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A5348 - Does Aspiration Worsen Enterovirus Infection and Lead to Type 1 Respiratory Failure in Non-Immunocompromised Adults? A Case Series
Author Block: P. Macauley1, A. A. Abbasi1, J. Samaroo-Campbell1, O. B. Taha2, Y. Kupfer2, C. Seneviratne2; 1Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States, 2Pulmonary and Critical Care, Maimonides Medical Center, Brooklyn, NY, United States.
Introduction Enterovirus infection usually presents as mild upper respiratory tract infection in adults but can cause severe illness in children and immunocompromised adults. We present four cases of acute respiratory failure with suspected aspiration pneumonia and enterovirus detection on respiratory swab during the month of October. Case presentation Patient 1: 64 year old male with a history of coronary artery disease presents with cough, pleuritic chest pain cough, fever, shortness of breath and confusion for two days. At presentation he was hypoxic with chest radiograph finding of right middle and lower lobe infiltrate. Course and Outcome: mechanical ventilation and tracheostomy. Patient 2: 32 year old female with history of mood and seizure disorder presents after being found unresponsive on the floor incontinent of urine with vomitus in the vicinity and had a prodrome of cough productive of yellow sputum. At presentation she was hypoxic and febrile. CT chest: near complete atelectasis of right middle, right lower and left lower lobe with heterogeneity likely superimposed infectious process. Course and outcome: high flow oxygen therapy and complete recovery. Patient 3: 93 year old male with a history of treated colon cancer presents with fevers, malaise and chills. On presentation patient was febrile and hypoxic. Chest radiography: bilateral pleural effusions, left lower lung filed opacification. Course and outcome: failed dysphagia evaluation. Initiation of high flow oxygen therapy followed by intubation, mechanical ventilation and successful liberation. Patient 4: 82 year old male with a history of early Parkinson’s disease and dysphagia due to a cricopharyngeal bar presents with cough and vomiting. At presentation patient was hypotensive and hypoxic. Course and outcome: non-invasive positive pressure ventilation followed by oxygen therapy via nasal cannula and full recovery. Conclusion Enteroviruses belong to the picornaviridae family and are single stranded RNA viruses that mostly cause self-limiting illnesses with prominent summer-fall seasonality in temperate climates. All our patients had negative bacterial respiratory cultures and had risk factors that predispose to aspiration such as a change in mental status, vomiting or dysphagia. We suspect that colonisation of the upper respiratory tract with enterovirus and subsequent aspiration can lead to a more severe presentation of respiratory failure in an otherwise healthy host. Reference Braccio S, Kapetanstrataki M, Sharland M, Ladhani SN. 2017. Intensive Care Admissions for Children with Enterovirus and Human Parechovirus Infections in the United Kingdom and The Republic of Ireland, 2010-2014. Pediatr Infect Dis J. 36(3):339-342