Presentation
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]
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]
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]
To identify evidence of any past viral infections in AFM patients, the researchers adapted a method developed by Elledge that uses bacteriophages to collect antibodies present in a sample, in this case, the patients’ spinal fluid. [the-scientist.com]
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]
Entire Body System
- Fever
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]
A wide range of symptoms can be caused by enteroviruses but most often include fever, mild respiratory symptoms, flu-like illness with fever and muscle aches, fever with a rash and gastrointestinal symptoms. Read more [ecdc.europa.eu]
[…] in these cases: Repeated temperature of 104°F (40°C) or higher in a child of any age Fever of 100.4° (38°C) or higher in baby younger than 3 months Fever that lasts more than 24 hours in a child under age 2 Fever that lasts for 3 days in a child age [urmc.rochester.edu]
Sometimes enteroviruses survive immune defenses and spread into the bloodstream, resulting in fever, headache, sore throat, and, at times, vomiting and diarrhea. [msdmanuals.com]
Symptomatic treatment can relieve fever and pain from the ulcers. In most cases, the illness is self-limiting and symptoms including fever, rash and ulcers usually subside in a week. [chp.gov.hk]
- Asymptomatic
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]
Although some people who contract an enterovirus are asymptomatic, others develop mild cold symptoms that naturally subside. [health.com]
This test should not be used to screen asymptomatic patients. [mayocliniclabs.com]
Clinical description The clinical manifestations of congenital EV infection ranges from asymptomatic to benign, febrile to severe illness consisting of variable combinations of sepsis, hepatitis, coagulopathy, myocarditis, pneumonitis and meningoencephalitis [orpha.net]
SITES OF INFECTION Most infections (estimated 90%) are asymptomatic or only cause mild illness. General viremia Gastrointestinal: gastroenteritis, asymptomatic viral shedding. Mucocutaneous: many manifestations. [hopkinsguides.com]
- Fatigue
"Chronic fatigue syndrome: clinical condition associated with immune activation". Lancet. ↑ Chia, John (November 2005). "The role of enterovirus in chronic fatigue syndrome". [me-pedia.org]
This can be accompanied by pain and general fatigue. Management of post-polio syndrome is supportive, with pain control and a regular but non-strenuous exercise or physical therapy regimen. [infectiousdiseaseadvisor.com]
Myocarditis / pericarditis – Upper respiratory symptoms typically precede onset of fatigue, chest pain, and shortness of breath. Central nervous system (CNS) disease – See below. [visualdx.com]
More serious symptoms such as meningitis or encephalitis (severe headache and stiff neck), and myocarditis (chest pain and extreme fatigue) require the immediate attention of one of our physicians. These complications are very rare. [afkpeds.org]
Respiratoric
- Cough
Symptoms of mild illness can include fever, runny nose, sneezing, cough, skin rash, mouth blisters, and body and muscle aches. [cdc.gov]
Symptoms usually include: Sore throat Runny nose Coughing Sneezing Headaches Body aches Most people recover within about seven to 10 days. [dhs.wisconsin.gov]
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]
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]
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]
- Sore Throat
Symptoms usually include: Sore throat Runny nose Coughing Sneezing Headaches Body aches Most people recover within about seven to 10 days. [dhs.wisconsin.gov]
Children suddenly develop fever with a sore throat, headache, loss of appetite, and frequently neck pain. Infants may vomit. Within 2 days of the start of the disease, grayish bumps develop inside the mouth and throat. [msdmanuals.com]
You have a new symptom, such as a sore throat, an earache, or sinus pain. You do not get better as expected. [healthy.kaiserpermanente.org]
This may include upper respiratory symptoms much like a “cold” with a runny nose, sore throat and cough. Headache is common with an enterovirus infection. Other children may develop a flu-like illness with fever and muscle aches. [afkpeds.org]
The signs and symptoms of mild enterovirus infection include: fever rash tiredness loss of appetite sore throat ulcers or blisters in the mouth or on the hands and feet If you think your child might be infected, it’s a good idea to take them to the doctor [pregnancybirthbaby.org.au]
- Pharyngitis
Clinical Manifestations can include the following: respiratory -- common cold, pharyngitis, herpangina, stomatitis, pneumonia, and pleurodynia skin --exanthem neurologic-- aseptic meningitis, encephalitis, and paralysis gastrointestinal --vomiting, diarrhea [meddean.luc.edu]
Well children with uncomplicated EV infections (e.g. with fever, pharyngitis, rash including HFMD) may be discharged with follow-up planned and clear advice given regarding warning signs. [health.nsw.gov.au]
