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SIMULTANEOUS ENTEROVIRUS EV-D68 AND CVA6 INFECTIONS CAUSING ACUTE RESPIRATORY DISTRESS SYNDROME AND HAND, FOOT AND MOUTH DISEASE
Enterovírus
Doença da febre aftosa
Síndrome do desconforto respiratório agudo
CVA6
Hand, foot and mouth disease
Acute respiratory distress syndrome
EV-D68
CVA6
Autor
Afiliación
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Enterovirus. Rio de Janeiro, RJ, Brasil.
Hospital Pequeno Príncipe. Divisão de Epidemiologia. Curitiba, PR, Brasil.
Universidade Federal Do Paraná. Laboratório de Virologia. Curitiba, PR, Brasil.
Secretaria de Saúde do Estado do Paraná. Laboratório de Saúde Pública. Curitiba, PR, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Vírus Respiratórios e do Sarampo. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Enterovirus. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Enterovirus. Rio de Janeiro, RJ, Brasil.
Hospital Pequeno Príncipe. Divisão de Epidemiologia. Curitiba, PR, Brasil.
Universidade Federal Do Paraná. Laboratório de Virologia. Curitiba, PR, Brasil.
Secretaria de Saúde do Estado do Paraná. Laboratório de Saúde Pública. Curitiba, PR, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Vírus Respiratórios e do Sarampo. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Enterovirus. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Enterovirus. Rio de Janeiro, RJ, Brasil.
Resumen en ingles
Background: 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, coinfected with EV-D68 and CVA6, is reported herein.
Case presentation: 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 confrmed positivity for EV-D68 and CVA6 in oro and nasopharynges
swabs and vesicles fuid, 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.
Conclusions: To the best of our knowledge, this case is the frst 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 signifcance of EV co-infections, as well as a potential synergistic pathway between these
viruses.
Palabras clave en portugues
EV-D68Enterovírus
Doença da febre aftosa
Síndrome do desconforto respiratório agudo
CVA6
Palabras clave en ingles
EnterovirusHand, foot and mouth disease
Acute respiratory distress syndrome
EV-D68
CVA6
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