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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Enterovirus 68 differential diagnosis

Introduction

Overview

Overview

Enterovirus 68 infection must be differentiated from other diseases that cause fever, cough, malaise, and rhinorrhea such as respiratory syncytial virus, adenovirus, parainfluenza virus, seasonal influenza virus B, coronavirus, and rhinovirus.

Differential Diagnosis

Differential Diagnosis

Enterovirus 68 infection must be differentiated from other diseases that produce symptoms such as fever, runny nose, sneezing, cough, malaise, chest pain, and diarrhea. Any viral upper respiratory infection must be included in the differential diagnosis of enterovirus 68 infection, and a definitive diagnosis is commonly achieved by PCR assay of a nasopharingeal or oral swab specimen[1][2]

Differential Diagnosis for Enterovirus 68 Infection[1][2][3]
  • Human metapneumovirus
Differentiating Acute Flaccid Myelitis From Other Diseases

Differentiating Acute Flaccid Myelitis From Other Diseases

The following table differentiates acute flaccid myelitis due to EV-D68 from other diseases that cause muscle weakness, hypotonia, and flaccid paralysis:

Diseases History and Physical Diagnostic tests Other Findings
Motor Deficit Sensory deficit Cranial nerve Involvement Autonomic dysfunction Proximal/Distal/Generalized Ascending/Descending/Systemic Unilateral (UL)

or Bilateral (BL)

or

No Lateralization (NL)

Onset Lab or Imaging Findings Specific test
Adult Botulism + – + + Generalized Descending BL Sudden Toxin test Blood, Wound, or Stool culture Diplopia, Hyporeflexia, Hypotonia, possible respiratory paralysis
Infant Botulism + – + + Generalized Descending BL Sudden Toxin test Blood, Wound, or Stool culture Flaccid paralysis (Floppy baby syndrome), possible respiratory paralysis
Guillian-Barre syndrome[4] + – – – Generalized Ascending BL Insidious CSF: ↑Protein

↓Cells

Clinical & Lumbar Puncture Progressive ascending paralysis following infection, possible respiratory paralysis
Eaton Lambert syndrome[5] + – + + Generalized Systemic BL Intermittent EMG, repetitive nerve stimulation test (RNS) Voltage gated calcium channel (VGCC) antibody Diplopia, ptosis, improves with movement (as the day progresses)
Myasthenia gravis[6] + – + + Generalized Systemic BL Intermittent EMG, Edrophonium test Ach receptor antibody Diplopia, ptosis, worsening with movement (as the day progresses)
Electrolyte disturbance[7] + + – – Generalized Systemic BL Insidious Electrolyte panel ↓Ca++, ↓Mg++, ↓K+ Possible arrhythmia
Organophosphate toxicity[8] + + – + Generalized Ascending BL Sudden Clinical diagnosis: physical exam & history Clinical suspicion confirmed with RBC AchE activity History of exposure to insecticide or living in farming environment. with : Diarrhea, Urination, Miosis, Bradycardia, Lacrimation, Emesis, Salivation, Sweating
Tick paralysis (Dermacentor tick)[9] + – – – Generalized Ascending BL Insidious Clinical diagnosis: physical exam & history – History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area)
Tetrodotoxin poisoning[10] + – + + Generalized Systemic BL Sudden Clinical diagnosis: physical exam & dietary history – History of consumption of puffer fish species.
Stroke[11] +/- +/- +/- +/- Generalized Systemic UL Sudden MRI +ve for ischemia or hemorrhage MRI Sudden unilateral motor and sensory deficit in a patient with a history of atherosclerotic risk factors (diabetes, hypertension, smoking) or atrial fibrillation.
Poliomyelitis[12] + + + +/- Proximal > Distal Systemic BL or UL Sudden PCR of CSF Asymmetric paralysis following a flu-like syndrome.
Transverse myelitis[13] + + + + Proximal > Distal Systemic BL or UL Sudden MRI & Lumbar puncture MRI History of chronic viral or autoimmune disease (e.g. HIV)
Neurosyphilis[14][15] + + – +/- Generalized Systemic BL Insidious MRI & Lumbar puncture CSF VDRL-specifc

CSF FTA-Ab -sensitive[16]

History of unprotected sex or multiple sexual partners.

History of genital ulcer (chancre), diffuse maculopapular rash.

Muscular dystrophy[17] + – – – Proximal > Distal Systemic BL Insidious Genetic testing Muscle biopsy Progressive proximal lower limb weakness with calf pseudohypertrophy in early childhood. Gower sign positive.
Multiple sclerosis exacerbation[18] + + + + Generalized Systemic NL Sudden ↑CSF IgG levels

(monoclonal)

Clinical assessment and MRI [19] Blurry vision, urinary incontinence, fatigue
Amyotrophic lateral sclerosis[20] + – – – Generalized Systemic BL Insidious Normal LP (to rule out DDx) MRI & LP Patient initially presents with upper motor neuron deficit (spasticity) followed by lower motor neuron deficit (flaccidity).
Inflammatory myopathy[21] + – – – Proximal > Distal Systemic UL or BL Insidious Elevated CK & Aldolase Muscle biopsy Progressive proximal muscle weakness in 3rd to 5th decade of life. With or without skin manifestations.
References

