Internal Medicine

P1: OXT/OZN/JDO P2: PSB

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

Enteroviruses 533

pain, and have history of preceding illness. Arrhythmia and sud-

den death can occur when conducting system involved. Pericar-

dial friction rub indicates myopericarditis.

➣Neonatal Sepsis: fever, nonspecific signs such as vomiting,

anorexia, rash and URI

➣Severe cases: hepatic necrosis, myocarditis, necrotizing entero-

colitis and encephalitis

➣Nervous system: paralytic poliomyelitis, aseptic meningitis,

rarely encephalitis

Poliomyelitis (caused by poliovirus serotypes)

➣^90 +% wild-type poliovirus are asymptomatic

➣remaining 10% develop fever, fatigue, HA, anorexia×2–3 days

Small % of these cases develop aseptic meningitis (indis-

tinguishable from nonpolio enteroviruses) and some then

develop paralysis

➣Aseptic Meningitis (many different serotypes cause):

nuchal rigidity

headache, photophobia

vomiting, anorexia, rash, diarrhea, cough, URI, diarrhea, myal-

gias

occasionally SIADH

some with skin rash (hand, foot and mouth)

➣Encephalitis:

Generalized encephalitis

Less commonly focal encephalitis

Chronic enteroviral meningoencephalitis occurs in indi-

viduals with defects immunoglobulin production (e.g.,

hypogammaglobulinemia)

tests

Nonspecific:

■Aseptic meningitis:

➣CSF: monocytic pleocytosis (100–1,000 cell/mm3)

normal glucose

normal to slight increase protein

Myocarditis

myocardial enzymes elevation

Specific:

■Isolation from affected site: respiratory secretions, stool, conjunc-

tival swab, CSF, and myocardial tissues (note: cell culture isolation

is possible with most enteroviruses except group A coxsackievirus,