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Enteroviruses


Presentation

  • This demonstrates that the amount of virus present in these tissues is low and needs further amplification in order to be detected.[diabetes.diabetesjournals.org]
  • Children should be isolated at home until the rash, if present, has gone, all blisters have dried up and any fever has settled.[health.nsw.gov.au]
  • Most enterovirus infections are asymptomatic or present with mild cold-like symptoms. Though, due to the multitude of enterovirus species the clinical presentation in severe symptomatic diseases is of broad variety.[clinical.r-biopharm.com]
  • Testing Guidelines for Patients with AFP/AFM or Other Acute Neurological Presentations of Possible Viral Cause Persons of any age presenting with AFM, or any child less than 15 years of age with AFP should have laboratory investigations to detect a viral[publichealthontario.ca]
  • The most common presentation is nonspecific febrile illness Most patients present with papulovescicular lesions and mild fever The maculopapular eruptions may also be evident on the buttocks, extremities, and face, more often in young children.[meddean.luc.edu]
Poor Feeding
  • Heart failure causes difficulty breathing and poor feeding. Many infants die.[msdmanuals.com]
Constitutional Symptom
  • Herpangina and hand-foot-mouth disease often can be distinguished from herpes simplex and varicella infections by the distribution of the rash and the severity of constitutional symptoms.[pedsinreview.aappublications.org]
Hypoxemia
  • However, serious complications can occur with EV-D68 infection and include asthma-type symptoms such as wheezing and difficulty breathing, hypoxemia (i.e. not getting enough oxygen in the blood), atelectasis (i.e. blockage of the air passage), pneumonia[bccdc.ca]
Sneezing
  • Watch a video on how to help stop diseases from spreading through coughing and sneezing. There are no vaccines for preventing EV-D68 infection.[health.govt.nz]
  • For mild cold-like symptoms (e.g. runny nose, cough, sneezing) and fever, over-the-counter medications can help relieve symptoms. Aspirin should not be given to children.[bccdc.ca]
  • Cover coughs and sneezes with a tissue or shirt sleeve. Clean and disinfect frequently touched surfaces, such as doorknobs, stair rails and toys. Stay home from school, work or child care if you are sick.[mayoclinic.org]
  • Cover noses and mouths when coughing or sneezing: use tissue or the crook of your elbow when you cough or sneeze and throw the tissue away in a covered trash bin.[seattlechildrens.org]
Respiratory Distress
  • distress Pulmonary oedema on chest X-ray Human parechovirus (HPeV) HPeV was detected in a number of neonates and young infants admitted to NSW hospitals in spring/summer 2013 and again in 2015.[health.nsw.gov.au]
  • Severe respiratory distress developed in a significant number of children, and EV-D68 was detected in specimens from a few children who died.[msdmanuals.com]
  • Some of the infected children had severe respiratory distress. In addition, in some children the spinal cord was affected, causing weakness or paralysis of one of their arms or legs, and several children died.[msdmanuals.com]
Pleural Effusion
  • (F) Case 7, day 1 CXR: increased left pleural effusion with underlying atelectasis; increased right lower lobe consolidation. (G) Case 7, day 4 CT: interval increase R pleural effusion; large L pleural effusion.[bloodjournal.org]
  • Fetal anomalies of the cardiovascular, gastrointestinal and genitourinary system, along with neurodevelopmental delay, bilateral pleural effusion, abdominal ascitis, severe respiratory failure, cortical necrosis (that may lead to severe long-term neurologic[orpha.net]
Hypertension
  • Signs of complicated EV71 infections include the following: Myoclonic jerks, particularly in sleep Urinary retention Ataxia, weakness, or any focal neurological signs Hypertension and/or bradycardia Severe, unexplained or persistent tachycardia or poor[health.nsw.gov.au]
Sore Mouth
  • Often there is a sore mouth for a few days before the ulcers or blisters appear and affected young children may refuse to eat or drink. EV71 infection usually causes only a mild illness in adults and children.[sahealth.sa.gov.au]
Jaundice
  • […] children, below) Severe headache that doesn't get better after taking a pain reliever Trouble breathing Chest pain when breathing Confusion Seizures Pain, swelling, and redness of the eyes Stiffness and trouble moving Yellow tint to the skin and eyes (jaundice[urmc.rochester.edu]
Eye Pain
  • The infection may also affect the clear, curved layer in front of the pupil (the cornea), causing eye pain, tearing, and pain with exposure to bright light.[msdmanuals.com]
  • pain, bleeding seen in the whites of the eyes, photophobia (avoidance of light due to discomfort) Myopericarditis: shortness of breath, chest pain, fever, weakness Herpangina: small flat sores on the oral mucosa ( tonsils and soft palate) that may produce[medicinenet.com]
Photophobia
  • Hemorrhagic conjunctivitis, unlike uncomplicated conjunctivitis, often leads to subconjunctival hemorrhages or keratitis, causing pain, tearing, and photophobia. Systemic illness is uncommon.[msdmanuals.com]
  • […] children; may also occur with a rash (on face, neck, and extremities), fever, painful headache, stiff neck, body aches, sensitivity to light, nausea and vomiting, irritability Conjunctivitis (hemorrhagic): eye pain, bleeding seen in the whites of the eyes, photophobia[medicinenet.com]
Eczema
  • "Eczema coxsackium" and unusual cutaneous findings in an enterovirus outbreak. Pediatrics. 2013 Jul. 132(1):e149-57. [Medline]. Begier EM, Oberste MS, Landry ML, et al.[emedicine.medscape.com]
Tremor
  • At admission, all of them presented with fever of several days’ duration and a constellation of neurologic symptoms that ranged from depression and somnolence to instability, ataxia and involuntary tremors.[analesdepediatria.org]
Nystagmus
  • Enterovirus rhombencephalitis causes acute and severe neurologic disorders such as ataxia, nystagmus, oculomotor palsies, or bulbar palsy. In some cases, neurologic affection can extend to the spinal cord 1.[radiopaedia.org]
Neurologic Manifestation
  • In fact, in our series only 1 of the 4 patients had a positive result, case 2, a female patient who had more severe neurologic manifestations.[analesdepediatria.org]

