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Williams on Emerging Viral Infections


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The DFTB team are really excited to announce an upcoming video series…We have teamed up with APLS to share the videos from their Paediatric Acute Care Conferences. These videos have never been open access before, so if you weren’t able to attend the conferences, then now’s your chance to catch up.

We will be sharing the videos from the last couple of conferences (2013 and 2014), and following the upcoming 2015 PAC Conference at the end of October we will be able to share the presentations from there too.

The PAC Conference is run each year by APLS and consists of presentations on a range of topics relevant to paediatric acute and critical care.

First up, we have Gary Williams on Emerging Viral Infections.

Gary Williams is a Staff Specialist in PICU at Sydney Children’s Hospital and is one of my former bosses. In this talk he shares his knowledge about three viruses: enterovirus 71; parechovirus; and MERS coronavirus.

You can watch the full video below, and we’ve added a few key points underneath the video.


Enterovirus – key points

  • Gary Williams discusses the range of presentations and complications, with specific focus on Enterovirus 71 and why it’s important.
  • In Taiwan, for example, Enterovirus 71 is a dominant causes of children admitted to hospital with severe infection and encephalitis.
  • Enterovirus 71 can mutate and evolve rapidly which has epidemiological implications
  • Transmitted by the faecal-oral route but also contact with droplets and can be present in stool for up to 3 months.
  • Most common manifestation is hand, foot, and mouth disease, but it has a broad range of other presentations.
  • Complications include aseptic meningitis, brainstem encephalitis and fulminant pulmonary oedema, and acute flaccid paralysis.
  • Myoclonic twitching, lethargy, and nausea seem to indicate a higher risk for deterioration.
  • There are no antiviral drugs active against Enterovirus 71; IVIG is used but with no real evidence for its effect; milrinone can be helpful in the acute management as an ionodilator.
  • Those patients with neurogenic pulmonary oedema have major morbidity in most survivors.
  • Predictors for severe disease include young age (<18 months), peak temp of 38.5oC or more, fever for three days, history of lethargy, hyperglycaemia and marked leukocytosis, tachycardia, and troponin quantitation.


Parechovirus – key points

  • 90% of children have been infected by the age of 2 years.
  • Often minimally symptomatic or unrecognised, however at other times it can have sepsis-like presentations, abdominal distension, hepatitis, or encephalitis.
  • Diagnosis is by PCR (best in stool).
  • Treatment is supportive, but sometimes requires circulatory and ventilatory support, inotropes, and albumin.
  • Parechovirus 3 is usually responsible for neonatal disease.
  • Encephalitis tends to cause white matter changes with later gliosis.


MERS Coronavirus – key points

  • Initially was thought to have a mortality of over 70%, but later work has shown that mortality is around 30% (WHO, 2014).
  • Risk of transmission of severe disease to household contacts is <5%.
  • Most cases are in Saudi Arabia, Jordan,  and the UAE.
  • MERS is different to SARS coronavirus.
  • Bats are a reservoir for MERS and camels are an intermediate host.
  • SARS had an overall lower mortality (15%).
  • Both MERS and SARS are not paediatric diseases.
  • Make sure you take an accurate travel history and consider in the differential diagnosis of community acquired pneumonia
  • Avoid contact with camels, camel urine, or drinking camel milk.



About the authors

  • Tessa Davis is a Consultant in Paediatric Emergency Medicine at the Royal London Hospital and a Senior Lecturer at Queen Mary University of London.


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