Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

532 Enteroviruses

Enteroviruses.......................................

CAROL A. GLASER, MD

history & physical

History

■Picornaviridae virus family

■Includes:

➣23 group A coxsackie viruses

➣3 serotypes of Polioviruses

➣6 group B coxsackie viruses

➣31 serotypes of Echoviruses (echo 22, 23 atypical)

➣4 enterovirus (types 68–71)

➣untyped entroviruses

■Humans only natural host

■Spread fecal-oral primarily, respiratory routes, mother/infant (peri-

partum) and contaminated fomites

■Incubation: variable depending on specific enterovirus types; gen-

erally 1–2 weeks but varies from 2–35 days

■fecal shedding 6–12 weeks, respiratory <1 week

■more common summer and early fall in temperate climates, year-

round in tropical and subtropical areas

Signs & Symptoms

■wide range of illness ranging from asymptomatic to serious disease

and fatalities. Individual serotypes may be most frequently associ-

ated with particular syndromes but considerable overlap in clinical

manifestations.

➣Most common: nonspecific febrile illness

➣Respiratory: common cold, pharyngitis, herpangina (sore throat

with papulovesicular pharyngeal lesions on erythematous base),

pneumonia, pleurodynia

➣Hand, Foot and Mouth; often associated with coxsackie A16 but

other serotypes can be involved, mild illness associated with

sore throat, fever, scattered vesicular lesions on pharynx/lips and

grayish vesicles on hands and feet

➣Gastrointestinal: vomiting, diarrhea, abdominal pain, occasion-

ally hepatitis

➣Acute hemorrhagic conjunctivitis

➣Cardiac: myocarditis; clinical symptoms dependent on region

and extent of cardiac involvement, often with palpitations, chest