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Magill’s Medical Guide, 8th Edition

Enteroviruses

by Andrew Ren, M.D.

Disease/Disorder

Anatomy or system affected: Brain, eyes, heart, nervous system, skin

Specialties and related fields: Cardiology, dermatology, environmental health, internal medicine, microbiology, neurology, virology

Definition: A class of viruses capable of infecting multiple organ systems, such as the central nervous system, the skin, the eyes, and the heart.

Key terms:

lesion: an abnormal area of tissue

meningitis: the inflammation of the protective tissues surrounding the brain and spinal cord

syndrome: a constellation of different symptoms or signs that are associated with a certain illness

vesicle: a fluid-filled blister

wild type: the form of species that occurs in nature

Causes and Symptoms

Enteroviruses are a class of viruses that include the well-known poliovirus and also coxsackieviruses, echoviruses, and other enteroviruses. Genetically, they are small, nonenveloped, single-stranded deoxyribonucleic acid (DNA) viruses that belong to the family Picornaviridae. These viruses are ubiquitous and infections occur year-round.

Enteroviruses cause a variety of clinical syndromes with different clinical manifestations depending on the specific viruses involved. Typically, transmission is through direct contact with fecal matter and contaminated food or water. The virus usually replicates initially in the throat and the small intestine, from where it then spreads to other organs.

Information on Enteroviruses

Causes: Virus

Symptoms: Fever, muscle weakness, rash, headache, neck stiffness, confusion, lethargy

Duration: Acute or chronic

Treatments: Supportive care, hydration, antipyretics; critical life support measures in severe cases; intravenous immunoglobulins

Rash is a symptom common in all enterovirus infections. A maculopapular rash (mixture of flat and raised spots) can be seen in echovirus and poliovirus infections. Coxsackieviruses can cause the hand-foot-mouth syndrome in children, which presents as fever and vesicles in the oral cavity, hands, feet, buttocks, and sometimes genitalia. Transmission is through direct contact, and the illness usually resolves in two to three days. Herpangina is another syndrome caused by coxsackieviruses; it presents with painful vesicular lesions on the tonsils and soft palates in children. Echovirus and coxsackievirus can both cause a petechial rash (small, red or purple spots), which sometimes may be confused with a meningococcal infection.

The central nervous system (CNS) is a well-known site of enteroviral infections. Enteroviruses as a group is the most common cause of viral meningitis in adults, which is usually due to echoviruses and coxsackieviruses. Because infants are not able to verbalize, they usually exhibit signs of irritability and fever, whereas in adults the common complaints are fever, headache, stiff neck, nausea, and vomiting. Encephalitis, the swelling and inflammation of the brain, is usually also the result of coxsackieviruses and echoviruses. It can develop either as a complication of meningitis or as an isolated event. Encephalitis typically presents as fever, lethargy, headache, seizures, or confusion. Paralytic poliomyelitis is the well-known syndrome due to polioviruses, but this presentation is the least common, since most people who have been infected with poliovirus do not have symptoms and only a minority of patients develop meningitis. Those who do develop paralysis usually present with a progressive, asymmetric weakness. The legs are commonly involved, followed by the arms and abdominal, chest, or throat muscles. It is the involvement of respiratory and throat muscles that may be life threatening since these patients are prone to respiratory failure. While muscle paralysis is the hallmark of poliovirus infection, a similar picture may also be seen with echovirus infections, although the symptoms are not as severe or persistent.

Enterovirus and coxsackievirus are also capable of causing eye infections, commonly known as acute hemorrhagic conjunctivitis (AHC), with red eyes, pain, and swelling of the eyelids.

Coxsackieviruses can affect the chest and abdominal muscles, causing what is known as pleurodynia, which presents as fever and spasms of the chest and abdominal muscles. Coxsackievirus infection of the heart muscles and its surrounding tissues, known as myopericarditis, can present with mild symptoms such as chest pain or severe and rapid progression to heart failure and death.

Treatment and Therapy

Because most enteroviral infections are self-limited and resolve spontaneously, specific treatments are not warranted. In cases of severe infections-such as paralytic disease, meningitis, or myocarditis-supportive therapies are needed as life preservation measures. Even in such severe cases, no specific antiviral agents are available. Serum intravenous immunoglobulin has been tested in patients with certain immunodeficiencies and in neonates, although results have been mixed.

As in most infections, prevention is just as important as treatment. Because enteroviral infections are transmitted through contaminated sources, it is imperative to exercise good judgment regarding handwashing and hygienic practices.

Perspective and Prospects

As one of the most recognized members of the enteroviral class, poliovirus has come a long way since its isolation in 1909 by Karl Landsteiner and Erwin Popper. The development of polio vaccines along with implementation of polio eradication programs have largely eliminated the disease due to wild-type poliovirus. The virus has been largely eradicated in the United States and other developed countries, and it is targeted for imminent global eradication.

The first polio vaccine was developed in 1952 by Jonas Salk. It was developed as an injectable vaccine using dead virus and is known as the inactivated polio vaccine (IPV). Doses are given at two, four, and six to eighteen months and at four to six years of age. Albert Sabin subsequently developed an oral polio vaccine (OPV) in 1962 that utilizes an attenuated but live poliovirus. Dosing is the same as that for the inactivated polio vaccine. A major concern of the oral polio vaccine is its ability to cause vaccine-induced polio, although the likelihood is very low, with rates of approximately 1 in 2.5 million vaccine recipients. Since most wild-type poliovirus have been eradicated, most cases of poliomyelitis in the twenty-first century are attributed to vaccine-induced poliomyelitis.

See also

Childhood infectious diseases; Encephalitis; Epidemiology; Hand-foot-and-mouth disease; Immunization and vaccination; Meningitis; Paralysis; Poliomyelitis; Viral infections.

For Further Information:

1 

Dugdale, David C. III, and David Zieve. “ECHO Virus.” MedlinePlus, Oct. 6, 2012.

2 

Fauci, Anthony, et al., eds. “Enteroviruses and Reoviruses.” In Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw-Hill, 2012.

3 

Mandell, Gerald, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia: Churchill Livingstone, 2010.

4 

“Non-Polio Enterovirus.” Centers for Disease Control and Prevention, May 10, 2013.

5 

Richman, Douglas, eds. Clinical Virology. 3d ed. Washington, D.C.: ASM Press, 2009.

6 

“Viral Infections.” MedlinePlus, Apr. 19, 2013.

7 

Vorvick, Linda J., and David Zieve. “Hand-Foot-Mouth Disease.” MedlinePlus, Aug. 10, 2012.

Citation Types

Type
Format
MLA 9th
Ren, Andrew. "Enteroviruses." Magill’s Medical Guide, 8th Edition, edited by Bryan C. Auday, et al., Salem Press, 2018. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2018_0447.
APA 7th
Ren, A. (2018). Enteroviruses. In B. C. Auday, M. A. Buratovich, G. F. Marrocco & P. Moglia (Eds.), Magill’s Medical Guide, 8th Edition. Salem Press. online.salempress.com.
CMOS 17th
Ren, Andrew. "Enteroviruses." Edited by Bryan C. Auday, Michael A. Buratovich, Geraldine F. Marrocco & Paul Moglia. Magill’s Medical Guide, 8th Edition. Hackensack: Salem Press, 2018. Accessed December 14, 2025. online.salempress.com.