Internal Medicine

P1: OXT/OZN/JDO P2: PSB

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

534 Enteroviruses

which do not grow in cell culture, only grow in suckling mice.

Most enteroviruses grow rapidily. The body site where enterovirus is

detected is important for interpretation to differentiate enterovirus

colonization versus enterovirus-associated disease. Note that

enterovirus is present in stool for weeks (and sometimes months)

after initial infection.

■Nucleic acid detection: available in some settings, specimen best

from affected site; CSF, respiratory secretions, conjunctival swab,

CSF, and myocardial tissues. Stool possible but as above may persist

for weeks.

■Serology: difficult due to large number of serotypes. Recently devel-

oped IgM tests have been developed and have variable success.

differential diagnosis

■Respiratory illnesses: other respiratory viruses

■Nervous system: Aseptic meningitis; large number of other viral and

bacterial causes

■Polio-like illness: important to distinguish poliovirus versus other

enterovirus (especially enterovirus 71)

■Cardiac: myocarditis – herpesviruses, adenovirus, parvovirus

management

■Supportive

specific therapy

■None widely available

➣Chronic enteroviral encephalitis -IVIG has been used success-

fully

follow-up

n/a

complications and prognosis

■Aseptic meningitis: outcome is excellent (except in neonates)

➣Encephalitis; may have profound acute disease and long-term

sequelae, case-dependent

➣Poliomyelitis; long-term outcome determined first 6 months

after onset; absence of improvement suggests permanent paral-

ysis with concomitant limb atrophy+deformity. If improvement

occurs – gradual, continues 9–18 months. Overall morality spinal

poliomyelitis∼5%

➣Myocarditis: most patients recover but some will have residual

EKG/ECHO abnormalities for months to years after infection.