Workup

  • If included earlier in the diagnostic workup, the value of a positive EV-PCR result may increase, especially in reducing unnecessary diagnostic tests.[jamanetwork.com]
  • […] affected; yield is increased if multiple sites are sampled Polymerase chain reaction (PCR) – Provides rapid results; the best diagnostic test for use in CSF In myopericarditis, chest radiography, echocardiography, and ECG can be used for diagnosis See Workup[emedicine.medscape.com]
Atelectasis
  • However, serious complications can occur with EV-D68 infection and include asthma-type symptoms such as wheezing and difficulty breathing, hypoxemia (i.e. not getting enough oxygen in the blood), atelectasis (i.e. blockage of the air passage), pneumonia[bccdc.ca]
  • (F) Case 7, day 1 CXR: increased left pleural effusion with underlying atelectasis; increased right lower lobe consolidation. (G) Case 7, day 4 CT: interval increase R pleural effusion; large L pleural effusion.[bloodjournal.org]
Hepatic Necrosis
  • Infection transmitted by a mother during delivery can cause severe disseminated neonatal infection, which may include hepatitis or hepatic necrosis, meningoencephalitis, myocarditis, or a combination of these, and can lead to sepsis or death.[msdmanuals.com]
Pleural Effusion
  • (F) Case 7, day 1 CXR: increased left pleural effusion with underlying atelectasis; increased right lower lobe consolidation. (G) Case 7, day 4 CT: interval increase R pleural effusion; large L pleural effusion.[bloodjournal.org]
  • Fetal anomalies of the cardiovascular, gastrointestinal and genitourinary system, along with neurodevelopmental delay, bilateral pleural effusion, abdominal ascitis, severe respiratory failure, cortical necrosis (that may lead to severe long-term neurologic[orpha.net]

