Enterovirus: Difference between revisions

Latest revision as of 14:09, 17 September 2020

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

Most common identified cause of aseptic meningitis

Respiratory Disease

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

Other Syndromes

Most common cause of myopericarditis
Myositis
Coxsackievirus diseases in the newborn
Non-specific exanthems
Upper respiratory tract infection

Enterovirus A71

Causes aseptic meningitis, gastroenteritis

Immunodeficiencies

Agammaglobulinemia predisposes to the development of chronic meningoencephalitis, which can be severe and fatal
Relevant diseases include X-linked agammaglobulinemia, common variable immunodeficiency, severe combined immunodeficiency disease, and hyper-IgM syndrome, as well as acquired defects including hematopoietic stem cell transplantation, rituximab, and obinutuzumab

Pregnancy

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

Differential Diagnosis

Other causes of aseptic meningitis

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

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-=== Microbiology ===
+===Microbiology===
-* A genus of small RNA viruses within the [[Has family::picornavirus]] family which includes [[rhinovirus]], [[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: CV-A2 to CV-A8, CV-A10, CV-A12, CV-A14, and CV-A16; EV-A71, EV-A76, EV-A89, EV-A90 to EV-A92, EV-A114
-** Enterovirus B: CV-A9, CV-B1 to CV-B6; E-1 to E-7, E-9, E-11 to E-21, E-24 to E-27, E-29 to E-33; 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: PV-1 to PV-3; CV-A1, CV-A11, CV-A13, CV-A17, CV-A19 to CV-A22, CV-A24; EV-C95, EV-C96, EC-C99, EV-C102, EV-C104, EV-C105, EV-C109, EV-C113, EV-C116
-** Enterovirus D: EV-D68, EV-D70, EV-D94, EV-D111
+*A genus of small RNA viruses within the [[Family::Picornaviridae]] family which includes [[rhinovirus]], [[echovirus]], [[coxsackievirus]], and [[poliovirus]]
-== Clinical Manifestations ==
+*Traditionally organized by subgenera ([[poliovirus]], group A and B [[coxsackievirus]], [[echovirus]], and numbered enterovirus) and serotype
-* Clinical syndromes are myriad, including mild febrile illnesses, upper or lower respiratory infections, aseptic meningitis, encephalitis, paralysis, myocarditis, and neonatal enteroviral sepsis
+*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
-=== Hand-foot-mouth disease ===
+=== Pathophysiology ===
-* 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
+* Local replication in the GI tract followed by viremia that seeds to other sites including upper respiratory tract (including conjunctivae) and meninges
-== Diagnosis ==
+* Some are transmitted via droplet/contact via eyes, especially some of the exclusively respiratory viruses like EV-D68
-* Diagnosis is usually PCR
+* There is receptor tropism by genotype
+=== Epidemiology ===
-[[Category:Enteroviridae]]
+* 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 ===
+* Most common identified cause of [[Causes::aseptic meningitis]]
+=== Respiratory Disease ===
+* Enteroviruses account for most upper respiratory infections in the summer, including undifferentiated febrile illness
+=== Other Syndromes ===
+* Most common cause of myopericarditis
+* Myositis
+* Coxsackievirus diseases in the newborn
+* Non-specific exanthems
+* [[Upper respiratory tract infection]]
+=== Enterovirus A71 ===
+* Causes [[Causes::aseptic meningitis]], [[Causes::gastroenteritis]]
+=== Immunodeficiencies ===
+* Agammaglobulinemia predisposes to the development of chronic meningoencephalitis, which can be severe and fatal
+* Relevant diseases include [[X-linked agammaglobulinemia]], [[common variable immunodeficiency]], [[severe combined immunodeficiency disease]], and [[hyper-IgM syndrome]], as well as acquired defects including [[hematopoietic stem cell transplantation]], [[rituximab]], and [[obinutuzumab]]
+=== Pregnancy ===
+* Enteroviral infection within the week before delivery has a high risk for severe neonatal sepsis
+== Differential Diagnosis ==
+* Other causes of [[aseptic meningitis]]
+==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
+[[Category:Picornaviridae]]