Enterovirus D68 Clinical Presentation

Updated: May 12, 2021
  • Author: HoJoon You, MD; Chief Editor: Michael Stuart Bronze, MD  more...
  • Print


The spectrum of clinical presentation of enterovirus D68 (EV-D68) infection can range from mild respiratory infection to severe disease, warranting intensive care unit admission, bi-level positive airway ventilation, or even intubation. Some cases have resulted in death. [3, 25]

Potential manifestations of EV-D68 infection are as follows:

  • Acute onset

  • Cough

  • Fever (although a considerable percentage of cases without fever reported in the latest outbreaks)

  • Rhinorrhea

  • Sore throat

  • Fatigue

  • Headache

  • Myalgia

  • Dyspnea

  • Diarrhea

  • Bronchiolitis [2]



Physical examination may reveal the following:

  • Wheezing

  • Rhinorrhea

  • Fever

  • Hypoxemia [2]

Cases involving acute neurological illness may have the following characteristics [29, 36] :

  • Preceding febrile illness with upper respiratory tract symptoms or GI prodrome occurring 3-16 days before onset of neurological illness

  • Limb paresis or flaccid paralysis

  • Ptosis, facial droop, dysarthria, dysphagia, diplopia

  • Absence of sensory deficits

  • Meningismus in cases of meningoencephalitis (one case described in 2008 in New Hampshire [26] )