Simultaneous enterovirus EV-D68 and CVA6 infections causing acute respiratory distress syndrome and hand, foot and mouth disease

Virology Journal

Heloísa Ihle Giamberardino¹  Ivanildo Pedro de Sousa²  Fernanda Marcicano Burlandy²  Edson Elias da Silva²  Maria Carmo Debur³  Sonia Mara Raboni⁴  Maria de Lourdes Aguiar Oliveira⁵ 

[1] Divisão de Epidemiologia, Hospital Pequeno Príncipe, Curitiba, Brazil;Laboratório de Enterovírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil;Laboratório de Saúde Pública, Secretaria de Saúde do Estado do Paraná, Curitiba, Brazil;Laboratório de Virologia, Universidade Federal Do Paraná, Curitiba, Brazil;Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil;

关键词: Enterovirus;    Hand, foot and mouth disease;    Acute respiratory distress syndrome;    EV-D68;    CVA6;   

DOI  :  10.1186/s12985-021-01560-w

来源: Springer

【 摘 要 】

BackgroundAlthough most enterovirus (EV) infections can be asymptomatic, these viral agents can cause serious conditions associated with central nervous system, respiratory disease and uncommon manifestations of hand, foot and mouth disease (HFMD). EV-coinfections have been rarely reported with development of complications and severe clinical outcome. An atypical case of a child presenting HFMD and severe acute respiratory syndrome, co-infected with EV-D68 and CVA6, is reported herein.Case presentationA 3-year-old boy was admitted in the emergency department unit showing fever, abdominal pain and tachycardia. Twenty-four hours after hospitalization the child developed severe clinical symptoms associated with HFMD and was discharged after recovery. Two days later, the child was readmitted with fever, cough and respiratory distress. RT-PCR and Sanger sequencing confirmed positivity for EV-D68 and CVA6 in oro and nasopharynges swabs and vesicles fluid, respectively. Phylogenetic analysis based on VP1 gene sequences suggested that CVA6 was closely related with HFMD viruses circulating in Turkey, while EV-D68 was genetically related to a Chinese strain.ConclusionsTo the best of our knowledge, this case is the first report of a double infection caused by CVA6 and EV-D68, which shed light on the pathogenesis of enterovirus infections. Further studies must be conducted to ascertain the role and clinical significance of EV co-infections, as well as a potential synergistic pathway between these viruses.

【 授权许可】

CC BY