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Enterovirus infections

Medical expert of the article

Infectious disease
, medical expert
Last reviewed: 20.11.2021

Enterovirus infections (Enterovirosis) are a large group of anthroponous infectious diseases with a fecal-oral mechanism of agent transmission caused by enteroviruses of the Coxsackie and ECHO group, which are characterized by polymorphism of the clinical picture (CNS, muscle, mucous membranes and skin lesions).

ICD-10 codes

  • A85.0 (G05.1). Enterovirus encephalitis, enterovirus encephalomyelitis.
  • A87.0 (G02.0). Enterovirus meningitis; meningitis caused by the Coxsackie / meningitis virus. Caused by the ECHO virus.
  • A88.0. Enterovirus exanthematous fever (Boston exanthema).
  • B08.4. Enterovirus vesicular stomatitis with exanthema, viral pemphigus of the oral cavity and extremities.
  • B08.5. Enterovirus vesicular pharyngitis, herpetic angina.
  • B08.8. Other specified infections, characterized by damage to the skin and mucous membranes; enterovirus lymphonodular pharyngitis.
  • B34.1. Enterovirus infection, unspecified: infection caused by the Coxsackie virus, BDU; infection caused by the ECHO virus, BDU.

What causes enterovirus infections?

Enterovirus infections are caused by enteroviruses, which together with rhinoviruses are picornaviruses (RNA viruses). Enteroviruses include type 1-3 polioviruses, A1-A22 and A24 coxaviruses, B1-B6, ECHO viruses 2-9, 11-21, 24-27, 29-33 and enteroviruses 68-71, 73. Coxakiviruses and ECHO viruses (capital letters from the English combination of the words enteric cytopathic human orphan) differ in the antigenic structure. They enter the environment with saliva, stool, blood, cerebrospinal fluid and are widespread in all geographic regions.

What are the symptoms of enterovirus infections?

Enterovirus infection has various symptoms. In the United States, the infection rises in summer and autumn. Epidemic pleurulation, viral pemphigus of the oral cavity and extremities, herpangina and poliomyelitis are caused almost exclusively by enteroviruses. Other diseases associated with enteroviruses often have a different etiology.

Aseptic meningitis in young children is most often caused by coxsakiviruses A and B, ECHO viruses. In older children and adults, aseptic meningitis causes other enteroviruses and other viruses in general. Rash can be associated with enterovirus aseptic meningitis. Rarely can severe enough encephalitis occur.

The incidence of hemorrhagic conjunctivitis in the US is rarely epidemic. Outbreaks of the disease can be caused by the introduction of a virus from Africa, Asia, Mexico, the Caribbean region. Eyelids rapidly swell, then subconjunctival hemorrhages and keratitis develop, causing pain, causing lacrimation and photophobia. Systemic manifestations are not characteristic, although transitory lumbosacral radiculomyelopathy or a polymyelitis-like syndrome may occur (in particular, if enterovirus 70 was the cause of hemorrhagic conjunctivitis). Recovery usually begins 1-2 weeks after the onset of the disease. Hemorrhagic conjunctivitis can be caused by coxsakivirus A24, but in this case subconjunctival hemorrhages occur less frequently.

Myopericarditis is caused by coxsack-viruses of group B and some enteroviruses, occurs in newborns (myocarditis of newborns and rarely in utero). Usually a few days after birth a new picture develops resembling sepsis, lethargy, DVS-syndrome, bleeding, multiple intraorganic lesions. Simultaneously, CNS, liver, pancreas and adrenal glands are affected. Recovering occurs within a few weeks, but death may occur as a result of vascular collapse or liver failure. In older children and adults, myocarditis can be caused by group C coxakiviruses, less often group A and ECHO viruses. These infections result in complete recovery.
The rash may appear as a result of infection with coxsack and ECHO viruses, often during epidemics. Usually it does not itch, it does not flake, it is located on the face, neck, chest and extremities.
It is usually spotty-papular or coresiform, rarely hemorrhagic, petechial or vesicular. Fever can often develop, aseptic meningitis.

Respiratory infection is caused by enteroviruses. Symptoms of enterovirus infection include fever, rhinorrhoea, pharyngitis, in some children (young children) - vomiting and diarrhea. Bronchitis and interstitial pneumonia are rare in adults and children.

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How are enterovirus infections diagnosed?

Diagnosis of enteroviral infections is clinical. Laboratory diagnostics of enterovirus infection does not have a significant significance, but virus cultivation can be carried out, seroconversion is proven, viral RNA in PCR is detected. Enterovirus cultures that cause aseptic meningitis can be isolated from the nasopharynx, stool, blood and cerebrospinal fluid. 

How are enterovirus infections treated?

Treatment of enterovirus infection is symptomatic, although antiviral drugs are being developed. Carry out detoxification treatment of enterovirus infection. With meningitis and meningoencephalitis, dehydration therapy with saluretics (furosemide, acetazolamide) is prescribed, in severe cases dexamethasone is used at 0.25 mg / kg per day for 2-4 days. It is recommended the appointment of human leukocyte interferon, ribonuclease, but there are no data on their effectiveness, obtained by the methods of evidence-based medicine.

What is the prognosis of enterovirus infections?

The vast majority of patients with lesions of the skin and mucous membranes forecast favorable. Enterovirus infection ends in complete recovery. Heavy current with fatal outcome is possible with encephalomyocarditis of newborns, encephalitis and meningoencephalitis, paralytic form of enterovirus infection, less often with epidemic myalgia. After the transferred encephalitis in a number of cases, hemi or monoparesis occur; after the poliomyelitis form of the disease - reduction of muscle tone and limb hypotrophy: with lesions of the organ of vision - cataract and bilateral blindness.

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