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LB8. Outbreak of Enterovirus A71 Neurologic Disease in Children—Colorado, 2018

BACKGROUND: In May 2018, an outbreak of enterovirus A71 (EV-A71) neurologic disease was detected at Children’s Hospital Colorado (CHCO) prompting a public health investigation. We characterized clinical, laboratory, and radiologic findings during this outbreak. METHODS: A case was defined as meningi...

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Autores principales: Messacar, Kevin, Burakoff, Alexis, Nix, William A, Rogers, Shannon, Lopez, Adriana S, Oberste, M Steve, Gerber, Susan I, Spence-Davizon, Emily, Herlihy, Rachel, Dominguez, Samuel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253202/
http://dx.doi.org/10.1093/ofid/ofy229.2182
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author Messacar, Kevin
Burakoff, Alexis
Nix, William A
Rogers, Shannon
Lopez, Adriana S
Oberste, M Steve
Gerber, Susan I
Spence-Davizon, Emily
Herlihy, Rachel
Dominguez, Samuel
author_facet Messacar, Kevin
Burakoff, Alexis
Nix, William A
Rogers, Shannon
Lopez, Adriana S
Oberste, M Steve
Gerber, Susan I
Spence-Davizon, Emily
Herlihy, Rachel
Dominguez, Samuel
author_sort Messacar, Kevin
collection PubMed
description BACKGROUND: In May 2018, an outbreak of enterovirus A71 (EV-A71) neurologic disease was detected at Children’s Hospital Colorado (CHCO) prompting a public health investigation. We characterized clinical, laboratory, and radiologic findings during this outbreak. METHODS: A case was defined as meningitis, encephalitis, or acute flaccid myelitis with EV-A71 identified from a biologic specimen in a child examined at CHCO after March 1, 2018. Biologic specimens from children with neurologic disease and EV identified by clinical reverse-transcription polymerase chain reaction (RT-PCR) were typed by VP1 sequencing at CDC. RESULTS: As of July 20, 2018, 28 cases of EV-A71 neurologic disease were identified. This report describes the clinical, laboratory, and radiologic findings for the first 13 children identified with EV-A71 neurologic disease, for whom complete information is available. The median age was 13 months (range = 10 days–35 months) and 11 (85%) were male. Neurologic presentations included 12 (92%) with meningitis, 9 (69%) with encephalitis, and 3 (23%) with acute flaccid myelitis (AFM). All 13 children had fever and irritability; 3 (23%) had hand, foot, and mouth disease. Neurologic signs included encephalopathy (n = 7, 54%), ataxia (n = 7, 54%), myoclonus (n = 6, 46%), limb weakness (n = 4, 31%), cranial nerve deficits (n = 2, 15%), and seizures (n = 1, 8%). Nine (90%) of 10 children with cerebrospinal fluid (CSF) specimen analyzed had a pleocytosis (>5 white blood cells/uL); 6 of 8 (75%) children who had brain imaging showed abnormalities, with 5 (63%) in the brainstem, 3 (38%) in the cerebellum, and 3 (38%) in the spinal cord. All 13 children had EV-A71 identified in nasopharyngeal, pharyngeal, or fecal specimens; only 2 of 11 (18%) tested had EV identified in CSF. All 13 children were hospitalized and 4 (31%) required intensive care. The 3 (23%) children with AFM had residual limb weakness at time of discharge. All children survived. CONCLUSION: EV-A71 should be considered when children present with myoclonus, ataxia, or limb weakness in the setting of a febrile illness. Testing of nonsterile sites (respiratory, pharyngeal, or fecal) should be considered when CNS disease associated with EV is suspected and initial CSF testing is negative. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62532022018-11-28 LB8. Outbreak of Enterovirus A71 Neurologic Disease in Children—Colorado, 2018 Messacar, Kevin Burakoff, Alexis Nix, William A Rogers, Shannon Lopez, Adriana S Oberste, M Steve Gerber, Susan I Spence-Davizon, Emily Herlihy, Rachel Dominguez, Samuel Open Forum Infect Dis Abstracts BACKGROUND: In May 2018, an outbreak of enterovirus A71 (EV-A71) neurologic disease was detected at Children’s Hospital Colorado (CHCO) prompting a public health investigation. We characterized clinical, laboratory, and radiologic findings during this outbreak. METHODS: A case was defined as meningitis, encephalitis, or acute flaccid myelitis with EV-A71 identified from a biologic specimen in a child examined at CHCO after March 1, 2018. Biologic specimens from children with neurologic disease and EV identified by clinical reverse-transcription polymerase chain reaction (RT-PCR) were typed by VP1 sequencing at CDC. RESULTS: As of July 20, 2018, 28 cases of EV-A71 neurologic disease were identified. This report describes the clinical, laboratory, and radiologic findings for the first 13 children identified with EV-A71 neurologic disease, for whom complete information is available. The median age was 13 months (range = 10 days–35 months) and 11 (85%) were male. Neurologic presentations included 12 (92%) with meningitis, 9 (69%) with encephalitis, and 3 (23%) with acute flaccid myelitis (AFM). All 13 children had fever and irritability; 3 (23%) had hand, foot, and mouth disease. Neurologic signs included encephalopathy (n = 7, 54%), ataxia (n = 7, 54%), myoclonus (n = 6, 46%), limb weakness (n = 4, 31%), cranial nerve deficits (n = 2, 15%), and seizures (n = 1, 8%). Nine (90%) of 10 children with cerebrospinal fluid (CSF) specimen analyzed had a pleocytosis (>5 white blood cells/uL); 6 of 8 (75%) children who had brain imaging showed abnormalities, with 5 (63%) in the brainstem, 3 (38%) in the cerebellum, and 3 (38%) in the spinal cord. All 13 children had EV-A71 identified in nasopharyngeal, pharyngeal, or fecal specimens; only 2 of 11 (18%) tested had EV identified in CSF. All 13 children were hospitalized and 4 (31%) required intensive care. The 3 (23%) children with AFM had residual limb weakness at time of discharge. All children survived. CONCLUSION: EV-A71 should be considered when children present with myoclonus, ataxia, or limb weakness in the setting of a febrile illness. Testing of nonsterile sites (respiratory, pharyngeal, or fecal) should be considered when CNS disease associated with EV is suspected and initial CSF testing is negative. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6253202/ http://dx.doi.org/10.1093/ofid/ofy229.2182 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Messacar, Kevin
Burakoff, Alexis
Nix, William A
Rogers, Shannon
Lopez, Adriana S
Oberste, M Steve
Gerber, Susan I
Spence-Davizon, Emily
Herlihy, Rachel
Dominguez, Samuel
LB8. Outbreak of Enterovirus A71 Neurologic Disease in Children—Colorado, 2018
title LB8. Outbreak of Enterovirus A71 Neurologic Disease in Children—Colorado, 2018
title_full LB8. Outbreak of Enterovirus A71 Neurologic Disease in Children—Colorado, 2018
title_fullStr LB8. Outbreak of Enterovirus A71 Neurologic Disease in Children—Colorado, 2018
title_full_unstemmed LB8. Outbreak of Enterovirus A71 Neurologic Disease in Children—Colorado, 2018
title_short LB8. Outbreak of Enterovirus A71 Neurologic Disease in Children—Colorado, 2018
title_sort lb8. outbreak of enterovirus a71 neurologic disease in children—colorado, 2018
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253202/
http://dx.doi.org/10.1093/ofid/ofy229.2182
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