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

• Published in: Virology journal Vol. 18; no. 1; p. 88
• Main Authors: de Sousa, Jr, Ivanildo Pedro, Giamberardino, Heloísa Ihle, Raboni, Sonia Mara, Debur, Maria Carmo, de Lourdes Aguiar Oliveira, Maria, Burlandy, Fernanda Marcicano, da Silva, Edson Elias
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30.04.2021; BioMed Central; BMC
• Subjects: Acute respiratory distress syndrome; Care and treatment; Case Report; Case studies; Central nervous system; Child, Preschool; Cough; CVA6; Diagnosis; Emergency medical care; Enterovirus; Enterovirus - genetics; Enterovirus D, Human; Enterovirus diseases; Enterovirus Infections - complications; Enterovirus Infections - diagnosis; EV-D68; Fever; Hand, foot and mouth disease; Hand, Foot and Mouth Disease - complications; Hand, Foot and Mouth Disease - diagnosis; Humans; Hypertension; Infections; Influenza; Laboratories; Male; Myocarditis; Pediatrics; Phylogenetics; Phylogeny; Polymerase chain reaction; Respiratory diseases; Respiratory distress syndrome; Respiratory Distress Syndrome - virology; Respiratory Tract Infections - virology; Severe acute respiratory syndrome; Tachycardia; Trees; Ventilators; Viruses; VP1 protein; Brazil; Acute respiratory distress syndrome; Hand, foot and mouth disease; Enterovirus; EV-D68; CVA6
• ISSN: 1743-422X; 1743-422X
• DOI: 10.1186/s12985-021-01560-w

Although 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. A 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. To 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.