Enterovirus 68 physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}}; {{AE}} {{AL}} | {{CMG}}; {{AE}} {{AL}} | ||
{{Enterovirus 68}} | {{Enterovirus 68}} | ||
==Overview== | ==Overview== | ||
* On physical examination, patients with EV-D68 infection generally develop typical signs of respiratory illness. The most common findings on physical exam include [[fever]], [[tachypnea]], [[skin rash]], erythematous tonsils without exudates, and [[wheezing]]. | |||
==Physical Examination== | ==Physical Examination== | ||
On physical examination, patients with EV-D68 infection may have signs of a mild to moderate acute upper respiratory tract infection.<ref name="CDC">{{cite web| url=http://www.cdc.gov/non-polio-enterovirus/about/symptoms.html| title=CDC Non-Polio Enterovirus Symptoms}}</ref><ref name="LuWo2013">{{cite journal|last1=Lu|first1=Q.-B.|last2=Wo|first2=Y.|last3=Wang|first3=H.-Y.|last4=Wei|first4=M.-T.|last5=Zhang|first5=L.|last6=Yang|first6=H.|last7=Liu|first7=E.-M.|last8=Li|first8=T.-Y.|last9=Zhao|first9=Z.-T.|last10=Liu|first10=W.|last11=Cao|first11=W.-C.|title=Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China|journal=Journal of Medical Microbiology|volume=63|issue=Pt_3|year=2013|pages=408–414|issn=0022-2615|doi=10.1099/jmm.0.068247-0}}</ref><ref name="ImamuraSuzuki2014">{{cite journal|last1=Imamura|first1=Tadatsugu|last2=Suzuki|first2=Akira|last3=Lupisan|first3=Socorro|last4=Kamigaki|first4=Taro|last5=Okamoto|first5=Michiko|last6=Roy|first6=Chandra Nath|last7=Olveda|first7=Remigio|last8=Oshitani|first8=Hitoshi|title=Detection of enterovirus 68 in serum from pediatric patients with pneumonia and their clinical outcomes|journal=Influenza and Other Respiratory Viruses|volume=8|issue=1|year=2014|pages=21–24|issn=17502640|doi=10.1111/irv.12206}}</ref><ref name="PirallaGirello2014">{{cite journal|last1=Piralla|first1=Antonio|last2=Girello|first2=Alessia|last3=Grignani|first3=Michela|last4=Gozalo-Margüello|first4=Monica|last5=Marchi|first5=Antonietta|last6=Marseglia|first6=Gianluigi|last7=Baldanti|first7=Fausto|title=Phylogenetic characterization of enterovirus 68 strains in patients with respiratory syndromes in Italy|journal=Journal of Medical Virology|volume=86|issue=9|year=2014|pages=1590–1593|issn=01466615|doi=10.1002/jmv.23821}}</ref><ref name="JacobsonRedd2012">{{cite journal|last1=Jacobson|first1=Lara M.|last2=Redd|first2=John T.|last3=Schneider|first3=Eileen|last4=Lu|first4=Xiaoyan|last5=Chern|first5=Shur-Wern W.|last6=Oberste|first6=M. Steven|last7=Erdman|first7=Dean D.|last8=Fischer|first8=Gayle E.|last9=Armstrong|first9=Gregory L.|last10=Kodani|first10=Maja|last11=Montoya|first11=Jennifer|last12=Magri|first12=Julie M.|last13=Cheek|first13=James E.|title=Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children|journal=The Pediatric Infectious Disease Journal|volume=31|issue=3|year=2012|pages=309–312|issn=0891-3668|doi=10.1097/INF.0b013e3182443eaf}}</ref><ref name="Meijervan der Sanden2012">{{cite journal|last1=Meijer|first1=Adam|last2=van der Sanden|first2=Sabine|last3=Snijders|first3=Bianca E.P.|last4=Jaramillo-Gutierrez|first4=Giovanna|last5=Bont|first5=Louis|last6=van der Ent|first6=Cornelis K.|last7=Overduin|first7=Pieter|last8=Jenny|first8=Shireen L.|last9=Jusic|first9=Edin|last10=van der Avoort|first10=Harrie G.A.M.|last11=Smith|first11=Gavin J.D.|last12=Donker|first12=Gé A.|last13=Koopmans|first13=Marion P.G.|title=Emergence and epidemic occurrence of enterovirus 68 respiratory infections in The Netherlands in 2010|journal=Virology|volume=423|issue=1|year=2012|pages=49–57|issn=00426822|doi=10.1016/j.virol.2011.11.021}}</ref> | |||
===Vitals=== | ===Vitals=== | ||
| Line 14: | Line 15: | ||
====Pulse==== | ====Pulse==== | ||
*[[Tachycardia]] may be present | *[[Tachycardia]] may be present | ||
====Respiratory Rate==== | ====Respiratory Rate==== | ||
*[[Tachypnea]] may be present | *[[Tachypnea]] may be present | ||
| Line 27: | Line 27: | ||
===Throat=== | ===Throat=== | ||
*[[Erythema]] and inflammation of the [[oropharynx]], [[tonsils]] and [[soft palate]]. | *[[Erythema]] and inflammation of the [[oropharynx]], [[tonsils]], and [[soft palate]]. | ||
*Exudates are usually absent | |||
===Lungs=== | ===Lungs=== | ||
*[[ | *[[Wheezing]] (most common finding on pulmonary auscultation) | ||
*[[Rhonchi]] | *[[Rhonchi]] | ||
*[[Rales]] | *[[Rales]] | ||
===Abdomen=== | ===Abdomen=== | ||
*[[Abdominal tenderness]] may be present | *[[Abdominal tenderness]] may be present among patients who complain of abdominal pain or diarrhea | ||
=== Neurological === | |||
Acute flaccid myelitis may develop in cases of severe infection with EV-D68. The following findings may be found on physical examination: | |||
* Motor loss on the affected side (Lower limbs > upper limbs) | |||
* Decreased [[Deep tendon reflex|deep tendon reflexes]] | |||
* [[Muscle atrophy]] on the affected side | |||
* Reduced [[muscle tone]] | |||
==References== | ==References== | ||
Latest revision as of 18:34, 1 November 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
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Overview
- On physical examination, patients with EV-D68 infection generally develop typical signs of respiratory illness. The most common findings on physical exam include fever, tachypnea, skin rash, erythematous tonsils without exudates, and wheezing.
