A presentation on enteroviral infection.

1. KHARKOV STATE MEDICAL
UNIVERSITY
Department of children infection
diseases
Enteroviral infection
MD Professor Olkhovska O.N.
Kharkiv

2. Etiology
Enterovirus infection (EVI) is a group of acute
diseases caused by enteroviruses and manifests
various clinical manifestations from mild febrile
states to the presence of meningoencephalitis,
myocarditis.
The causative agents - intestinal viruses of the Picornaviridae
family, of the genus Enterovirus:
polioviruses (3 serovars) → polio
Koksaki A viruses (24 serovars), Koksaki B viruses (6 serovars)
ECHO viruses (34 serovars)
5 human enteroviruses (unclassified viruses of 68–72 types)
enterovirus 72 → HAV (isolated as an independent genus
Hepatovirus).

3. Epidemiology
Enteroviruses are shed in respiratory
secretions and stool and sometimes are present
in the blood and cerebrospinal fluid of infected
patients.
Infection is usually transmitted by direct
contact with respiratory secretions or stool but
can be transmitted by contaminated
environmental sources.
Infection transmitted by a mother during delivery
can cause severe disseminated neonatal nfection,
which may include hepatitis or hepatic necrosis,
meningoencephalitis, myocarditis, or a combination of
these, and can lead to sepsis or death.

4. CLINICAL MANIFESTATIONS
ENTEROVIRAL INFECTION
Poliomyelitis-Like Illness
Aseptic meningitis
Herpangina (Coxsackie A virus)
Hand, foot, and mouth disease
Nonspecific febrile illness
Pleurodynia
Pericarditis and/or myocarditis
Acute hemorrhagic conjunctivitis

5. Poliomyelitis-Like Illness
Poliomyelitis-Like Illness clinically similar
to polio, but does not leave irreversible
residual changes after recovery
Clinically differentiating from polio is
almost impossible.
Considering
- mild course
- combination with other syndromes
- the presence of an epidemiological
situation.
Diagnostics - virological and
serological research methods.

6. Aseptic meningitis
Most common among infants
and children. Caused by one of
the following:
- a group A or B coxsackievirus
- an echovirus
- a human parechovirus
The course is usually benign. A
rash may accompany enteroviral
aseptic meningitis.
Rarely,encephalitis occurs,
which may be severe.
CSF -
colorless, transparent
at a puncture follows
with the increased
pressure (250-350 mm
of water. art.)
lymphocytic pleocytosis
(up to several hundred in
1 mm3)
the first 1-2 days of
illness in the CSF can be
dominated by neutrophils
(up to 90%)
normal protein
glucose level Normal or
increased.

7. Herpangina (Coxsackie A virus)
2/3 of patients - mild febrile illness
1/3 - a characteristic clinical picture:
- acute onset: a rapid increase in T to 39.0–40.5°С (fever is
usually 2-3 days)
- oropharynx examination:
hyperemia of the mucous membranes
↓
(24–48 h) on the front surface of the tonsils, palatine arches
5–30 small grayish-white papules, 1-2 mm
↓
vesicles with transparent contents
↓
(12–24 hours) opening of vesicles, erosion with a diameter
of up to 2– 3mm, covered with a grayish coating, with a
narrow border of hyperemia
- sore throat intensifies with the formation of erosion (heal
within 4-6 days)
Not caused by the
herpes virus!

8. Herpangina (Coxsackie A virus)
It can be differentiated from herpetic
gingivostomatitis by the positioning of vesicles -
in herpangina, they are typically found on the
posterior oropharynx, as compared to
gingivostomatitis where they are typically found
on the anterior oropharynx and the mouth.

9. Hand, foot, and mouth disease
Symptoms Fever, flat discolored spots or
bumps that may blister
Complications Temporary loss of nails, viral
meningitis[
Usual onset 3–6 days post exposure
Duration 1 week
Causes Coxsackievirus A16, Enterovi
rus 71
Diagnostic
method
Based on symptoms, viral
culture
Prevention Handwashing
Treatment Supportive care
Medication Pain medication such
as ibuprofen
Frequency As outbreaks

10. Pleurodynia
caused most commonly by a group B coxsackievirus, an
enterovirus.
Epidemic pleurodynia may occur at any age but
is most common among children.
Severe, frequently intermittent, often pleuritic
pain begins suddenly in the epigastrium,
abdomen, or lower anterior chest, with fever and
often headache, sore throat, and malaise. The
involved truncal muscles may become swollen
and tender. Symptoms of epidemic pleurodynia
usually subside in 2 to 4 days but may recur
within a few days and persist or recur for several
weeks.

11. Acute hemorrhagic
conjunctivitis
The eyelids rapidly swell. Hemorrhagic conjunctivitis,
unlike uncomplicated conjunctivitis, often leads to
subconjunctival hemorrhages or keratitis, causing pain,
tearing, and photophobia. Systemic illness is uncommon.
However, when hemorrhagic conjunctivitis is due to
enterovirus 70, transient lumbosacral
radiculomyelopathy or poliomyelitis-like illness (with
paralysis) can occur but is rare. Recovery is usually
complete within 1 to 2 weeks of onset.
Coxsackievirus A24 also causes hemorrhagic
conjunctivitis, but subconjunctival hemorrhage is less
frequent, and neurologic complications have not been
described. Most patients recover in 1 to 2 weeks.

12. Minor illness ("summer flu")
Enterovirus D68 (EV-D68) causes a respiratory illness,
primarily in children
One of the most common forms of enterovirus
infections!
Short-term fever (≤ 3 days).
Headache, often vomiting.
Weakness, weakness, myalgia, abdominal pain.
Catarrhal phenomena (hyperemia and
granularity of the mucous membrane of the
pharynx), a moderate increase in the
submandibular and other lymph nodes.
a two-wave course of the disease is possible.

13. RASH
Certain coxsackieviruses, echoviruses, and human
parechoviruses may cause rashes, often during epidemics.
Rashes are usually nonpruritic, do not desquamate, and
occur on the face, neck, chest, and extremities. They are
sometimes maculopapular or morbilliform but occasionally
hemorrhagic, petechial, or vesicular. Fever is common.
General weakness, severe headache, muscle pain, sore
throat, cervical lymphadenitis are characteristic.
In infants the enteroviral infection could accompanied by
secretory dairhea.

14. DIAGNOSIS
Laboratory diagnostic methods:
serological studies: on 4th – 5th day of illness →
after the 14th day). The diagnostic criterion is an
increase in antibody titer of 4 times or more.
Isolation of the virus from nasopharyngeal mucus,
CSF, feces, blood.
PCR
Instrumental diagnostic methods:
ECG
chest x-ray
CT and MRI of the brain
Echocardiography

15. Treatment and prevention
The treatment is symptomatic, there is no
specific therapy.
The oral antiviral drug pleconaril, which has
shown activity against a number of
picornaviruses, is being investigated for
treatment of severe neonatal enteroviral disease
Specific prevention is not developed.
Non-specific - consists in early isolation of the
patient, disinfection of the premises, the use of
immunoglobulin for children after contact is
possible, isolation for 14 days after contact