ENTEROVIRUS

INFECTIONS
Submitted by:
Z. A. BORJA
MD-2
 INTRODUCTION

PICORNAVIRUSES
 Represent a very large virus family with
respect to the number of members
 BUT one of the smallest in terms of virion
size and genetic complexity
 INTRODUCTION

PICORNAVIRUSES
Include two major groups of human
pathogens:

 ENTEROVIRUSES
 RHINOVIRUSES
 INTRODUCTION

ENTEROVIRUSES

 POLIOVIRUSES
 COXSACKIE VIRUSES
 ECHOVIRUSES
 EPIDEMIOLOGIC FEATURES

ENTEROVIRUSES
 Occur in all parts of the globe
 Virus is present in sewage during periods
of high prevalence and can serve as a
source of contamination of water used for
drinking, bathing or irrigation
 There is direct correlation between poor
hygiene, sanitation and crowding and the
acquisition of infection and antibodies at
an early age
 EPIDEMIOLOGIC FEATURES

 The last polio case in the Philippines was

recorded in 1993
 In the year 2000 the Philippines was
certified polio-free

Philippine statistics from UNICEF:

Use of improved drinking 92.4
water sources (%) 2011, total

Use of improved drinking 92.7

water sources (%) 2011,
urban

Use of improved drinking 92.1

water sources (%) 2011, rural
 EPIDEMIOLOGIC FEATURES

Philippine statistics from UNICEF:

Use of improved sanitation 74.2
facilities (%) 2011, total

Use of improved sanitation 79.2

facilities (%) 2011, urban

Use of improved sanitation 69.3

facilities (%) 2011, rural

Immunization coverage 86
(%) 2012, polio3
 INFECTIOUS DISEASE
PROCESS

POLIOVIRUS
 INFECTIOUS DISEASE
PROCESS

1. AGENT/ ETIOLOGY:

• Poliovirus (Types 1-3)

2. RESERVOIR:

• Humans— only known

reservoir of
infection
 INFECTIOUS DISEASE
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3. PORTAL OF ENTRY/EXIT:
• Mouth

• Primary multiplication takes place in the

oropharynx or intestine

• Virus regularly present in throat and in stools

before onset of illness

• A week after infection, there is little virus in

throat, but virus continues to be excreted in
stools for several weeks (even when high
antibody levels are present in the blood)
 INFECTIOUS DISEASE
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4. INCUBATION PERIOD:
• Usually 7 -14 days; May range
from 3 - 35 days
5. MODE OF TRANSMISSON
• Highly contagious, easily transmitted through
contaminated water supplies and unsanitized
objects
• Fecal-oral route
• Person-to-person through fecal contamination
and oropharyngeal secretions
 INFECTIOUS DISEASE
PROCESS

6. SUSCEPTIBLE HOST
• Occurs in all age groups, but children
are usually more susceptible than adults
because of the acquired immunity of
the adult population

• Disease of infancy and early childhood

in developing areas where living
conditions favor the wide dissemination
of the virus
 CLINICAL
MANIFESTATIONS

POLIOVIRUS MAY CAUSE THE FOLLOWING:

 Milddisease
 Nonparalytic poliomyelitis (Aseptic meningitis)
 Paralytic poliomyelitis
 Progressive postpoliomyelitis muscle atrophy
 CLINICAL
MANIFESTATIONS

1. MILD DISEASE
 Most common form of disease

 Maymanifest minor illness in various

combinations of the following:
Fever Headache
Malaise Nausea
Drowsiness Vomiting
Sore throat Constipation

 Recovery in a few days

 CLINICAL
MANIFESTATIONS

2. NONPARALYTIC POLIOMYELITIS
 AKA: Aseptic meningitis

 Signs and symptoms of MILD DISEASE

including stiffness and pain in the back and
neck

 Lasts
2-10 days and recovery is rapid and
complete
 CLINICAL
MANIFESTATIONS

3. PARALYTIC POLIOMYELITIS
 Flaccidparalysis resulting from lower motor
neuron damage

 Incoordination secondary to brainstem

invasion

 Painful spasms of nonparalyzed muscles

 Maximal recovery usually occurs within 6

months
 CLINICAL
MANIFESTATIONS

4. PROGRESSIVE POSTPOLIOMYELITIS MUSCLE

ATROPHY

 Recrudescence of paralysis and muscle

wasting in individuals decades after their
experience with paralytic poliomyelitis

 Not a consequence of persistent infection,

rather a result of physiologic aging changes
in paralytic patients already burdened by
loss of neuromuscular functions
 DIAGNOSIS/DIAGNOSTIC
TESTS

