The enterovirus D68 (EV-D68) infection began as a quickly spreading respiratory disease, but is now believed to be causing neurological issues-including partial paralysis for one Washtenaw County child.
The EV-D68 virus spreads relatively easily and cases have been reported in 41 states and Washington D.C. There is no vaccine for the virus and doctors are working to find treatments that will help with the more severe symptoms.
EV-D68 symptoms include mild ones such as fever, runny nose, sneezing, cough, and body and muscle aches, and more severe symptoms such as wheezing and difficulty breathing, according the the Centers for Disease Control and Prevention.
'We have put out info to health care providers about what we know so far,' Washtenaw County Public Health spokeswoman Susan Cerniglia said. 'We're asking them to tell us about these cases if they're seeing them to make sure they're connected to state and federal authorities.'
Dr. Marie Lozon, division director of pediatric emergency medicine at University of Michigan's C.S. Mott Children's Hospital, said that the one confirmed case of EV-D68 in Washtenaw County is being cared for at Mott. The patient is a 7-month old infant who has limb paralysis.
'It does appear that cases with the limb weakness going on are being prioritized and returned more quickly,' Cerniglia said. 'There are some other cases that have been sent out for testing but we only have the one confirmation so far.'
The hospital has sent four other samples to the CDC from children who have been exhibiting neurological symptoms similar to the infant with partial paralysis. The Michigan Department of Community Health reported Tuesday that 25 of 34 tests completed on patients from the state have come back positive.
Lozon said that if parents notice their child is unable to stand or walk properly, or is clearly not using one of his or her extremities, they should be bring them into the emergency department.
'They can see a primary care physician if they're not sure, but if they notice that their child is having trouble moving an arm or a leg we would be happy to see them,' Lozon said.
There is no cure for the EV-D68 virus, but hospitals have been providing supportive care to patients with neurological and respiratory symptoms of the infection.
'If the child has a flaccid paralysis, meaning that the limb just hangs there or that the limb is very weak, you must provide external muscle conditioning to prevent the muscle from atrophying,' Lozon, who also serves as the associate chief of staff of the University of Michigan Health System, said.
'We've been providing physical therapy to our patients who are having muscle issues.'
Further treatments have been experimental, with doctors attempting to use medications that work for similar symptoms but with different root causes.
'We don't know what works yet,' Lozon said.
'We have colleagues around the country dealing with it and trying different things. Some IV medicines being tried, but no one knows for certain whether they will absolutely work.'
The Centers for Disease Control and Prevention in Atlanta, Georgia, is responsible for coordinating the country's response to major disease outbreaks and has been actively monitoring both the spread of the disease and the efficacy of different treatments being used.
'As the CDC gathers the deep details on these kids in Colorado, here and in other places, they'll see which kids are recovering, their ages, what their characteristics they have and what's working,' Lozon said.
'The people taking care of these children are in communication with each other and with the CDC.'
Only a very small percentage of people infected by the virus exhibit neurological symptoms such as paralysis. The much more common symptoms among children are difficulty breathing and other respiratory issues.
'These children come in and they sound as if they're having a very bad asthma attack,' Lozon said. 'They breathe fast and hard, often wheezing and with low oxygen levels.'
Dr. Anurag Malani, medical director for infection prevention and control at the St. Joseph Mercy Health System, said that her hospital also has several suspected cases of the viral infection but are waiting for confirmation from the CDC to hear if they are EV-D68.
Lozon said that the children coming in with respiratory illnesses have a wide range in the severity of their symptoms. Some children are able to leave the hospital after a few hours of treatment, while others can remain in intensive care units for multiple days.
'We have had one child that we had to put on extra-corporal life support,' she said. 'Many other children have required intensive care with medication given though aerosols mixed with extra oxygen.'
Malani said that the range of treatments can include supplemental oxygen, hydration, nebulizers and inhaled steroids.
Mott Hospital has seen a 25 to 30 percent increase in respiratory diseases over the past few weeks, and Lozon said she believes much of that is attributable to the EV-D68 virus.
'We have a basic test that we do here in the hospital that can tell us if the patient is infected with an enterovirus or rinovirus,' she said.
'So if the child does have an entero or rinoviral infection and is exhibiting the symptoms common to this viral strain we are assuming that they have the EV-D68. We only send the swab to the CDC if there's a special need to know with certainty if they have the virus.'
Cerniglia said that data gathered by the CDC and state health departments across the country has shown that children with asthma or other lung problems are at greater risk for contracting the respiratory symptoms associated with the infection.
'We don't know yet for the limb weakness or paralysis whether there are any similar markers,' she said. 'This is a rare but not necessarily unanticipated consequence of this type of infection.'
All medical professionals in the area have been preaching the importance of good hygiene in dealing with the outbreak.
'The best thing we can do is make sure we're preventing this, and lots of other bugs and germs, with good hand washing and staying away from people when you're sick,' Cerniglia said.
Ben Freed is a general assignments reporter for The Ann Arbor News. Email him at benfreed@mlive.com and follow him on twitter at @BFreedinA2. He also answers the phone at 734-623-2528.
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Entities 0 Name: Lozon Count: 8 1 Name: CDC Count: 6 2 Name: Cerniglia Count: 3 3 Name: Washtenaw County Count: 2 4 Name: Centers for Disease Control and Prevention Count: 2 5 Name: University of Michigan Health System Count: 1 6 Name: University of Michigan Count: 1 7 Name: Dr. Anurag Malani Count: 1 8 Name: The Ann Arbor News Count: 1 9 Name: Dr. Marie Lozon Count: 1 10 Name: Malani Count: 1 11 Name: C.S. Mott Children 's Hospital Count: 1 12 Name: Susan Cerniglia Count: 1 13 Name: St. Joseph Mercy Health System Count: 1 14 Name: Atlanta Count: 1 15 Name: Georgia Count: 1 16 Name: Michigan Department of Community Health Count: 1 17 Name: Washtenaw County Public Health Count: 1 18 Name: Mott Hospital Count: 1 19 Name: Washington D.C. Count: 1 20 Name: Colorado Count: 1 21 Name: Mott Count: 1 Related 0 Url: http://ift.tt/YTSoCG Title: First Reported Death From Enterovirus Description: On Wednesday, the Rhode Island Health Department confirmed that a local child died last week from complications involving an unusual respiratory virus that has been afflicting children nationwide. The 10-year-old girl, identified as Emily Ortrando, died due to complications from an enterovirus 68 (sometimes referred to as EV-D68) infection combined with a staph infection.