The clinical syndromes associated with a nonpolio human enterovirus can include nonspecific febrile illness; upper respiratory tract infection; pharyngitis; herpangina; hand, foot, and mouth syndrome; various skin exanthems; bronchiolitis; asthma exacerbation [mdedge.com]
Symptoms include fever, coryza, pharyngitis, and, in some infants and children, vomiting and diarrhea. Bronchitis and interstitial pneumonia occasionally occur in adults and children. 1. [msdmanuals.com]
Poliovirus is spread via oral fecal transmission, or more rarely by pharyngeal spread. Ninety percent of infections are asymptomatic. Enterovirus infections are highly prevalent worldwide. [infectiousdiseaseadvisor.com]
- Dyspnea
All patients developed cough with a range of additional respiratory symptoms including rhinorrhea, dyspnea, and sore throat. [bloodjournal.org]
Pericarditis and/or myocarditis are typically caused by enteroviruses; symptoms consist of fever with dyspnea and chest pain. Arrhythmias, heart failure, and myocardial infarction have also been reported. [en.wikipedia.org]
[…] as the pain recedes; during paroxysms, respirations are rapid and shallow; the pain is reproducible, and patients appear healthy between paroxysms of pain; auscultation may reveal a pleural friction rub Myopericarditis – The most common symptoms are dyspnea [emedicine.medscape.com]
- Rales
Atypical pneumonia (Mycoplasma pneumoniae, Chlamydia pneumoniae) – Typically mild, insidious onset; can cause diffuse rales and wheezing. Asthma / reactive airways disease – Enteroviruses may trigger asthma / reactive airways disease. [visualdx.com]
Gastrointestinal
- Overeating
Be careful when giving your child over-the-counter cold or flu medicines and Tylenol at the same time. Many of these medicines have acetaminophen, which is Tylenol. [healthy.kaiserpermanente.org]
For mild respiratory illness, symptoms can be relieved by taking over-the-counter medications for pain and fever. Aspirin should not be given to children under 19. [mass.gov]
The vast majority of people infected with enteroviruses—over 90%—will either have no symptoms or have non-specific symptoms, such as sudden fever. [ecdc.europa.eu]
For those with mild respiratory illness, symptoms can be relieved by taking over-the-counter medications for pain and fever. They usually recover completely. [solutionsdesignedforhealthcare.com]
There are over 100 types of enteroviruses; other common enterovirus infections include Hand Foot Mouth disease and viral meningitis. Enterovirus D68 is one of these types of enterovirus which was first detected in 1962 in California. [acphd.org]
- Vomiting
Sometimes enteroviruses survive immune defenses and spread into the bloodstream, resulting in fever, headache, sore throat, and, at times, vomiting and diarrhea. [msdmanuals.com]
Vomiting and diarrhea are treated according to “vomiting and diarrhea” guidelines in this handbook. Give plenty of fluids to prevent dehydration. Sometimes Zofran or promethazine is prescribed to control nausea. [afkpeds.org]
Signs may include: fever stiff neck vomiting rash cough irritability seizures (fits) unsteadiness weakness paralysis. The infection can also involve the heart, causing fast or slow heart rate, high blood pressure, or breathing difficulties. [sahealth.sa.gov.au]
Symptoms of more serious infection include: vomiting cough a stiff neck seizures unsteadiness excessive irritability weakness or paralysis an unusually fast heart rate breathing difficulties If your child shows any of these signs, you should take them [pregnancybirthbaby.org.au]
Clinical Manifestations can include the following: respiratory -- common cold, pharyngitis, herpangina, stomatitis, pneumonia, and pleurodynia skin --exanthem neurologic-- aseptic meningitis, encephalitis, and paralysis gastrointestinal --vomiting, diarrhea [meddean.luc.edu]
- Nausea
CNS disease: Viral meningitis – Fever, irritability, headache, stiff neck, photophobia, nausea, vomiting Encephalitis / meningoencephalitis – Acute onset of altered mental status, abnormal neurologic examination, and/or seizures. [visualdx.com]
Sometimes Zofran or promethazine is prescribed to control nausea. Fever is treated according to our “fever” guidelines in this handbook. [afkpeds.org]
There is then a ‘minor’ viremia which allows spread of virus to lymphoid tissue throughout the body, and then in less than 10% of individuals a ‘major’ viremia occurs with fever, malaise, fatigue, nausea, vomiting and CNS symptoms 8-12 days following [infectiousdiseaseadvisor.com]
Most symptoms usually go away in a few days and can include: Fever Muscle aches Sore throat Runny nose Sneezing Coughing Trouble breathing Nausea and vomiting Diarrhea Red sores or clear-whitish blisters in the mouth and on the palms of the hands and [urmc.rochester.edu]
[…] coloration change (bluish to cherry red), rapid heart rate Aseptic meningitis: most common among infants and children; may also occur with a rash (on face, neck, and extremities), fever, painful headache, stiff neck, body aches, sensitivity to light, nausea [medicinenet.com]
