Enteroviruses are single-stranded RNA viruses that are transmitted through the fecal-oral route and can cause a variety of mild to severe infections. There are over 100 serotypes including poliovirus, coxsackie virus, and echovirus. Common symptoms include fever, rash, hand-foot-and-mouth disease, myocarditis, aseptic meningitis, and herpangina. Treatment is usually supportive as there are no antiviral medications; prevention relies on good hygiene and vaccination against poliovirus.
2. ๏ Enteroviruses are named because of their ability to
multiply in the gastrointestinal tract.
๏ Single stranded RNA virus
๏ Have no lipid layer and are stable in acidic environments.
๏ There are more than 100 serotypes.
๏ These serotypes include many subtypes of
๏ Polio virus
๏ Coxsackie virus A and B
๏ Echo virus
๏ Entero viruses 68-71
3. ๏ Risk Populations :
๏ Overcrowded
๏ Poor hygienic and poor economic status populations
๏ Immuno compromised patients
๏ Infants and young adults
๏ Transmission:
๏ Faecal-Oral or Oral-Oral route โ common
๏ Nosocomial transmission โ seen in Nursery Homes โ Coxsackie
&Echovirus
๏ Airborne transmission โ Coxsackie A21
๏ Vertical transmission โ Coxsackie virus
๏ Inoculation(from fingers to eye) โ Enterovirus 70
๏ Distribution :
๏ Worldwide distribution
๏ Infections occur often in summer and fall.
4.
5. ๏ Asymptomatic
๏ Non-specific symptoms โ fever, headache, sore throat,
malaise, myalgia, anorexia
๏ Polio infection is presented as
โข Paralytic poliomyelitis โ paralysis usually legs and
arms
โข Vaccine associated poliomyelitis โ seen in patients
with hypo/agammaglobulinemia.
โข Post polio syndrome - a condition that
affects polio survivors years after recovery from an
initial acute attack of the poliomyelitis virus.
6. ๏ It is also known as non-specific febrile illness that includes
symptoms like fever, malaise, headache, nausea, vomiting,
upper respiratory symptoms.
๏ Resolve within a week.
7. ๏ Develop during the first week of life
๏ Resembles bacterial sepsis with fever, irritability and lethargy.
๏ This illness is complicated by
๏ Myocarditis
๏ Hypotension
๏ Disseminated Intravascular Coagulation
๏ Fulminant hepatitis
๏ Meningitis
๏ Pneumonia
8. ๏ Highly infectious
๏ Lesions are seen on the
buccal mucosa, tongue and
dorsum of hand which
resolve within a week.
๏ Infection also associated with
fever, rash and brainstem
encephalitis with myoclonic
jerks.
9. ๏ The virus spreads through the air
๏ The droplets from coughs and sneezes of infected people
๏ By persons with unwashed, virus-contaminated hands and by
contact with virus-contaminated surfaces
๏ Incubation period 3-5 days
10. ๏ Fever
๏ Loss appetite
๏ Sore throat
๏ Fatigue
๏ Painful sores usually develop in the mouth. They begin as
small red spots that blister and then often become
ulcers.
๏ Sores are usually located on the tongue, gums, and
inside of the cheeks.
๏ The rash is usually located on the palms of the hands and
soles of the feet; it may also appear on the buttocks and/or
genitalia.
11. ๏ There is no specific treatment for HFMD.
๏ Symptoms can be treated to provide relief from pain from
mouth sores and from fever and aches.
๏ Fluid intake should be enough to prevent dehydration (lack of
body fluids). If moderate-to-severe dehydration develops, it
can be treated medically by giving fluids through the veins.
12. ๏ Patient present with acute onset of fever and spasms of
pleuritic chest pain or upper abdominal pain.
๏ Chest pain in adults
๏ Abdominal pain in children
๏ Pain lasts for 15-30 minutes.
13. ๏ Caused by Coxsackie A virus
๏ Presents as acute-onset of fever, sore throat, odynophagia and
grayish-white papulovesicular lesions on an erythematous
base that ulcerate.
14. ๏ Patient presents with an acute onset of severe eye pain,
blurred vision, photophobia and watery discharge from the
eyes.
๏ Examination reveals edema, chemosis and sub-conjunctival
hemorrhage.
16. ๏ Cultures shows the Cytopathic effect produced by Enterovirus
๏ Blood
๏ CSF
๏ Body fluids
๏ Tissue
๏ Micro agglutination test โ for detection of antibodies.
๏ Serum titer Ig M is increased.
๏ PCR โ specific to detect viral RNA but not widely use.
๏ Reverse Transcriptase PCR โ for detection and identification and
quantification of Enterovirus 70 and Coxsackie A.
17. ๏ Most enterovirus infections are mild and resolve
spontaneously.
๏ No antiviral medications are currently approved.
๏ There is only supportive and symptomatic treatment.
๏ Intensive supportive care may be needed for Cardiac, Hepatic
or CNS disease.
๏ Analgesics โ for pain relief
๏ IV Ig therapy is administered for immunocompromised
patients
18. ๏ Hygienic measures such as hand washing and adequate
disposal of infected secretions helps to prevent the spread of
enteroviral infections.
๏ No vaccine available for enterovirus infections except for Polio
virus infections
๏ POLIO VACCINE
๏ Inactivated polio vaccine (IPV)
๏ Oral polio vaccine (OPV)