Echovirus meningitis (EM) is a type of aseptic meningitis, caused by various serotypes of Echovirus (EV), an enterovirus. Other viruses can also cause aseptic meningitis [1] [2]. Echovirus infections are usually asymptomatic; however, major infections can develop, exemplified by EM and pericarditis. Children are more at risk of infection than adults, but the former typically do not exhibit neurological symptoms. In the event that they do, the disease may progress to meningoencephalitis. Meningitis caused by EM is referred to as aseptic because it is neither bacterial or fungal.

EM can have an acute or insidious onset and may emerge in two phases. Initial symptoms include fever and muscle pain. Vomiting and diarrhea may also occur. The second phase is characterized by signs of meningism, namely headache, neck stiffness, photophobia, as well as positive Kernig's and Brudinski's signs; these signs are observed only in about 33% of the patients affected by an echovirus meningitis infection [3]. Features of upper respiratory tract infection may also be present.

A minority of cases are complicated by seizures, coma, and movement disorders. Generally, the disease course in older patients is longer, when compared to that of the younger patients.

• Malaise

  Hand-Foot-and-Mouth Disease Patients with hand-foot-and-mouth disease present with fever, anorexia, and malaise; these manifestations are followed by the development of sore throat and vesicles on the buccal mucosa and often on the tongue and then by [doctorslounge.com]

  Herpangina is caused by Coxsackie A virus and results in a vesicular rash in the oral cavity and on the pharynx, along with high fever, sore throat, malaise, and often dysphagia (difficulty swallowing), loss of appetite, back pain, and headache. [getwellstaywellathome.com]

  He presented fever, sores in the mouth, malaise, poor appetite and rash on the palms and feet soles. Other eight children of the same center, in a range from 10 months to three years old, presented similar symptoms. [scilit.net]

  In general, enteroviruses cause febrile illnesses, which are often accompanied by a viral exanthem, vomiting, diarrhea, and malaise. [pedclerk.bsd.uchicago.edu]

  Enterovirus D68 (EV-D68) causes a respiratory illness, primarily in children; symptoms usually resemble those of a cold (eg, rhinorrhea, cough, malaise, fever in a few children). [merckmanuals.com]

• Acutely Ill Patient

  Prognosis Meningitis kills more UK children under the age of 5 than any other infectious disease. [ 2 ] Prognosis depends on the pathogen, the patient's age and condition and the severity of acute illness. [patient.info]

• Back Pain

  Herpangina is caused by Coxsackie A virus and results in a vesicular rash in the oral cavity and on the pharynx, along with high fever, sore throat, malaise, and often dysphagia (difficulty swallowing), loss of appetite, back pain, and headache. [getwellstaywellathome.com]

• Headache

  Symptoms included headache (100%), photophobia (87.5%), and nausea (67.5%), and severity ranged from minimal signs to those consistent with a meningoencephalitis. [ncbi.nlm.nih.gov]

  […] cause for the headache was evident. [health.gov.au]

  Illness was characterized by fever, vomiting, and headache. Over the next 4 months, additional cases of meningitis and the fever and vomiting syndrome emerged in other indigenous communities and subsequently in the major urban center of Darwin. [digitallibrary.health.nt.gov.au]

  Among the 12 meningitis patients, the most common symptoms were headache (12), stiff neck ( 10 ), nausea ( 10 ), and photophobia (eight). [cdc.gov]

• Neck Stiffness

  Headache was present in 93%, photophobia in 86%, vomiting in 69%, fever in 72%, and neck stiffness in 62%. In spite of temporal clustering, the mode(s) of transmission in this outbreak remain speculative. [health.gov.au]

  A meningitis patient was defined as a seasonal camper with headache and either neck stiffness or photophobia, with illness onset during July 16--August 17, 2003. [cdc.gov]

  Common clinical symptoms included fever (97.5%), vomiting (95.0%), and neck stiffness (90.0%). [ncbi.nlm.nih.gov]

  The second phase is characterized by signs of meningism, namely headache, neck stiffness, photophobia, as well as positive Kernig's and Brudinski's signs; these signs are observed only in about 33% of the patients affected by an echovirus meningitis infection [symptoma.com]

  However, 95% had at least two of the four symptoms of headache, fever, neck stiffness and altered mental status. [ 12 ] Most patients with viral meningitis present with subacute neurological symptoms developing over 1-7 days. [patient.info]

• Confusion

  The most common symptoms are fever, severe headache, neck stiffness, photophobia, drowsiness or confusion, nausea and vomiting. [ncbi.nlm.nih.gov]

  Symptoms in those over the age 2: Headache Nausea and vomiting Stiff neck High fever Confusion Sleepiness Lack of appetite Light sensitivity. [innerbody.com]

  Sub clinical infections are very common due to a frequent exposure to HEV and the results could be confused. [scielo.br]

• Kernig's Sign

  sign, focal neurological signs) and laboratory data (full blood count, differential white cell count, biochemistry including liver function tests). [health.gov.au]

  Meningococcal septicaemia without meningitis does not tend to present with stiff neck, back rigidity, bulging fontanelle, photophobia, Kernig's sign, Brudzinski's sign, paresis, focal neurological deficits or seizures. [patient.info]

• Altered Mental Status

  However, 95% had at least two of the four symptoms of headache, fever, neck stiffness and altered mental status. [ 12 ] Most patients with viral meningitis present with subacute neurological symptoms developing over 1-7 days. [patient.info]

Echovirus meningitis is diagnosed when EV is isolated or cultured from fluid or tissue. The following biochemical techniques can be employed:

• Viral culture
• Polymerase chain reaction (PCR)
• Serology

Samples that can be cultured include throat and rectal swabs, as well as stool, blood, pericardial and cerebrospinal fluid. The presence of EV in stool and in the throat is in itself not adequate for diagnosis, as a culture may be positive weeks after the infection has subsided and symptoms have resolved.