- Mucus in Stool
Enteroviruses can be found in the respiratory secretions (for example, saliva, sputum, or nasal mucus) and stool of an infected person. [medicinenet.com]
Enteroviruses can be found in the respiratory secretions (e.g., saliva, sputum, or nasal mucus) and stool of an infected person. [afkpeds.org]
and stool of an infected person. [en.wikipedia.org]
Skin
- Blister
The symptoms of hand, foot and mouth disease are: fever rash tiredness loss of appetite ulcers or blisters in the mouth, and on the hands and feet. [sahealth.sa.gov.au]
They begin as small red spots with blisters and then often become ulcers. They usually appear on the tongue, gum and inside of the cheeks. There may also be a skin rash that is non-itchy and sometimes accompanied by blisters. [chp.gov.hk]
Symptoms of mild illness can include fever, runny nose, sneezing, cough, skin rash, mouth blisters, and body and muscle aches. [cdc.gov]
How It Spreads Non-polio enteroviruses can be found in an infected person's feces (stool), eyes, nose, and mouth secretions (such as saliva, nasal mucus, or sputum), or blister fluid. [health.ri.gov]
- Skin Rash
Symptoms of mild illness can include fever, runny nose, sneezing, cough, skin rash, mouth blisters, and body and muscle aches. [cdc.gov]
Enteroviruses are common and can cause cold-like illnesses; hand, foot and mouth disease; and skin rashes. Some types of enteroviruses can cause more serious illnesses such as meningitis, encephalitis and acute flaccid myelitis. [colorado.gov]
Symptoms Symptoms Someone with mild illness may have: a fever runny nose, sneezing, cough skin rash mouth blisters body and muscle aches According to the Centers for Disease Control and Prevention, the infection also can cause: viral conjunctivitis hand [childrensnational.org]
Symptoms: Symptoms of mild illness may include: fever runny nose, sneezing, cough skin rash mouth blisters body and muscle aches Some non-polio enterovirus infections can cause: viral conjunctivitis (infection of the eye) hand, foot, and mouth disease [dchealth.dc.gov]
- Ulcer
Symptomatic treatment can relieve fever and pain from the ulcers. In most cases, the illness is self-limiting and symptoms including fever, rash and ulcers usually subside in a week. [chp.gov.hk]
The symptoms of hand, foot and mouth disease are: fever rash tiredness loss of appetite ulcers or blisters in the mouth, and on the hands and feet. [sahealth.sa.gov.au]
Mouth ulcers are also possible. An individual child may have one or all of the above mentioned symptoms with any particular infection. [afkpeds.org]
The signs and symptoms of mild enterovirus infection include: fever rash tiredness loss of appetite sore throat ulcers or blisters in the mouth or on the hands and feet If you think your child might be infected, it’s a good idea to take them to the doctor [pregnancybirthbaby.org.au]
[…] 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 blisters and ulcerate [medicinenet.com]
- Urticaria
Skin — vesicles, maculopapular rash, petechiae, urticaria, vasculitis. Oral — enanthem (rash on the mucous membranes), herpangina, tongue and oral ulcers. [me-pedia.org]
- 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]
Neurologic
- Agitation
After low-speed agitation at 4 °C for about 6 h, the mixture was spun down. The resultant pellets were resuspended in buffer A, which was combined with the previous supernatant from the step that dealt with the cell pellets. [pnas.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]
Treatment
Treatment: The treatment of an enterovirus infection is supportive and determined by the symptoms present. Because it is a virus, there is no definitive treatment to stop this infection. [afkpeds.org]
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]
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]
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]
Etiology Coxsackie A, B, ECHO viruses, and numbered EVs are believed to cross the placenta and cause fetal disease. [orpha.net]
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
Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire, 58 (36), 278. https://apps.who.int/iris/handle/10665/224634 Journal Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire, 58 (36): 278 [apps.who.int]
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]
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]
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]
Research on EV-D68 has mainly focused on its epidemiology, and its virologic characteristics and pathogenesis still need to be further explored. [mdpi.com]
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. https://www.cdc.gov/non-polio-enterovirus/about/ev-d68.html. Accessed Oct. 1, 2020. Non-polio enterovirus. Centers for Disease Control and Prevention. https://www.cdc.gov/non-polio-enterovirus/index.html. [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]