References

  1. ↑ 1.0 1.1 Lu, Q.-B.; Wo, Y.; Wang, H.-Y.; Wei, M.-T.; Zhang, L.; Yang, H.; Liu, E.-M.; Li, T.-Y.; Zhao, Z.-T.; Liu, W.; Cao, W.-C. (2013). “Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China”. Journal of Medical Microbiology. 63 (Pt_3): 408–414. doi:10.1099/jmm.0.068247-0. ISSN 0022-2615.
  2. ↑ 2.0 2.1 Lekana-Douki, Sonia; Nkoghe, Dieudonné; Drosten, Christian; Ngoungou, Edgar; Drexler, Jan; Leroy, Eric M (2014). “Viral etiology and seasonality of influenza-like illness in Gabon, March 2010 to June 2011”. BMC Infectious Diseases. 14 (1): 373. doi:10.1186/1471-2334-14-373. ISSN 1471-2334.
  3. ↑ Jacobson, Lara M.; Redd, John T.; Schneider, Eileen; Lu, Xiaoyan; Chern, Shur-Wern W.; Oberste, M. Steven; Erdman, Dean D.; Fischer, Gayle E.; Armstrong, Gregory L.; Kodani, Maja; Montoya, Jennifer; Magri, Julie M.; Cheek, James E. (2012). “Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children”. The Pediatric Infectious Disease Journal. 31 (3): 309–312. doi:10.1097/INF.0b013e3182443eaf. ISSN 0891-3668.
  4. ↑ Talukder RK, Sutradhar SR, Rahman KM, Uddin MJ, Akhter H (2011). “Guillian-Barre syndrome”. Mymensingh Med J. 20 (4): 748–56. PMID 22081202.
  5. ↑ Merino-Ramírez MÁ, Bolton CF (2016). “Review of the Diagnostic Challenges of Lambert-Eaton Syndrome Revealed Through Three Case Reports”. Can J Neurol Sci. 43 (5): 635–47. doi:10.1017/cjn.2016.268. PMID 27412406.
  6. ↑ Gilhus NE (2016). “Myasthenia Gravis”. N Engl J Med. 375 (26): 2570–2581. doi:10.1056/NEJMra1602678. PMID 28029925.
  7. ↑ Ozono K (2016). “[Diagnostic criteria for vitamin D-deficient rickets and hypocalcemia-]”. Clin Calcium. 26 (2): 215–22. doi:CliCa1602215222 Check |doi= value (help). PMID 26813501.
  8. ↑ Kamanyire R, Karalliedde L (2004). “Organophosphate toxicity and occupational exposure”. Occup Med (Lond). 54 (2): 69–75. PMID 15020723.
  9. ↑ Pecina CA (2012). “Tick paralysis”. Semin Neurol. 32 (5): 531–2. doi:10.1055/s-0033-1334474. PMID 23677663.
  10. ↑ Bane V, Lehane M, Dikshit M, O’Riordan A, Furey A (2014). “Tetrodotoxin: chemistry, toxicity, source, distribution and detection”. Toxins (Basel). 6 (2): 693–755. doi:10.3390/toxins6020693. PMC 3942760. PMID 24566728.
  11. ↑ Kuntzer T, Hirt L, Bogousslavsky J (1996). “[Neuromuscular involvement and cerebrovascular accidents]”. Rev Med Suisse Romande. 116 (8): 605–9. PMID 8848683.
  12. ↑ Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J (2010). “Aging and sequelae of poliomyelitis”. Ann Phys Rehabil Med. 53 (1): 24–33. doi:10.1016/j.rehab.2009.10.002. PMID 19944665.
  13. ↑ West TW (2013). “Transverse myelitis–a review of the presentation, diagnosis, and initial management”. Discov Med. 16 (88): 167–77. PMID 24099672.
  14. ↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). “Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients”. J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
  15. ↑ Berger JR, Dean D (2014). “Neurosyphilis”. Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
  16. ↑ Ho EL, Marra CM (2012). “Treponemal tests for neurosyphilis–less accurate than what we thought?”. Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
  17. ↑ Falzarano MS, Scotton C, Passarelli C, Ferlini A (2015). “Duchenne Muscular Dystrophy: From Diagnosis to Therapy”. Molecules. 20 (10): 18168–84. doi:10.3390/molecules201018168. PMID 26457695.
  18. ↑ Filippi M, Preziosa P, Rocca MA (2016). “Multiple sclerosis”. Handb Clin Neurol. 135: 399–423. doi:10.1016/B978-0-444-53485-9.00020-9. PMID 27432676.
  19. ↑ Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). “Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group”. Arch Neurol. 51 (1): 61–6. PMID 8274111.
  20. ↑ Riva N, Agosta F, Lunetta C, Filippi M, Quattrini A (2016). “Recent advances in amyotrophic lateral sclerosis”. J Neurol. 263 (6): 1241–54. doi:10.1007/s00415-016-8091-6. PMC 4893385. PMID 27025851.
  21. ↑ Michelle EH, Mammen AL (2015). “Myositis Mimics”. Curr Rheumatol Rep. 17 (10): 63. doi:10.1007/s11926-015-0541-0. PMID 26290112.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]