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Key Features

  • Human enteroviruses are neurotropic and a potential role for these viruses in amyotropic lateral sclerosis is under investigation

  • Household contacts, especially children under 6 months of age, are at particular risk for enterovirus 71 acquisition

  • A number of nonpolio type C enteroviruses are associated with polio-like syndromes and surveillance for these is most active in China

  • Enterovirus infection of the pancreas can trigger cell-mediated autoimmune destruction of beta cells resulting in diabetes

  • Enterovirus myocarditis can be a serious infection in neonates, complicated by cardiac dysfunction and arrhythmias

Clinical Findings

  • Enterovirus 68 (EV-D68)

    • Typically associated with respiratory illness

    • Has also been implicated in aseptic meningitis and encephalitis

    • Associated with acute flaccid myelitis but not definitively linked

  • Enterovirus 70 (EV-70)

    • Responsible for abrupt bilateral eye discharge and subconjunctival hemorrhage with occasional systemic symptoms

    • Most commonly associated with acute hemorrhagic conjunctivitis

  • Enterovirus 71 (EV-71)

    • Associated with hand, foot, and mouth disease (HFMD), herpangina as well as a form of epidemic encephalitis associated on occasion with pulmonary edema, and acute flaccid paralysis often mimicking poliomyelitis

    • Autonomic nervous system dysregulation, which may develop prior to the pulmonary edema, is a complication

    • Disease is usually more severe and sequelae more common than with other enteroviruses

Diagnosis

  • Isolating EV-D68 in respiratory secretions

  • Isolating EV-70 in conjunctival scraping

  • Isolating EV-71 in vesicle swabs, body secretions, or cerebrospinal fluid

  • Enzyme immunoassays and complement fixation tests show good specificity but poor sensitivity (< 80%)

  • RT-PCR may increase the detection rate and is useful in analysis of cerebrospinal fluid samples among patients with meningitis and of blood samples among infants with a sepsis-like illness

Treatment

  • EV-D68 requires supportive care with particular attention to respiratory support

  • Largely symptomatic for EV-70 and -71

  • Extracorporeal life support may be required for some children with enterovirus-associated cardiopulmonary failure

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