Echovirus Infections

Key Features

• Most common serotypes for disease are types 6, 9, 11, 19, 29, 30, and 33 as well as C99

• 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 myelitis (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