SESSION TYPE: Critical Care Student/Resident Case Report Posters II
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Enterovirus (EV) and Human rhinovirus(HRV), belong to the Picornaviridae family and most commonly cause acute respiratory tract illness(RTI) in the pediatric age group. Chronic airway disease and immunocompromise predispose to pneumonia, bronchitis, bronchiolitis and trachietis. For community acquired pneumonia (CAP), their disease spectrum ranges from mild upper RTI most commonly to severe lower RTI requiring mechanical ventilation. So far, only a handful of adult cases have been reported, all of whom had either chronic lung disease or were immunocompromised.
CASE PRESENTATION: 20 year old male presented with worsening cough for 2 weeks. He presented a week prior with gastrointestinal (GI)symptoms and had been diagnosed with gastroenteritis. This visit prompted a workup for Legionella pneumonia among other pathogens. CXR showed patchy infiltrates over bilateral lung fields and pneumomediastinum. Lab work was within normal limits on admission. He rapidly decompensated requiring emergent intubation. Repeat CXR was suggestive of ARDS and hypoxic respiratory failure on arterial blood gas. Workup included Sputum stain and culture including acid fast bacilli, respiratory virus panel, PCR for pertussis, urine legionella and strep antigen, blood cultures, ricketsial antibody screen and leptospira antibody, HIV Elisa. Patient was covered with broad spectrum antibiotics empirically: Piperacillin-tazobactum, Vancomycin, Gentamycin and Azithromycin. Positive labwork included an escalating neutrophilic leucocytosis and positive PCR for HRV/Enterovirus. Antibiotics were discontinued and patient improved dramatically within 72hours. Patient was successfully extubated with no subsequent complications and diagnosed with EV-HRV CAP with ARDS. The pneumomediastinum present on admission was likely secondary to violent coughing that the patient had presented with.
DISCUSSION: In the United States, 2 systems are commonly used for detection of multiple viral pathogens from pharyngeal swabs: Luminex xTAG Respiratory Virus panel and Idaho Technologies. These systems use PCR for detection of Influenza viruses, Respiratory syncytial virus, Human metapneumovirus , Adenovirus and HRV/EV. Both systems utilize reactive primers for RNA amplification from HRV or EV reporting the results as a combined positive in contrast to Reverse transcription- polymerase chain reaction which identifies Human EV 68 separately. As stated earlier, these viruses commonly affect the pediatric age group, patients with chronic lung disease and those who might be immunocompromized likeHIV positive, transplant patients or those with leukemias. Disease spectrum is variable but severe disease requiring mechanical ventilation is rare, even more so in healthy young adults, like the case we present.
CONCLUSIONS: As Above
1) Clusters of Acute Respiratory Illness Associated With Human Enterovirus 68-Asia, Europe, and USA, 2008-2010. Centers for Disease Control and Prevention. September 2011.
DISCLOSURE: The following authors have nothing to disclose: Pratik Dalal, Divyashree Varma
No Product/Research Disclosure InformationSUNY-Upstate Medical University, Syracuse, NY