Enterovirus: Difference between revisions

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== Background ==
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==Background==
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=== Microbiology ===
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===Microbiology===
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* 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
  
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** 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
  
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** 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:
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**'''Enterovirus A'''
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***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
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**'''Enterovirus B'''
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***Coxsackieviruses: CV-A9, CV-B1 to CV-B6
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***Echoviruses: E-1 to E-7, E-9, E-11 to E-21, E-24 to E-27, E-29 to E-33
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***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
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**'''Enterovirus C'''
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***Polioviruses: PV-1 to PV-3
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***Coxsackieviruses: CV-A1, CV-A11, CV-A13, CV-A17, CV-A19 to CV-A22, CV-A24
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***Enteroviruses: EV-C95, EV-C96, EC-C99, EV-C102, EV-C104, EV-C105, EV-C109, EV-C113, EV-C116
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**'''Enterovirus D'''
  ⚫
***Enteroviruses: EV-D68, EV-D70, EV-D94, EV-D111
   
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=== Hand-foot-mouth disease ===
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=== Pathophysiology ===
⚫
* Typically caused by group A enteroviruses, especially coxsackie A16, enterovirus A71, and enterovirus A6
  
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* Causes painful lesions in oral mucosa and palms and soles in young children
  
   
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* Local replication in the GI tract followed by viremia that seeds to other sites including upper respiratory tract (including conjunctivae) and meninges
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== Diagnosis ==
  
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* Some are transmitted via droplet/contact via eyes, especially some of the exclusively respiratory viruses like EV-D68
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* Diagnosis is usually PCR
  
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* There is receptor tropism by genotype
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=== Epidemiology ===
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* Most common cause of aseptic meningitis
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=== Risk Factors ===
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* Hypogammaglobulinemia from a number of causes
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* Neonates
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  ⚫
==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===
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  ⚫
*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
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=== Neurologic Syndromes ===
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* Most common identified cause of [[Causes::aseptic meningitis]]
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=== Respiratory Disease ===
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* Enteroviruses account for most upper respiratory infections in the summer, including undifferentiated febrile illness
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=== Other Syndromes ===
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* Most common cause of myopericarditis
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* Myositis
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* Coxsackievirus diseases in the newborn
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* Non-specific exanthems
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* [[Upper respiratory tract infection]]
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=== Enterovirus A71 ===
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* Causes [[Causes::aseptic meningitis]], [[Causes::gastroenteritis]]
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=== Immunodeficiencies ===
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* Agammaglobulinemia predisposes to the development of chronic meningoencephalitis, which can be severe and fatal
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* 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]]
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=== Pregnancy ===
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* Enteroviral infection within the week before delivery has a high risk for severe neonatal sepsis
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== Differential Diagnosis ==
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* Other causes of [[aseptic meningitis]]
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  ⚫
==Diagnosis==
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*Molecular diagnostics are the gold standard
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**Possible samples include CSF, nasopharyngeal swab, throat, stool, and conjunctiva
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**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
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*Viral culture is not routinely done
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== Management ==
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* Supportive
   
 
[[Category:Picornaviridae]]
  
[[Category:Picornaviridae]]

Latest revision as of 10:09, 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

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
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