Treatment

  • Diagnosis and Treatment Although a laboratory test can detect enterovirus, most diagnoses are made on the basis of symptoms. Treatment for enterovirus means managing the symptoms until the infection clears.[intermountainhealthcare.org]
  • Treatment There are no specific treatments or antiviral medications for people with illness caused by EV-D68. If symptoms become severe enough, infected people may need to be hospitalised.[health.govt.nz]
  • Management and treatment There is no specific curative treatment for EV maternal or congenital infection. Prognosis Prognosis of mild congenital EV infections is quite good if reanimation procedures are available.[orpha.net]
  • Learn about non-polio enterovirus infections, their causes, symptoms, risks, treatment and prevention. Also find information on surveillance and for health professionals.[canada.ca]
  • : There is no specific treatment for non-polio enterovirus infection.[dchealth.dc.gov]

Prognosis

  • Prognosis Prognosis of mild congenital EV infections is quite good if reanimation procedures are available. Prognosis of severe congenital EV infections is poor and the disease has been reported to be fatal.[orpha.net]
  • In most cases, the prognosis (outcomes) of enterovirus infections is good with no complications; however, the prognosis worsens as the severity of infection increases and when complications develop.[medicinenet.com]

Etiology

  • “While continued vigilance for other possible etiologies of AFM is warranted, together, our combined [results support] the notion that EV infection likely underlies the majority of AFM cases tested in this study,” the authors write in their paper, which[the-scientist.com]
  • Etiology Coxsackie A, B, ECHO viruses, and numbered EVs are believed to cross the placenta and cause fetal disease.[orpha.net]
  • While a lot of work still remains to fully determine the etiological agents that cause acute flaccid myelitis/paralysis, JCVI scientists continue to characterize EV-D68 pathogenesis and its disease phenotype.[jcvi.org]
  • Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children : More information is available at the following resources: www.cdc.gov[dchealth.dc.gov]
  • Etiology: The nonpolio Enteroviruses are positive strand RNA viruses.[meddean.luc.edu]

Epidemiology

  • This special issue, published in Journal of Biomedical Science, presents reviews and primary research papers on EV71 that cover several topics: a clinical guideline on management of children with HFMD, epidemiology of EV71 in Thailand, the cell and tissue[biomedcentral.com]
  • Here, we review the features of this virus and related viruses, the clinical syndromes this virus causes, the epidemiology of the recent outbreak, and its diagnosis and treatment.[mdedge.com]
  • Epidemiology: Transmission Enterovirus infections are common and are spread by fecaloral and respiratory routes and from mother to infant in the peripartum period.[meddean.luc.edu]
  • Tengelsen, PhD, DVM - Epidemiology[healthy.kaiserpermanente.org]
  • Summary Epidemiology The prevalence of congenital EV infection is still unknown. EV infections are underdiagnosed in the mother (mainly because of frequent subclinical infections) and hence may be far more frequent than supposed.[orpha.net]
Sex distribution
Age distribution

Pathophysiology

  • Useful For Suggests clinical disorders or settings where the test may be helpful Aids in diagnosing enterovirus infections Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Enteroviruses[mayocliniclabs.com]
  • Pathophysiology Enteroviruses are transmitted predominantly via the fecal-oral route.[emedicine.medscape.com]

Prevention

  • Centers for Disease Control and Prevention. . Accessed July 20, 2017. Non-polio enterovirus. Centers for Disease Control and Prevention. . Accessed July 20, 2017. Enterovirus D68 for health care professionals.[mayoclinic.org]
  • Prevention Learn how non-polio enterovirus infections can be prevented. Surveillance Discover how non-polio enterovirus infections are monitored. Report a problem or mistake on this page Thank you for your help! You will not receive a reply.[canada.ca]
  • Prevention Vaccine to prevent EV71 infection is not available in Hong Kong at the moment. Good personal and environmental hygiene are the mainstay of prevention. 1.[chp.gov.hk]
  • There are no vaccines for preventing EV-D68 infection.[health.govt.nz]
  • Also, see a graphic that shows these prevention steps.[solutionsdesignedforhealthcare.com]

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