Enteroviral infections

What are enteroviral infections?

Enteroviral infections cover a wide range of diseases caused by enteroviruses (EVs). They are members of the Picornaviridae family, which are small, icosahedral, single-stranded, positive-sense RNA virus

The best known of the enteroviruses is poliovirus (PV), but it has mostly been eradicated. Other enteroviruses are Coxsackieviruses A and B (CVA and CVB) and echoviruses (ECHO: enteric cytopathic human orphan).

How are enteroviruses classified?

Enteroviruses have been classified into five groups based on their molecular properties.

1. Poliovirus: PV1 – PV3
2. Human EV A (HEV-A): CVA2 – CVA9, CVA10, CVA12, CVA14, CVA16 and EV71
3. Human EV B (HEV-B): CVA9, CVB1 – CVB6, E1 – E7, E9, E11 – E21, E24 – E27, E29 – E33, EV69
4. Human EV C (HEV-C): CVA1, CVA11, CVA13, CVA15, CVA17 – CVA22, CVA2
5. Human EV D (HEV-D): EV68, EV70, EV73 – EV75, EV77 – EV78

Enteroviruses are the cause of many illnesses, including the common cold. Some of the coxsackieviruses, echoviruses, and EV71 cause rashes (skin eruption or skin eruption as a symptom of a more general disease) or enanthems (rash on the mucous membranes). Cutaneous Manifestations can be severe atypical in some cases.

Who gets enteroviral infections?

Enteroviral infections are extended and it is estimated that more than one billion people worldwide are affected annually. In the United States, between 30,000 and 50,000 hospitalizations each year are due to enteroviral infections. People at risk include:

• Infants and children
• Neonates acquiring infection of mothers
• Immunocompromised patients
• People in lower socioeconomic groups.

How are enterovirus infections spread?

Enteroviral infections are highly contagious. Enteroviruses are spread from person to person through:

• oral-oral routes; for example, viruses are carried in respiratory droplets and spread when someone coughs and sneezes
• Oral-faecal transmission
• Direct contact with fluid from skin lesions.
• From mother to child in the peripartum period.

the incubation The period for enteroviruses is usually 2-5 days. Once someone is infected, enteroviruses implant and replicate in the alimentary tract.

If the infection persists located Usually there are no symptoms. However, if the virus passes to the lymphatic system, generalized poor well-being may develop. If the virus spreads to the bloodstream, more severe symptoms are experienced.

What enteroviral infections cause skin signs?

Many enteroviruses cause diseases with associated cutaneous or cutaneous diseases. mucous membrane reactions

Herpangina

• Herpangina is caused by Coxsackie group A, Coxsackie B, enterovirus 71, and echovirus.
• The lesions develop in the mucous membranes, more often in the previous tonsils, uvula and soft palate of the mouth.
• The lesions are characterized by a minute grayish white. papulovesicles about 1–2 mm in diameter.
• They are self-limited and resolve in 5 to 10 days.
• Generalized symptoms include high fever, headache, sore throat, difficulty swallowing, vomiting, and abdominal pain.

Hand, foot and mouth disease

• Hand, foot and mouth disease (enterovirals) stomatitis) is caused by Coxsackievirus A16 and enterovirus 71.
• Oral lesions develop anywhere inside the mouth, but most often appear on the hard palate, tongue, cheeks, and gums.
• Oral lesions begin as erythematous maculesand papules (flat, inflamed red spots) 2–8 mm in diameter and progress to form thin walls vesicles (blisters) that burst and form painful ulcers surrounded by a red halo. These heal without treatment for 5 to 10 days.
• Skin lesions appear at the same time or shortly after oral lesions. There can be anywhere from a few to more than 100 injuries to the hands and feet.
• Skin lesions begin as erythematous macules or papules that rapidly turn into small gray vesicles surrounded by a red halo. These lesions resolve spontaneously over 7-10 days without scarring.

Boston exanthema disease

• Boston disease rash is cused by echovirus 16.
• After a brief fever, pink macules and papules appear suddenly on the face and trunk, and less often on the extremities.
• Small ulcers can also be found on the soft palate and tonsils.

Eruptive pseudoangiomatosis

• Eruptive Pseudoangiomatosis is caused by echovirus 25 and 32, Coxsackie B, Epstein-Barr virus, and CMV.
• Up to ten cherry-red lesions develop on the face, trunk, and extremities.
• Pseudoangiomas are 2–4 mm in diameter and resemble a cherry. angiomas.
• They resolve spontaneously in ten days.

Other skin features are sometimes seen in enterovirus infections and include:

• Pustular stomatitis with erythema multiforme: caused by CVB5
• Extended vesicular rash (blisters): CVA4

• Childish papular acrodermatitis (Gianotti-Crosti): CVA16

• Rubelliform rash (rash looks like rubella): E2
• Morbid rash (rash looks like measles): E6, E11, E25
• Petechiae (small purple spots or purple): E11, E19
• Dotted macular rash: E19
• A vesicular rash (blisters): E11
• Eczema coxsackium (a serious infection associated with atopic dermatitis)

See enteroviral images.

What are the complications of enteroviral infections?

Fewer than 1% of enterovirus infections cause severe symptomatic illness. Occasionally, enteroviruses can cause heart and nervous system complications, such as myocarditisaseptic meningitis, meningoencephalitis and paralysis.

How are enterovirus infections diagnosed?

Diagnosis of enteroviral infections is based primarily on clinical findings.

• Enterovirals PCR assays are useful to confirm the pathogens.
• Serological tests and culture of the virus are performed in rare cases.

What is the treatment for enterovirus infections?

Treatment is limited to supportive therapy.

• Handwashing (especially after changing a diaper) and personal hygiene.
• Disinfect surfaces and objects
• avoid close contact
• Hydration with plenty of fluids.
• Antipyretics such as paracetamol for fever.

• mouthwashes containing current anesthetics (2% lidocaine) and antihistamines (eg, diphenhydramine hydrochloride) to relieve oral pain

Intravenous immunoglobulin It has been used for the treatment of enterovirus infection in symptomatic infants.

the antiviral The drug pleconaril has been shown to be an effective treatment in some severe enterovirus infections. Pleconaril is not available in New Zealand (Dec 2016).

What is the outcome of enteroviral infections?

Most enteroviral infections resolve spontaneously in 7 to 10 days. Skin lesions heal without scarring.