 Virus may be recovered from throat swabs

taken soon after onset of illness
 Rectal swabs on stool samples collected over
long periods
 Uncommonly recovered from cerebrospinal
fluid
 Specimens should be kept frozen during transit
to the laboratory
 Virus can be identified by Polymerase Chain
Reaction Assays
 Paired serum specimens are required to show
a rise in antibody titer during the course of the
disease
 TREATMENT

 NO antiviral drugs for the treatment of

poliovirus infection

 Best
care is provided through supportive
measures

 Fluidhydration and antipyretics are mainstays

of care
 CONTROL & PREVENTION
STRATEGIES

 Immunization is the most effective method for

preventing the disease

 All
children should receive vaccination for
poliovirus

 May controlled through proper sanitation and

clean water supplies
 CONTROL & PREVENTION
STRATEGIES

TWO FORMS OF VACCINES ARE AVAILABLE:

1. Inactivated poliovirus vaccine (IPV/ Salk
vaccine)
 Developed by Salk
 Offers immunity without risk of vaccine-
associated paralytic polio (VAPP)
 May be given intramuscularly or
subcutaneously

2. Oral polio vaccine (OPV/ Sabin

vaccine)
 Developed by Sabin
 Consist of live–attenuated poliovirus
 Creates herd immunity through viral
shedding by the intestinal tract
 INFECTIOUS DISEASE
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COXSACKIEVIRUS
 INFECTIOUS DISEASE
PROCESS

1. AGENT/ ETIOLOGY:

• Coxsackievirus (Groups A & B)

2. RESERVOIR:

• Humans
 INFECTIOUS DISEASE
PROCESS

3. PORTAL OF ENTRY/EXIT:
• Mouth

• Virus is found in throat for a few

days early in infection and in stools
for up to 5-6 weeks

4. INCUBATION PERIOD:
• Ranges from 2-9 days
 INFECTIOUS DISEASE
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5. MODE OF TRANSMISSON

• Fecal-oral-route
• Inhalation of infected aerosols
• Spread by direct contact with
nasal and throat secretions from
an infected person
• Recent studies showed that the
virus could be acquired through
water
 INFECTIOUS DISEASE
PROCESS

6. SUSCEPTIBLE HOST
• Children and the immunocompromised
are most sensitive
 CLINICAL
MANIFESTATIONS

COXSACKIEVIRUS MAY CAUSE THE FOLLOWING:

 Range from mild febrile illness to CNS, skin,
cardiac, and respiratory diseases
 Aseptic meningitis
 Hemorrhagic conjunctivitis
 Herpangina
 Hand-foot-and-mouth disease
 Pleurydonia
 Myocarditis
 Generalized disease of infants
 CLINICAL
MANIFESTATIONS

1. ASEPTIC MENINGITIS
 Caused by Group B and Group A coxsackie
viruses

 Common early symptoms:

Fever Nausea
Malaise Abdominal pain
Headache

 May progress to mild muscle weakness

 CLINICAL
MANIFESTATIONS

2. HEMORRHAGIC
CONJUNCTIVITIS
 Infection that affects the sclera
 Begins as eye pain followed by red,
watery eyes with swelling, light
sensitivity and blurred vision
 CLINICAL
MANIFESTATIONS

3. HERPANGINA

 Severe febrile pharyngitis

 Caused by certain Group A coxsackieviruses
 Nothing to do with herpesviruses
 Abrupt onset of fever and sorethroat with
discrete vesicles on posterior half of palate,
pharynx, tonsils and tongue
 Self-limited; frequent on small children
 CLINICAL
MANIFESTATIONS

4. HAND-FOOT-AND-MOUTH DISEASE
 Associated with coxsackievirus
A16 and B1
 Characterized by oral and
pharyngeal ulcerations and
vesicular rash of palms and soles
(may spread to arms and legs)
 Vesicles heal without crusting
(clinically differentiates them
from the vesicles of
herpesviruses and poxviruses)
 NOT to be confused with foot-
and-mouth disease of the cattle
caused by unrelated
picornavirus (does not normally
infect humans)
 CLINICAL
MANIFESTATIONS

5. PLEURYDONIA
 AKA: Epidemic myalgia
 Caused by Group B coxsackieviruses
 Fever and stabbing chest pain (lasts for 2-14
days) are usually abrupt in onset
 Sometimes preceded by headache, malaise
and anorexia
 Abdominal pain occurs in approximately half
of cases (chief complaint in children)
 Self-limited and recovery is complete
 Relapses are common
 CLINICAL
MANIFESTATIONS

6. MYOCARDITIS

 Coxsackievirus B usually cause primary

myocardial disease in adults and children
 Serious disease
 Acute inflammation of the heart or its covering
membranes (pericarditis)
 Fatal in neonates or may cause permanent
heart damage at any age
 CLINICAL
MANIFESTATIONS

