Post-viral syndromes
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Recently, there has been a rise in cases of myelitis associated with enterovirus D68 and enterovirus D71. In these cases, patients present with flaccid paralysis and a polio-like clinical picture. Termed acute flaccid myelitis (AFM), it is presumed that this disease results from direct viral infection of the anterior horn cells with secondary edema and possible demyelination of the cord [27]. While there are overlapping features with TM, key differences will allow the distinction of these two diseases. AFM presents with acute onset of flaccid paralysis of one or more extremities with loss of deep tendon reflexes in a lower motor neuron pattern, typically with pain in the affected extremity, cranial nerve palsies, and respiratory compromise. MRI of the spine demonstrates a lesion largely restricted to gray matter and spanning more than one spinal cord segment, and outcome is poor with up to 90% of patients experiencing residual deficits [27]. Created for epidemiological studies, Centers for Disease Control and Prevention (CDC) case definitions for confirmed and probable AFM are shown in Table 25.3 [28]. Similar clinical pictures have also been described associated with West Nile virus [29], adenovirus [30], and rarely, other infections [31].
Poliovirus
Patricia G. Melloy in Viruses and Society, 2023
Although poliovirus has been eliminated for 90% of the world’s population, it is important to note that there are other enteroviruses that are an emerging threat. The enterovirus D68, also known as EV-D68, was first discovered in California in 1962. It is a member of the picornavirus family like poliovirus and displays characteristics of both enteroviruses and rhinoviruses in some respects, since it is primarily a mild respiratory illness that can cause neurological symptoms like acute flaccid myelitis (AFM) involving muscle weakness and paralysis. However, AFM itself is poorly understood. Although research is ongoing, scientists believe that EV-D68 is responsible for most cases of AFM (Cassidy et al. 2018; CDC 2021c; Baggen et al. 2018). The CDC indicates that many cases of AFM began to be reported in the United States in 2014 (CDC 2021c). It is not known why cases of AFM are on the rise. Future studies of the picornavirus family of viruses need to focus not only on polio, but also on the non-poliovirus enteroviruses and how to control infection and/or develop a vaccine against these viruses.
Enterovirus
Dongyou Liu in Handbook of Foodborne Diseases, 2018
Enteroviruses have a ubiquitous distribution and are among the most frequent human pathogens, with 10–15 million new infections diagnosed annually in the United States alone. Among EV-A71 (or EV71) genogroups A, B (B1–B5), C (C1–C5), D, E, and F (based on analysis ofVP1 protein), genogroup A (including the prototype strain) is present in the United States; genogroups B and C in Asia and Europe (including B3, B4, C1, and C2 in Malaysia; B3 in Singapore and Western Australia; B4, B5, C2, and C4 in Taiwan; C4, particularly C4a, in Korea; C4a in China and Vietnam; C1 and C2 in France and the Netherlands), genogroup D in India, and genogroups E and F in Africa [13–15]. Through examination of the seroprevalence of neutralizing antibodies (NAbs), it was shown that human enterovirus 68 (EV-D68) has become more common during the period of 2004 and 2011 in Beijing, China [16].
Clinical characteristics of children infected with enterovirus D68 in an outpatient clinic and the association with bronchial asthma
Published in Infectious Diseases, 2018
Tsutomu Itagaki, Yoko Aoki, Yohei Matoba, Shizuka Tanaka, Tatsuya Ikeda, Katsumi Mizuta, Yoko Matsuzaki
Human enterovirus D68 (EV-D68) was first isolated from respiratory specimens of 4 hospitalized children with lower respiratory tract illness in 1962 in the USA [1]. EV-D68 belongs to the Human enterovirus D species, Enterovirus genus and Picornaviridae family. Three genetic groups, lineage 1 (clade C), lineage 2 (clade B) and lineage 3 (clade A), are circulating worldwide [2,3]. Unlike many other enteroviruses, EV-D68 is biologically more similar to human rhinoviruses (species, Human rhinovirus; genus, Enterovirus; family, Picornaviridae) and is associated with acute respiratory diseases [4]. Recently, a glycan array analysis revealed that EV-D68 preferentially recognizes sialic acid receptors with an α2–6-linkage, which are dominantly expressed in the upper respiratory tract, suggesting that EV-D68 might have an affinity for the upper respiratory tract [5].
Inhaled corticosteroid prescribing in a pediatric emergency department: Sustained success and prescription filling rates
Published in Journal of Asthma, 2018
Sarah Nicole Adams, Mary Abel, Dustin Fowler, Jennifer Braden, Myla D. Ebeling, Annie N. Simpson, M. Olivia Titus, Annie Lintzenich Andrews
After achieving an ICS prescribing median of 79% through several Plan-Do-Study-Act (PDSA) cycles during the initial high-intensity intervention phase of this QI project we were able to maintain goal-prescribing rates after transition to a low-intensity intervention phase. Through continued chart review we determined that our ICS prescribing median over a period of 2.5 years remained at 79%, above our study goal of 75%. We did experience quite a bit of variation in ICS prescribing rates from July 2014 to Jan 2015 but no significant trends were noted that would necessitate recalculating the median [16]. Interestingly, this time period correlates precisely with the Enterovirus –D68 outbreak that was associated with severe respiratory illness including wheezing children [17]. This likely affected prescribing rates during that time. Less month to month variation is noted from Feb 2015 through Sept 2016. Stopping monthly directed attending-level feedback has not resulted in a drop in ICS prescribing median (Figure 1).
Enteroviruses and coronaviruses: similarities and therapeutic targets
Published in Expert Opinion on Therapeutic Targets, 2021
Varpu Marjomäki, Kerttu Kalander, Maarit Hellman, Perttu Permi
The enterovirus genus consists of 15 different species out of which four enterovirus species (EV-A, EV-B, EV-C and EV-D) and three rhinovirus (RV) species (RV-A, RV-B and RV-C) infect humans [6]. Human enterovirus species include over 100 serotypes of echoviruses, polioviruses, Coxsackieviruses and enteroviruses and over 100 serotypes of rhinovirus species, many of which have emerged during the last 10 years [7]. Although poliovirus has been almost eradicated from the world, several non-polioviruses are causing difficult epidemics all around the world, especially enterovirus-D68 belonging to EV-D group, and enterovirus-A71 belonging to EV-A group [8,9]. Enterovirus-A71 causes hand-foot-and-mouth disease and may lead to difficult neurological symptoms [9]. It has caused several difficult outbreaks especially in Asia. Infections by enterovirus-D68 have caused severe pneumonia and even deaths especially in the United States [8]. Human rhinoviruses are the primary causative agent of the common cold worldwide [10]. They cause mostly mild symptoms but can also cause muscle fatigue and headaches.
Related Knowledge Centers
- Coxsackievirus
- Enterovirus
- Picornavirus
- Poliovirus
- Rna
- Viral Envelope
- Polio
- Acute Flaccid Myelitis
- Echovirus
- Lability