Enterovirus

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(Redirected from Hand-foot-mouth disease)

Background

Microbiology

  • A genus of small RNA viruses within the Picornaviridae family which includes rhinovirus, echovirus, coxsackievirus, and poliovirus
  • Traditionally organized by subgenera (poliovirus, group A and B coxsackievirus, echovirus, and numbered enterovirus) and serotype
  • Now organized by sequencing of VP1 gene into four species:
    • Enterovirus A
      • Coxsackieviruses: CV-A2 to CV-A8, CV-A10, CV-A12, CV-A14, and CV-A16
      • Enteroviruses: EV-A71, EV-A76, EV-A89, EV-A90 to EV-A92, EV-A114
    • Enterovirus B
      • Coxsackieviruses: CV-A9, CV-B1 to CV-B6
      • Echoviruses: E-1 to E-7, E-9, E-11 to E-21, E-24 to E-27, E-29 to E-33
      • Enteroviruses: EV-B69, EV-B73 to EV-B75, EV-B77 to EV-B88, EV-B93, EV-B97, EV-B98, EV-B100, EV-B101, EV-B106, EV-B107, EV-B110
    • Enterovirus C
      • Polioviruses: PV-1 to PV-3
      • Coxsackieviruses: CV-A1, CV-A11, CV-A13, CV-A17, CV-A19 to CV-A22, CV-A24
      • Enteroviruses: EV-C95, EV-C96, EC-C99, EV-C102, EV-C104, EV-C105, EV-C109, EV-C113, EV-C116
    • Enterovirus D
      • Enteroviruses: EV-D68, EV-D70, EV-D94, EV-D111

Pathophysiology

  • Local replication in the GI tract followed by viremia that seeds to other sites including upper respiratory tract (including conjunctivae) and meninges
  • Some are transmitted via droplet/contact via eyes, especially some of the exclusively respiratory viruses like EV-D68
  • There is receptor tropism by genotype

Epidemiology

  • Most common cause of aseptic meningitis

Risk Factors

  • Hypogammaglobulinemia from a number of causes
  • Neonates

Clinical Manifestations

  • Clinical syndromes are myriad, including mild febrile illnesses, upper or lower respiratory infections, aseptic meningitis, encephalitis, paralysis, myocarditis, and neonatal enteroviral sepsis

Hand-Foot-Mouth Disease

  • Typically caused by group A enteroviruses, especially coxsackie A16, enterovirus A71, and enterovirus A6
  • Causes painful lesions in oral mucosa and palms and soles in young children

Neurologic Syndromes

Respiratory Disease

  • Enteroviruses account for most upper respiratory infections in the summer, including undifferentiated febrile illness

Other Syndromes

Enterovirus A71

Immunodeficiencies

Pregnancy

  • Enteroviral infection within the week before delivery has a high risk for severe neonatal sepsis

Differential Diagnosis

Diagnosis

  • Molecular diagnostics are the gold standard
    • Possible samples include CSF, nasopharyngeal swab, throat, stool, and conjunctiva
    • Stool is more sensitive but less specific than CSF, so should only be requested when CSF is negative but there is a high pretest probability
  • Viral culture is not routinely done

Management

  • Supportive