7. GENERALIZED DISEASE OF INFANTS

 Caused by Group B coxsackieviruses
 Extremely serious disease
 Infants are overwhelmed by simultaneous viral
infections of multiple organs, including the
heart, liver and brain
 May be rapidly fatal or patient may recover
completely
 May be acquired transplacentally
 DIAGNOSIS/DIAGNOSTIC
TESTS

 Virus can be isolated from throat washings

during the first few days and from stools during
first few weeks
 Reverse transcription Polymerase Chain
Reaction tests can be broadly reactive or
more specific
 Serum antibodies can be detected by
immunofluorescence
 TREATMENT

 NOvaccines or antiviral drugs currently

available for prevention and treatment of
coxsackievirus infections

 Supportive care
 CONTROL & PREVENTION
STRATEGIES

 Properpersonal hygiene and hand washing is

the best protection

 Thoseinfected with the virus are advised to

avoid crowded places (or better to stay at
home) to prevent the spread of the virus
 INFECTIOUS DISEASE
PROCESS

ECHOVIRUS
 INFECTIOUS DISEASE
PROCESS

1. AGENT/ ETIOLOGY:

• Echovirus (Enteric
cryptopathogenic human
orphanvirus)

2. RESERVOIR:
• Humans
 INFECTIOUS DISEASE
PROCESS

3. PORTAL OF ENTRY/EXIT:
• Mouth
• During acute phase of the disease, it
is excreted in feces for weeks after
symptoms have subsided
4. INCUBATION PERIOD:
• Difficult to estimate because both
healthy and symptomatic individuals
spread the virus
• Incubation is believed to range
between 2-14days
 INFECTIOUS DISEASE
PROCESS

5. MODE OF TRANSMISSON
• Fecal-oral-route
• Person-to-person spread is common

6. SUSCEPTIBLE HOST
• More often in younger than older
individuals
• Five times more frequent in children of
lower income families than in those
living in more favorable circumstances
 CLINICAL
MANIFESTATIONS

It was believed that echovirus primarily

caused the following:
 Aseptic meningitis – Echovirus 9 &30
 Acute carditis & Pleurydonia – Echovirus 6 & 19
 Exanthems
 Pericarditis
 Non-specific febrile illness
 Occasional fulminant encephalomyocarditis
of newborn
 Severe fatal encephalits - Echovirus 7
 Brainstem encephalomyelitis – Echovirus7
 Flaccid paralysis – Echovirus 33
 DIAGNOSIS/DIAGNOSTIC
TESTS

 Polymerase Chain Reaction – more rapid than

virus isolation for diagnosis

 Virusisolation may be accomplished from

throat swabs and rectal swabs

 Inaseptic meningitis, cerebrospinal fluid is

tested

 Immunofluorescence or neutralization test to

determine the type of virus
 TREATMENT

 NO antiviral drugs or vaccines available for

treatment or prevention of echovirus infections

 Supportive care
 CONTROL & PREVENTION
STRATEGIES

 Avoidance of contact with patients exhibiting

acute febrile illness is advisable fro very young
children

 Proper personal hygiene, hand washing and

disinfection of surfaces
 UPDATES
September 26, 2014

The CDC is closely monitoring the spread of the EV-

D68 virus in the US and has recommended the
following preventative actions:
 Wash hands often with soap and water for 20
seconds, especially after changing diapers.
 Avoid touching eyes, nose and mouth with
unwashed hands.
 Avoid kissing, hugging, and sharing cups or eating
utensils with people who are sick.
 Disinfect frequently touched surfaces, such as toys
and doorknobs, especially if someone is sick.
 Individuals with asthma are at higher risk for
respiratory illness, the CDC recommends they take
medicines and maintain control of their illness.
They should also take advantage of influenza
vaccine since people with asthma have a difficult
time with respiratory illnesses.
 UPDATES
September 26, 2014
LYSOL works closely with the Centers for Disease Control
and Prevention (CDC) to educate consumers on healthy
habits to prevent the spread of germs, including viruses
that cause respiratory illnesses.

Based on the CDC guidelines for disinfection, the

following LYSOL products can be used as they are likely to
be effective against EV-D68 (when used as directed)

 LYSOL Brand III Disinfectant Spray

 LYSOL Brand Disinfectant All Purpose Cleaner with
Bleach
 LYSOL Brand Mold & Mildew Remover with Bleach
 LYSOL Brand Disinfectant Bathroom Foam Cleaner
 LYSOL Brand Disinfectant Basin, Tub & Tile Cleaner
 LYSOL Toilet bowl Cleaner Lime & Rust Remover
 LYSOL Toilet Bowl Cleaner with Bleach
 LYSOL Toilet Bowl Cleaner Advanced
THANK YOU!