Enterovirus D68 Treatment & Management

Updated: May 15, 2018
  • Author: HoJoon You, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Approach Considerations

In outpatient settings, ensure that the patient has an asthma action plan to control asthma long-term and understands how to manage worsening asthma or attacks. Provide instructions concerning when to call his or her primary physician or to seek emergency treatment. [29]

Patients with severe respiratory infection should be hospitalized for supportive treatment, as follows:

  • Oxygen if the patient is hypoxic
  • Bronchodilator therapy if the patient presents with clinical evidence of bronchospasm
  • Endotracheal intubation and mechanical ventilation may be needed in patients with impending respiratory failure

No specific intervention has been shown definitive efficacy in EV-D68 infections with acute flaccid myelitis. Human intravenous immunoglobulin (IVIG) may offer some benefit, as reported by Zhang et al, who found high levels of neutralizing antibodies to EV-D68. [31] Studies performed in mice with EV-D68 infection with paralytic myelitis showed that human IVIG reduced paralysis and decreased spinal cord paralysis, while fluoxetine had no effect and dexamethasone resulted in worse motor impairment and increased mortality and increased viral loads. [32] However, in a small review of 5 cases of poliolike syndrome, steroids, intravenous immunoglobulin, and plasma exchange showed no apparent clinical benefit. [33]

No data on the efficacy of antivirals in humans exist. Promising data have shown that rupintrivir, an irreversible inhibitor of the human rhinovirus 3C protease, and novel diketopiperazines have in vitro activity against EV-D68. [34]

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Consultations

Consider consultation with an infectious disease specialist and/or neurologist.

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Prevention

No vaccinations are available for EV-D68 infection. As no suitable animal model still exists for EV-D68, a full understanding of the pathogenesis and immune response against EV-D68 is incomplete. Studies are underway to establish animal models and the effect of EV-D68 on their immune system to investigate antiviral therapies and vaccines. [18, 35]

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