Diagnosing EV-D68The nation is grappling with an outbreak of enterovirus D68 (EV-D68), which has affected nearly 700 people in 46 states and the District of Columbia from mid-August to October 10, 2014. Infectious diseases physicians are calling EV-D68 even more dangerous than Ebola. Enterovirus D68 (EV-D68) causes respiratory illness. Symptoms range from fever, runny nose, sneezing, cough, wheezing and body and muscle aches to severe infections that require hospitalization. What is worrying is that there are no vaccines or antiviral treatments for EV-D68.Only CDC and some state health departments can perform testing for EV-D68. According to a recent report, the CDC’s Division of Viral Diseases has developed a new test for EV-D68 that specifically detects the virus and is providing results faster – in two days instead of one week.

CDC advises healthcare providers to consider this virus as a possible cause of acute, unexplained severe respiratory illness.Typically, infants, children, and teenagers are more susceptible to enterovirus infections. Adults can get infected too but are more likely to have no symptoms or mild symptoms. CDC recommends that clinicians only consider EV-D68 testing for patients with severe respiratory illness and when the cause is unclear.

In addition to being aware that outbreaks of severe respiratory illness and possibly neurologic symptoms especially in young children are a sign of EV-D68, healthcare providers should consider laboratory testing to differentiate between enterovirus infections and other viral infections. Imaging studies, echocardiography, or lumbar puncture are other diagnostic tests that may be recommended to establish the extent of infection. Cases and outbreaks of severe acute respiratory illnesses and/or acute neurological abnormalities should be reported.

Diagnosis and Testing

The only way EV-D68 can be diagnosed is by doing specific lab tests on specimens from a person’s nose and throat. As of now, this is done only by CDC and a few state labs. While many hospitals and some commercial or clinical diagnostic laboratories can perform tests to detect enterovirus infection in patients who are ill, most cannot do the specific test to determine EV-D68 or other types of enteroviruses. The tests that clinical labs can do are only specific enough to report positive results as ‘entero-rhinovirus’ or ‘human rhinovirus/enterovirus’.

The testing protocol for EV-D68 is a two-step process:

  • Real-time reverse transcription polymerase chain reaction (rRT-PCR) testing for enterovirus
  • Sequence analysis to identify EV-D68, i.e., partial sequencing of the structural protein genes, VP4-VP2 or VP1

Accurate realtime PCR magnifies enterovirus D68 in samples. By identifying the genetic material of the virus, the PCR testing format allows the virus it to be detected accurately and inexpensively.

Medical Laboratory Products for Infectious Diseases Care

With diseases such as EV-D68, influenza and Ebola on the rise, laboratory equipment manufacturers can expect to see a rise in demand for diagnostic devices to test for infectious disease pathogens. The CDC has asked physicians to send in throat swabs, spinal fluid, blood and other samples for testing. Clinicians should follow CDC’s instructions for reporting, collecting and shipping specimens for enterovirus D68.

PCR instruments, reagents and several components are necessary to perform PCR. High quality microscopes are required for the diagnosis of infectious diseases as microscopic examination of clinical specimens is one the rapid methods in diagnostic microbiology. Safe and efficient blood collection kits are necessary for proper collection of blood samples.

Avoiding contact with infected people, adhering to good sanitation practices, washing hands, and using superior quality disinfectants on potentially contaminated surfaces can help prevent non-polio enterovirus infection.