Enteroviruses are RNA viruses that include the groups Coxackie A & B, Echoviuses, and Enteroviruses. They are common etiologies of illness in the pediatric age group.
Epidemiology
1. spread by fecal oral and respiratory routes. There may also
be vertical transmission from delivering mothers to their newborns.
2. The viruses can live for long periods of time on fomites.
3. Infections are more common in the lower socio-economic groups
4. In the temperate zones, infections are more common in summer and
early fall.
5. Shedding may occur for many weeks after infection and the incubation
period is 3-6 days.
6. Different members of a family may manifest different symptoms and
disease with the same virus.
7. Contact Isolation in hospital
Clinical Manifestations
1. Non-specific febrile illness with an abrupt onset often associated
with a headache. Lasts 2-4 days
2. Conjunctivitis
3. Hand Foot Mouth Syndrome- Presence of papular vesicular lesions in the mouth and the palms and soles. May have fever and trouble swallowing. Most often coxsackie A16 but others types as well.
4. Pharyngitis
5. Herpangina- presence of fever and pain on swallowing. Average number of discrete papular vesicular lesions on the posterior pharynx.is 5.
6. Non-specific rash
7. Myocarditis and pericarditis
8. Pleurodynia- abrupt onset of chest pain with spasmodic episodes. May mimic myocardial infarction
9. Gastrointestinal illness with vomiting, diarrhea, and abdominal pain
10. Aseptic meningitis- headache, vomiting, photophobia, stiff neck. Initial spinal fluid findings may have a predominance of polys with normal glucose, elevated protein, and negative gram stain and subsequent culture.
11. Neonatal sepsis picture- may be confused with bacterial sepsis and usually secondary to vertical transmission from mother. May manifest with CNS, cardiac, pulmonary, and liver disease.
Diagnosis
1. Culture of virus from the throat, stool, rectal swab, and CSF
2. Serology of limited use because need acute and convalescent serum
3. PCR
Treatment
1. Usually self limited and symptomatic treatment. Antipyretics,
pain relief, and fluids.
2. IVIG- has been tried but clinical trials have not shown advantage
over symptomatic treatment
3. Pleconaril- not approved by FDA but has been used in clinical trials
for enteroviral meningitis and neonatal infections.