Physical Examination
On physical examination, patients with EV-D68 infection may have signs of a mild to moderate acute upper respiratory tract infection.[1][2][3][4][5][6]
Vitals
Temperature
- Fever is often present
Pulse
- Tachycardia may be present
Respiratory Rate
- Tachypnea may be present
Skin
Nose
- Nasal discharge
- Nasal flaring (neonates)
Throat
- Erythema and inflammation of the oropharynx, tonsils, and soft palate.
- Exudates are usually absent
Lungs
Abdomen
- Abdominal tenderness may be present among patients who complain of abdominal pain or diarrhea
Neurological
Acute flaccid myelitis may develop in cases of severe infection with EV-D68. The following findings may be found on physical examination:
- Motor loss on the affected side (Lower limbs > upper limbs)
- Decreased deep tendon reflexes
- Muscle atrophy on the affected side
- Reduced muscle tone
References
- ↑ "CDC Non-Polio Enterovirus Symptoms".
- ↑ Lu, Q.-B.; Wo, Y.; Wang, H.-Y.; Wei, M.-T.; Zhang, L.; Yang, H.; Liu, E.-M.; Li, T.-Y.; Zhao, Z.-T.; Liu, W.; Cao, W.-C. (2013). "Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China". Journal of Medical Microbiology. 63 (Pt_3): 408–414. doi:10.1099/jmm.0.068247-0. ISSN 0022-2615.
- ↑ Imamura, Tadatsugu; Suzuki, Akira; Lupisan, Socorro; Kamigaki, Taro; Okamoto, Michiko; Roy, Chandra Nath; Olveda, Remigio; Oshitani, Hitoshi (2014). "Detection of enterovirus 68 in serum from pediatric patients with pneumonia and their clinical outcomes". Influenza and Other Respiratory Viruses. 8 (1): 21–24. doi:10.1111/irv.12206. ISSN 1750-2640.
- ↑ Piralla, Antonio; Girello, Alessia; Grignani, Michela; Gozalo-Margüello, Monica; Marchi, Antonietta; Marseglia, Gianluigi; Baldanti, Fausto (2014). "Phylogenetic characterization of enterovirus 68 strains in patients with respiratory syndromes in Italy". Journal of Medical Virology. 86 (9): 1590–1593. doi:10.1002/jmv.23821. ISSN 0146-6615.
- ↑ Jacobson, Lara M.; Redd, John T.; Schneider, Eileen; Lu, Xiaoyan; Chern, Shur-Wern W.; Oberste, M. Steven; Erdman, Dean D.; Fischer, Gayle E.; Armstrong, Gregory L.; Kodani, Maja; Montoya, Jennifer; Magri, Julie M.; Cheek, James E. (2012). "Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children". The Pediatric Infectious Disease Journal. 31 (3): 309–312. doi:10.1097/INF.0b013e3182443eaf. ISSN 0891-3668.
- ↑ Meijer, Adam; van der Sanden, Sabine; Snijders, Bianca E.P.; Jaramillo-Gutierrez, Giovanna; Bont, Louis; van der Ent, Cornelis K.; Overduin, Pieter; Jenny, Shireen L.; Jusic, Edin; van der Avoort, Harrie G.A.M.; Smith, Gavin J.D.; Donker, Gé A.; Koopmans, Marion P.G. (2012). "Emergence and epidemic occurrence of enterovirus 68 respiratory infections in The Netherlands in 2010". Virology. 423 (1): 49–57. doi:10.1016/j.virol.2011.11.021. ISSN 0042-6822.