Enteroviruses

Family
Genus

Picronaviridae (note: includes Hepatitis A & Rhinovirus in this fam.)

Poliovirus

Coxsackieviruses (A& B)

Echoviruses
(ECHO= Enteric Cytopathic Human Orphan)

Small "pico"
Non-enveloped (naked)

Envelope/ Shape

-Translated into single polyprotein which is cleaved into enzymatic & structural proteins
DNA/RNA

ALL ARE (+) ssRNA

Rarely causes enteric dz
Spreads primarily by fecal-oral route

Characteristics

Since non-eveloped highly resistant to pH 3 to 9, heat, detergents, mild sewage treatment, salt water & solvents
Replication is rapid, often results in cytolysis (main cause of dz)

Transmission:
-mainly fecal-oral
-some via respiratory secretions
Reservoir/Source:
-HUMANS only
-Contaminated food, water sources
Geography:
[worldwide]

Source/
Transmission

Season/place:
-Schools, daycares
-Summer, warm climates
Age:
all ages
(more severe in older kids, adults)

1. Enters & replicates in upper respiratory tract, oropharynx, & GIT

2. Primary viremia w/ spread to target tissues
3. Replication in target tissue --> second phase of viremia & Sx
Pathophysiology

4. Cell destruction is primary cause of dz sx/presentation

5. Incubation period: 1-35 days, depending on virus, target tissue, risk factors
6. Communicability Duration: viral shedding from oropharynx prior to Sx, shedding from intestines may last for > month
7. Major protective immune response is Ab production

Enteroviruses 60-71

Asymptomatic illness
>90% asymptomatic
Stays in oropharynx & gut
Young kids usually asymptomatic

Group A:

Abortive poliomyelitis: (minor illness):

non-specific flu-like symptoms

-Skin Infections:
--> Herpangina
(Oropharyngeal lesions with fever)

Non-paralytic poliomyelitis (aeptic meningitis):

spreads to CNS, meninges
-non-specific flu-like sx w/ back pain, muscle spasms, & neck stiffness
Paralytic Polio (major illness): 1% paralysis
-Spreads from blood to spinal cord (anterior horn cells) & motor cortex of brain
-Biphasic:
--> initial mild symptoms, subside, then
--> 3-4 days later: onset of major illness
-Asymmetric flaccid paralysis, NO sensory loss
--> Degree of paralysis variable with severity of illness & nerves affected
--> Paralysis spreads for days w/ either complete recovery (6mo-2yrs), residual
paralysis, or death
Paralytic polio with bulbar involvement: MOST SEVERE (75% die)
-Flaccid paralysis + oropharynx, vocal cords, and respiratory muscles
-Iron lungs used for this (note some people still use them)

-May be spread by droplet nuclei

-Flaccid paralysis, generalized myositis

-Acute hemorrhagic conjunctivitis (AHC)

--> Catarrhal inflamm.
--> Progress to conjunctival petechiae that coalesce
--> Subconjunctival hemorrhages
--> Painful progressive conjunctivitis
--> Swollen eyelids
--> Resolves ~ 1 week
--> Dx: Cx conjunctival swabs, serology
--> Tx: treat sx, no antiviral drugs avail.
"Hand-foot- and-mouth disease" (HFM)
--> Mild & self limiting
--> Sore throat or mouth, low grade fever
--> Macular Lesions on buccal mucosa, tongue, hard palate
--> Lesions quickly turn into vesicles and erode becoming surrounded by a RED
(erythematous) HALO
--> Resolves in 7-10 days
--> Dx: clinical, serology, or vesicle fluid culture
--> Tx: supportive, no antiviral avail.

Disease
Post polio syndrome: 30 yrs. later, Rememergence after infection
-Sequelae of poliomyelitis
-Caused by degeneration of motor axon sprouts that had grown to innervate orphaned
muscle fibers to compensate
-Years of compensation by these fibers cause them to "wear out"
-Fatigue, muscle weakness & pain, respiratory probs., gait disturbance, sleep apnea
Flat-back syndrome****** (unable to stand erect b/c of leg & back pain)
-Rarely life threatening, not infections

Group B:

MUCH MORE SERIOUS

-May be spread by droplet nuclei

-Spastic paralysis
-Focal muscle injury, degeneration of neuronal tissue
Myocarditis
Epidemic Pluerodynia/ Bornholm's Disease (Devils grip)
--> Abrupt onset of fever
--> Sharp spasms of chest pain & abdominal muscles
--> Resolves ~ 1 week
--> Dx: Cx or serology
--> Tx: treat sx, no antiviral drugs avail.
Acute aseptic meningitis
--> major cause of CAM

Lab Diagnosis

Prevention

PCR of CSF****
Serology, Isolation, & Culture of nasopharyngeal secretions/ stool samples
Killed SalK vaccine: Inactivated poliovirus vaccine (IPV)
-Formalin inact., 3 strains of poliovirus
-Req. booster
-Children
-Immunodeficient****** & their household contacts
-High-risk adults (traveling to endemic area, exposure)
Live Sabin vaccine: Live attenuated oral poliovirus vacc. (OPV)
3 strains of poliovirus
Provides local GI tract immunity
Cheap and easily administered since oral (NOT USED in U.S. b/c of VAPP)
DO NOT USE w/ immunodeficient since live virus could mutate & infect

Myoperiocarditis
Causes over 50% of acute myopericarditis by
enteroviruses

Non-specific febrile illness

Epidemic Pluerodynia/ Bornholm's Disease

Acute hemorrhagic conjunctivitis

--> highly contagious
--> priamry cause of AHC epidemics

Acute aseptic meningitis

--> major cause of CAM

Non-polio paralytic disease

(Russia, E Europe, SE Asia)

--> Dx: Cx or serology

--> Tx: treat sx, no antiviral drugs avail.

Aseptic meningitis
--> Dx: Cx or serology
--> Tx: treat sx, no antiviral drugs avail.