Differentials
Rhinovirus infection
SIGNS / SYMPTOMS
No differentiating signs/symptoms.
Enterovirus D68 (EV-D68) should be considered in patients testing positive for rhinovirus who have severe lower respiratory disease or asthma exacerbation.
INVESTIGATIONS
Molecular tests for rhinovirus frequently cross-react with enterovirus and do not distinguish the closely related EV-D68.[13]
Specific testing for EV-D68 is performed with rRT-PCR assay or molecular sequencing.[35] In the US, specific testing can be obtained on a case-by-case basis through state or local health departments, or the Centers for Disease Control and Prevention (CDC).[35]
Seasonal influenza infection
SIGNS / SYMPTOMS
Patients present with fever (patients with enterovirus D68 [EV-D68] are often afebrile). Usually presents in winter-time. Distinguishing EV-D68 from influenza is of clinical importance because specific antivirals are available to treat influenza.
INVESTIGATIONS
Respiratory viral testing for influenza.
Respiratory syncytial virus infection
SIGNS / SYMPTOMS
A frequent cause of moderate to severe respiratory disease in children, and bronchiolitis in infants.
INVESTIGATIONS
Respiratory viral testing for respiratory syncytial virus.
Poliovirus infection
SIGNS / SYMPTOMS
Patients present with decreased tone and motor function, decreased tendon reflexes, and muscle atrophy of the affected limb.
INVESTIGATIONS
Stool, cerebrospinal fluid, or pharynx viral testing for poliovirus.
Other nonpolio enteroviruses
SIGNS / SYMPTOMS
Patients present with acute limb weakness, with decreased tone, and motor function.
INVESTIGATIONS
Stool, cerebrospinal fluid, serum, and nasopharyngeal/oropharyngeal swab for enterovirus testing.
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