outbreak.

Can Respir J. 2016;2016:8302179.

Martin G1, Li R2, Cook VE3, Carwana M2, Tilley P4, Sauve L5, Tang P6, Kapur A7, Yang CL7.

Author information

1Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8.

2Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, BC, Canada V6H 3V4.

3Division of Allergy and Clinical Immunology, British Columbia Children’s Hospital, Vancouver, BC, Canada V6H 3V4.

4Pathology & Lab Medicine, British Columbia Children’s Hospital, Vancouver, BC, Canada V6H 3V4.

5Division of Infectious Diseases, British Columbia Children’s Hospital, Vancouver, BC, Canada V6H 3V4.

6British Columbia Centre for Disease Control, Vancouver, BC, Canada V5Z 4R4.

7Division of Respiratory Medicine, British Columbia Children’s Hospital, Vancouver, BC, Canada V6H 3V4.

Abstract

Background.

In the fall of 2014, a North American outbreak of enterovirus D68 resulted in a significant number of pediatric hospital admissions for respiratory illness throughout North America. This study characterized the clinical presentation and risk factors for a severe clinical course in children admitted to British Columbia Children’s Hospital during the 2014 outbreak.

Methods.

Retrospective chart review of patients with confirmed EV-D68 infection admitted to BCCH with respiratory symptoms in the fall of 2014. Past medical history, clinical presentation, management, and course in hospital was collected and analyzed using descriptive statistics. Comparison was made between those that did and did not require ICU admission to identify risk factors.

Results.

Thirty-four patients were included (median age 7.5 years). Fifty-three percent of children had a prior history of wheeze, 32% had other preexisting medical comorbidities, and 15% were previously healthy. Ten children (29%) were admitted to the pediatric intensive care unit. The presence of complex medical conditions (excluding wheezing) (P = 0.03) and copathogens was associated with PICU admission (P = 0.02).

Conclusions.

EV-D68 infection resulted in severe, prolonged presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of wheeze and preexisting medical comorbidities appear to be most severely affected, but the virus can also cause wheezing in previously well children.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004002/pdf/CRJ2016-8302179.pdf

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October 17, 2016 at 8:26 am

Enterovirus D68 Infection.

Viruses. 2015 Nov 24;7(11):6043-50.

Esposito S1, Bosis S2, Niesters H3, Principi N4.

Author information

1Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy. susanna.esposito@unimi.it

2Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy. samantha.bosis@unimi.it

3Department of Medical Microbiology, Division of Clinical Virology, University Medical Center, The University of Groningen, 9713 Groningen, The Netherlands. maria.favero@policlinico.mi.it

4Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy. nicola.principi@unimi.it

Abstract

First described in 1962 in children hospitalized for pneumonia and bronchiolitis, the Enterovirus D68 (EV-D68) is an emergent viral pathogen. Since its discovery, during the long period of surveillance up to 2005, EV-D68 was reported only as a cause of sporadic outbreaks. In recent years, many reports from different countries have described an increasing number of patients with respiratory diseases due to EV-D68 associated with relevant clinical severity. In particular, an unexpectedly high number of children have been hospitalized for severe respiratory disease due to EV-D68, requiring intensive care such as intubation and mechanical ventilation. Moreover, EV-D68 has been associated with acute flaccid paralysis and cranial nerve dysfunction in children, which has caused concerns in the community. As no specific antiviral therapy is available, treatment is mainly supportive. Moreover, because no vaccines are available, conventional infection control measures (i.e., standard, for contacts and droplets) in both community and healthcare settings are recommended. However, further studies are required to fully understand the real importance of this virus. Prompt diagnosis and continued surveillance of EV-D68 infections are essential to managing and preventing new outbreaks. Moreover, if the association between EV-D68 and severe diseases will be confirmed, the development of adequate preventive and therapeutic approaches are a priority.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664996/pdf/viruses-07-02925.pdf

October 17, 2016 at 8:25 am

An Enterovirus D68 Outbreak Highlights the Value of Pediatric Infectious Disease Specialists.

J Pediatric Infect Dis Soc. 2015 Mar;4(1):87-8.

Schuster JE1, Newland JG1.

Author information

1Division of Infectious Diseases, Department of Pediatrics, Children’s Mercy Hospitals-Kansas City, University of Missouri-Kansas City School of Medicine.

PDF

http://jpids.oxfordjournals.org/content/4/1/87.full.pdf+html

October 17, 2016 at 8:24 am

ANTIBIOTIC GUIDELINES 2015-2016 Johns Hopkins Medicine

Treatment Recommendations for Adult Inpatientes 163 pags

PDF

http://www.hopkinsmedicine.org/amp/guidelines/antibiotic_guidelines.pdf

October 17, 2016 at 7:32 am


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