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Key Features

  • Most common serotypes for disease are types 6, 9, 11, 19, and 30

  • Infection is most common during summer

  • Males younger than 20 years are more commonly infected than other persons

  • Transmission is primarily fecal-oral

  • Outbreaks have also been related to fecal contamination of water sources, including drinking water and swimming and bathing pools

Clinical Findings

  • Aseptic meningitis, which may be associated with a rubelliform rash

  • Other conditions associated with echoviruses

    • Common respiratory diseases

    • Epidemic diarrhea

    • Myocarditis

    • A hemorrhagic obstetric syndrome

    • Keratoconjunctivitis

    • Severe hepatitis with coagulopathy

    • Leukocytoclastic vasculitis

    • Encephalitis with sepsis

    • Interstitial pneumonitis

    • Pleurodynia

    • Hemophagocytic syndromes (in children with cancer)

    • Sudden deafness

    • Acute flaccid paralysis (a leading cause in India)

    • Optic neuritis, uveitis

    • Septic shock

  • Also a common cause of nonspecific exanthems

Diagnosis

  • Cytopathic effects are produced in tissue culture after recovery of virus from throat washings, blood, or cerebrospinal fluid

  • An enterovirus PCR of the cerebrospinal fluid is associated with a shorter duration of hospitalization in febrile neonates

  • Fourfold or greater rises in antibody titer signify systemic infection

Treatment

  • Usually symptomatic

  • In vitro data suggest some role for amantadine or ribavirin, but clinical studies supporting these findings are not available

  • Hand-washing is an effective control measure in outbreaks of aseptic meningitis

  • Prevention of fecal-oral contamination and maintenance of pool hygiene through chlorination and pH control

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