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.

1. MARIA
MEDICAL STUDENT
TSMU

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 – common
 Nosocomial transmission – seen in Nursery Homes – Coxsackie
&Echovirus
 Airborne transmission – Coxsackie A21
 Vertical transmission – Coxsackie virus
 Inoculation(from fingers to eye) – Enterovirus 70
 Distribution :
 Worldwide distribution
 Infections occur often in summer and fall.

5.  Asymptomatic
 Non-specific symptoms – fever, headache, sore throat,
malaise, myalgia, anorexia
 Polio infection is presented as
• Paralytic poliomyelitis – paralysis usually legs and
arms
• Vaccine associated poliomyelitis – seen in patients
with hypo/agammaglobulinemia.
• 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.

15.  Adenovirus infections
 Bacterial pharyngitis
 Viral pharyngitis
 Botulism
 Rocky mountain spotted fever
 Varicella zoster virus infections
 Lyme disease
 Ehrlichiosis

16.  Cultures shows the Cytopathic effect produced by Enterovirus
 Blood
 CSF
 Body fluids
 Tissue
 Micro agglutination test – for detection of antibodies.
 Serum titer Ig M is increased.
 PCR – specific to detect viral RNA but not widely use.
 Reverse Transcriptase PCR – 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 – 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)

19. 1) http://emedicine.medscape.com/article/217146-workup
2) https://www.cdc.gov/dotw/enteroviruses/index.html
3) https://link.springer.com/article/10.1007/s00125-016-4177-z
4) http://www.medicalnewstoday.com/articles/315126.php