Traditional PCR can be used to detect viral ribonucleic acid, however, a newer technique, reverse transcriptase PCR (RT-PCR), is preferred as it has a higher sensitivity and specificity than PCR and viral culture. In addition, it is a rapid test. Ideally, samples for RT-PCR should be obtained within 2 days of onset of the illness. This is due to the fact that the viral load decreases during the course of the infection, thus reducing chances of detection [4]. The decrease in detection rate is even more pronounced in a viral culture [5].

Viral culture is currently the most standard test for EM. Its advantage is that it identifies the serotype of the EV causing infection. The disadvantage is that it is slow and has limited sensitivity. Moreover, some serotypes of EV take a long time to grow, and this may contribute to false negative results [6] [7]. Serology for EV can be performed, although this test is time-consuming and is the least useful.

Rapid diagnosis is convenient as it guides treatment modalities, shortens the hospital stay, and reduces overall cost [8] [9].

More treatment-centered approach helps you focus on the therapeutic process—from diagnostic evaluation and testing to treatment selection. [books.google.com]

Immune system treatment called IVIG may help people with severe ECHO virus infections who have a weakened immune system. Outlook (Prognosis) People who have the less severe types of illness should recover completely without treatment. [nicklauschildrens.org]

Immune system treatment called IVIG may help people with severe ECHO virus infections who have a weakened immune system. Antibiotics are not effective against this virus, or any other virus. [ufhealth.org]

Timely diagnosis and treatment of meningitis, in particular bacterial meningitis, is critical; delayed treatment can result in severe complications, including brain damage, hearing loss, impaired memory/learning, seizures and even death. [innerbody.com]

Prognosis of aseptic meningitis caused by the enteroviruses is generally good, and acute encephalitis is rather rare. [idsc.nih.go.jp]

[…] immunosuppressed status exposure to others with echovirus public swimming pool Pathogenesis echovirus binds to decay-accelerating factor, a receptor the virus then replicates in Peyer’s patches it travels to regional lymph nodes and central nervous system Prognosis [medbullets.com]

Outlook (Prognosis) People who have the less severe types of illness should recover completely without treatment. Infections of organs such as the heart may cause severe disease and can be deadly. [nicklauschildrens.org]

Prognosis Meningitis kills more UK children under the age of 5 than any other infectious disease. [ 2 ] Prognosis depends on the pathogen, the patient's age and condition and the severity of acute illness. [patient.info]

Thirty-four samples which were positive for enterovirus were subject to group-specific PCR, sequencing, and phylogenetic analysis to identify the etiological agent of the outbreak. [jidc.org]

In Brazil, 11,500 cases per year with suspected viral etiology are notified, but in most cases the etiological agent is not identified ( 19 ). [ncbi.nlm.nih.gov]

Analyzing notified meningitis cases in the period from 1979 to 1999 in São Paulo State, Brazil, we observed a high incidence of meningitis cases without determined etiology, and among them, 50% to 60% of probable viral etiology (10). [scielo.br]

In 183 short chapters, the book provides the essentials clinicians need on symptoms/signs, diagnostic tests, and neurologic disorders of all etiologies. For this edition, Timothy A. [books.google.com]

A limitation of the present study is the large number (76%) of AM cases that did not have an enteroviral etiology. [virologyj.biomedcentral.com]

Based on these facts the authors make an epidemiological analyses of their series. Medicine Epidemiology Outbreak Intensive care medicine Pediatrics Echovirus Meningitis [scinapse.io]

Weekly Epidemiological Record Relevé épidémiologique hebdomadaire, 54 (‎11)‎, 84. [who.int]

The results of the epidemiological investigation are given in Table 2. [health.gov.au]

IFA and Nt have been used to provide epidemiological data about the circulation of Enterovirus and the etiological profile of AM in Brazil. [ncbi.nlm.nih.gov]

Pathophysiology Human echoviral infection occurs via fecal-oral transmission. Host susceptibility depends on the presence of specific cellular membrane receptor proteins that bind different enteroviral types along taxonomic lines. [emedicine.medscape.com]

J Med Virol 87:1471–1479 View Article Google Scholar Jain S, Patel B, Bhatt GC (2014) Enteroviral encephalitis in children: clinical features, pathophysiology, and treatment advances. [springerplus.springeropen.com]

Special attention is given to the prevention and treatment of these diseases found in developing countries as well as the latest findings about new antimicrobial agents, gram-negative infections and their management, and recommendations for immunization [books.google.com]

but may be Ordered Title: Meningitis and a febrile vomiting illness caused by Echovirus type 4, Northern Territory, Australia Author: Markey, Peter Davis, Josh Harnett, Gerry Williams, Simon Speers, David Publisher: Centers for Disease Control and Prevention [territorystories.nt.gov.au]

Emerg Infect Dis 2010 Jan;16(1):63-68 Publisher: Centers for Disease Control and Prevention, Atlanta, Georgia Abstract: In July 2007, a cluster of meningitis cases caused by an echovirus 4 strain was detected in 1 indigenous community in the Top End of [digitallibrary.health.nt.gov.au]

CDC - Centers for Disease Control and Prevention. Enterovirus surveillance - United States, 2000 - 2001. MMWR Morb. Mortal. Wkly. Rep. 2002; 51 (46):1047–1049. [ PubMed ] [ Google Scholar ] 4. CDC - Centers for Disease Control and Prevention. [ncbi.nlm.nih.gov]

Vaccines can help prevent you from getting many viral diseases. [icdlist.com]

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9. Makwana N, Nye K, Riordan FA. Meningitis without a petechial rash in children in the Hib vaccine era. J Infect. 2004;49(4):297-301.