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Enteroviruses

Enteroviruses. Dr M.Karimi. Genera of Picornaviruses. Enterovirus: Polio,Coxsackie A and B Echo,Other enteroviruses Rhinovirus Cardiovirus Hepatovirus Aphthovirus Others.

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Enteroviruses

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  1. Enteroviruses Dr M.Karimi

  2. Genera of Picornaviruses • Enterovirus: Polio,Coxsackie A and B Echo,Other enteroviruses • Rhinovirus • Cardiovirus • Hepatovirus • Aphthovirus • Others

  3. With only six polio endemic countries left in the world, polio transmission could be stopped by end 2005.  The world could then be certified polio-free by end-2008.

  4. Enteroviruses • RNA Viruses Polio • Include some group of Coxackieviruses Polio viruses Picornaviruses Echoviruses Herpangina

  5. Aseptic meningitis Nonspecific febrile illness Colds Conjunctivitis Pharyngitis Herpangina Hepatitis Exanthems Encephalitis Paralytic polio Vomiting Diarrhea Pericarditis Myocarditis Hand-foot-mouth syndrome Clinical manifestation of Enterovirus Infections

  6. Epidemiology • Transmission from person to person: Fecal-Oral Respiratory • Peak incidence : Summer & Fall • Male =Female • Age: Young children • Incubation period: 3-6 Days

  7. Pathogenesis • URI Infection • Regional lymph nodes involvement • Low-Grade viremia (Heart,Skin,Pericardium ,Lung..) • Clinical illness & Major viremia • Antibody appearance on 7th day • GI Replication

  8. Pathophysiology • Polio→Motor neurons (Pathogonomic finding) • Coxackieviruses → Herpangina → Hand foot-mouth → Myocarditis Meningoencephalitis,Adrenal glands,Pancrease,Liver,Pleura 3. Echovirus → Hepatic necrosis

  9. Clinical manifestation Polioviruses(1) • Asymptomatic infection(95%) • Abortive form:Fever, Headache, Malaise,Anorexia ,Nausea,Vomiting,Pharyngitis,Abdominal pain • Nonparalyticform:Abortive form symptoms, Menengeal sign, Decrease deep and superficial tendon reflexes,

  10. Clinical manifestation Polioviruses(2) • Paralytic form:Similar to nonparalyticform+Muscleweakness,BPchanges,Respiratory and cardiac arrhythmia, Weakness,Falccid Paralysis(Typically asymetric proximal muscle involvement) • Spinal form: Axial and extremity muscle weakness • Bulbar form: Cranial nerve involvement (Dysphagia) • Encephalitic form: irritability,disorientation ,drowsiness,tremor

  11. Polioviruses • Prodrome: Headache,Malaise,Menengealsign,CSFpleocytosis • Severe myalgia, Meningismus,Weakness,Flaccid paralysis • Asymetric distribution • Proximal muscles involve more than distal muscles • Sensory function remains intact

  12. Respiratory Insufficiency symptoms • Anxiety • Tachypnea • Respiratory distress symptoms • Decrease cough • Paradoxic abdominal movement • Immobility of intercostal spaces • Arm&Deltoid weakness

  13. Bulbar Polio • Palatal & Pharyngeal weakness (nasal voice) • Pooling of saliva • Poor cough • Nasal regurgitation of saliva • Deviation of palate,uvula,tongue • Hoarseness , Aphonia • BP Changes

  14. Differential diagnosis • Guillain-Barre syndrom • Other viral encephalomyelitis • Tick paralysis • CNS Tumor • Trauma • Vaccine associated paralytic polio

  15. Prognosis • Determined during 1 month after infection • Some degree of permanent damage • Bulbar paralysis generally recover completely TYPICAL CONTRACTURES IN POLIO

  16. Nonpolio Enteroviral Infection • Asymptomatic: (Less than 50%) • Nonspecific febrile illness:(Lasts 3 days) (Most common manifestation of all types of entroviral infections) Fever, Malaise, Headache, Pharyngitis, Myalgia, GI symptoms in neonate • Respiratory tractillness: Conjunctivitis, Herpangina,Pharyngitis,Stomatitis, Parotitis ,Croup,Bronchitis, Pneumonia,Pleurodynia,

  17. Herpangina:Fever, Oral ulcers and vesiclesDuration 3-6 days

  18. Pleurodynia • Acute febrile illness • Intense pleuritic pain • Upper abdominal muscular pain • CXR: Normal • WBC: Normal or elevated myeloid cell

  19. NonpolioEnteroviral Infection • Gasterointestinal manifestation: Vomiting,Non bloody diarrhea,Abdominal pain, Pseudoappendicitis • Acute hemorrhagic conjunctivitis: Eye pain, Photophobia,Blurredvision,Lacrimation,Erythma, Conjunctivitis • Pericarditis&Myocarditis: High mortality especially in neonate

  20. Nonpolio Enteroviral Infection • Hand-foot-mouth syndrome: Small intraoral ulcer, Macular or vesicular lesion on hands and feet&buttock

  21. Hand-foot-mouth syndrome:

  22. Nonpolio Enteroviral Infection • Aseptic meningitis syndrome: Rash,Sore throat,Muscle pain, Sign of meningeal irritation CSF (PMN pleocytosis,High protein,Normal glucose), • Seasonal Encephalitis: • Paralysis: Acute hemiplegia,Perphral neuritis • Genitourinary: Orchitis,Epididymitis,Cystitis ,Hematuria • Myositis&Arthritis: Dermatomyositis-like syndrome

  23. Nonpolio Enteroviral Infection • Neonatal nonspecific febrile illness: Duration 3-4 days, Fever, Anorexia , Irritability, Mild vomiting, Diarrhea, PMN leuckocytosis • Neonatal myocarditis: Fever,Tachycardia, Cardiomegaly , ECG changes ,Transient systolic murmur ,Shock, Respiratory distress • Fulminant encephalomyocarditis

  24. Diagnosis • Age, Season, Location, Exposure • Clinical manifestation • PCR • Culture from sterile sites biopsy

  25. Treatment: Supportive therapy Pleconaril in immunocompetent No Steroids Prevention: OPV/IPV

  26. Vaccination program • At Birth: BCG’ OPV’ Hepatitis B* • 2 Month: DPT’ OPV’ Hepatitis B • 4 Month: DPT’ OPV • 6 Month: DPT’ OPV’ Hepatitis B • 12 Month: MMR • 18 Month: DPT’ OPV • 4-6 years old: DPT’ OPV’MMR • 14-16 years old: Td

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