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Pir 37-12 Enterovirus PPT Final PDF
Pir 37-12 Enterovirus PPT Final PDF
Asif Noor, MD
Leonard R. Krilov, MD
Introduction
• Enterovirus (EV) is a member of the family picornaviridae (pico= small).
Parechoviruses (PV) and Saffold viruses (SV) are now grouped with EVs, as they share
certain morphological and functional properties.
• The virion is nonenveloped, spherical, and about 30 nm in diameter, and the genome is a
positive-sense RNA.
• Shedding: Most of the EVs are shed in respiratory secretions for 1-3 weeks and in feces
for 2-8 weeks.
• Incubation period: The period for brief EV febrile illnesses is 1-3 days and for polio
virus is 9-12 days.
• Seasonality: Most EV infections are seen in summer and fall in the temperate northern
hemisphere; the virus circulates throughout the year in the tropics.
Pathogenesis
Herpangina (coxsackievirus) Vesicular eruptions on hand (A), Eczema Coxsackium in a 6-month-old infant
lesions on the posterior palate of a foot (B), and mouth (C) of a 6- with underlying atopic dermatitis and acute
young adult male. year-old boy with coxsackievirus onset of vesicles and erosive rash
A6 infection. Several of his
fingernails shed (D) 2 months after Eczema Coxsackium in a 6-month-old infant with underlying
the initial pictures were taken. atopic dermatitis and acute onset of vesicles and erosive rash
Clinical Presentation
Common clinical syndromes due to a picornavirus infection
Clinical syndrome Viral type Clinical features
Nonspecific febrile All viral types Fevers for 3-4 days, can be biphasic. Minimal respiratory or gastrointestinal
illness symptoms. Normal white blood cell count on CBC.
Aseptic meningitis CV-B5; Echoviruses Fever with meningeal signs. CSF pleocytosis with normal glucose and protein.
4,6,9,13, and 30-33 Good prognosis in majority of the cases.
Acute hemorrhagic EV 70, CV A24 (rare) Sudden onset of eye pain with subconjunctival hemorrhage.
conjunctivitis
Herpangina CV A & B; PV 1 & 6; EV 71; Fevers with painful vesicles or ulcers over posterior palate and/or tonsils.
SV 2 & 3
Hand-foot-mouth CV A (6 & 16) & B; EV71; Fever with painful enanthem (vesicles/ulcers) in mouth and exanthem
disease Echoviruses (vesicles, papular rash), particularly on hands and feet.
Immunocompromised Echovirus 11 Serious and persistent infection in children with defective congenital or acquired B-
hosts lymphocyte function
Poliovirus infection
Acute paralytic disease Poliovirus 1-3 Rapid onset of paralysis occurs after 1-3 days of febrile illness with sore throat,
headache, myalgias. Asymmetric paralysis primarily effects proximal muscles.
Management
• Laboratory diagnosis: EV is diagnosed via polymerase chain reaction (PCR), culture, or serology.
Test Method Sensitivity Specificity
Viral culture (3-8 days) Cell culture 0% to 80% 100%
PCR assay (1-2 hours) -CSF PCR 100% 97%
-Respiratory multiplex PCR Variable Variable
(some report as
rhinovirus/enterovirus)
Serology Microneutralization Limited use because it is relatively insensitive, poorly
standardized, and labor-intensive
• Treatment
o No specific treatment exists to date; supportive care is the mainstay.
o Some evidence supports use of IVIG in neonatal infection or infection in immunocompromised hosts.
o Pleconaril, an antiviral agent, is not licensed and is not available in the United States.