Enteroviruses
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Enteroviruses are primarily spread from host to host by fecal-oral or fecal-hand-oral transmission. Infection is acquired orally, and virus replicates in the oropharynx and lower gastrointestinal tract. Virus is shed for about a week in the oral secretions but sometimes for several months (usually 2–4 weeks) in the feces [13]. Thus, the usual source of infection is fecal contamination (fingers, utensils, food, etc.), although less frequently transmission may also occur via oral secretions. Respiratory spread by airborne aerosols is very rare. The viruses are frequently found in water (both salt and fresh). Thus, contact with contaminated water during either recreational activities or land irrigation occasionally serves as the mode of infection. Good sewage practices have been attributed to keeping this source of infection from people who take part in water recreational activities.
Infections and infestations of nail unit
Archana Singal, Shekhar Neema, Piyush Kumar in Nail Disorders, 2019
Hand-foot-mouth disease is a viral infection of childhood that is caused by viruses of the genus Enterovirus and is commoner in summers and autumn. Coxsackievirus A6 is the most common causative agent followed by Enterovirus A71.25 It usually occurs in small epidemics and is characterized by erosive stomatitis along with palmoplantar vesicular eruptions. Beau’s lines, yellow orange discoloration of the nail plate, and onychomadesis (Figure 18.10) are common long-term sequelae.26 After 36–39 days of an outbreak in a Spanish nursery, onychomadesis occurred in two-thirds of the patients and Beau’s lines in one-third. Enterovirus was detected in stool samples in 47% of the patients.27 No treatment is required as the pathology is self-limiting and growth of normal nail ensues gradually over a span of a few months.
Meningitis
Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni in Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Central nervous system symptoms in viral meningitis are preceded with common complaints associated with a viral illness (fever and myalgias). The individual may also experience gastrointestinal symptoms with both enteroviruses and arboviruses. Altered level of consciousness is seen in an estimated two-thirds of patients with bacterial meningitis. In contrast, individuals with a viral etiology generally do not experience a change in consciousness. However, these patients can appear very ill. Seizures may also occur with bacterial meningitis. The incidence is estimated to be approximately 20%. The occurrence of seizures has also been associated with a poorer clinical prognosis. In addition, the physical examination should include a thorough inspection of the skin for the presence of a rash. This information can be utilized to aid in the determination of the etiology of the suspected meningitis. A rash is often seen with a viral etiology such as an enterovirus (Russell, 2012; Noto and Marcolini, 2014; Mohan et al., 2012; Manika and Joseph, 2014; Karen et al., 2014).
An Atypical Case of Enterovirus Meningitis Presenting with Unilateral Optic Disc Swelling and Minimal Optical Symptoms
Published in Ocular Immunology and Inflammation, 2023
Efthymios Karmiris, Georgios Vasilakos, Konstantinos Tsiripidis, Evangelia Chalkiadaki
Enteroviruses constitute a genus of the picornavirus family which includes poliovirus, coxsackievirus and human enterovirus A, B, C and D.10 The non-polio human enteroviruses, which are transmitted via the fecal–oral route of infection, may completely shut down host translational machinery causing CNS dysfunction following infection, due to cytopathic effects.9 They can cause a broad spectrum of illnesses such as febrile disease, hand-foot-mouth, herpangina, aseptic meningitis, encephalitis, pancreatitis, chronic inflammatory myopathy, myocarditis and neonatal sepsis.9,10 Their clinical presentation may be varied, and symptoms such as fever, headache, neck stiffness, altered consciousness, seizures, and focal neurological findings often overlap various infectious agents.11 In uncomplicated viral meningitis, the clinical course is usually self-limited, with complete recovery in 7–10 days and no proven treatments.7 However enteroviruses have been linked to autoimmune-like diseases, including diabetes, chronic inflammatory myopathy and chronic myocarditis, perhaps in part due to the long-term presence of viral RNA potentially causing lasting neuropathology.10
Infant botulism: an underestimated threat
Published in Infectious Diseases, 2021
Luca Antonucci, Cristian Locci, Livia Schettini, Maria Grazia Clemente, Roberto Antonucci
In the absence of serious hospital-acquired complications, the prognosis for IB patients is excellent, with anticipated full and complete recovery. In the United States, the mortality rate for IB is less than 1% [40,104]. The course of recovery from IB usually proceeds with a gradual improvement in muscle function, usually without relapses. The worsening of clinical symptoms during the recovery of the patient should let the physician suspect a complication or inadequate respiratory or nutritional support. Infection is the most common complication and can affect the middle ear (otitis media), lungs (aspiration pneumonia) and urinary and intestinal tracts. Regarding intestinal involvement, patients should be carefully monitored for signs of secondary C. difficile infection (diarrhea, change in stool colour, abdominal tenseness, or distention), which can result from colonic stasis due to botulism. Bacteraemia and sepsis may also develop from indwelling venous lines [40,104,106]. Among complications, concomitant intestinal viral infections (mostly caused by enteroviruses) have been also described [125]. Infections and other potential causes of clinical deterioration are listed in Table 5 [72]. Sedatives or other drugs potentially resulting in CNS depression are relatively contraindicated [40].
Hypothetical emergence of poliovirus in 2020: part 1. Consequences of policy decisions to respond using nonpharmaceutical interventions
Published in Expert Review of Vaccines, 2021
Kimberly M. Thompson, Dominika A. Kalkowska, Kamran Badizadegan
We use our exiting global poliovirus transmission model [48], but initialize the population in 2020 assuming no prior immunity or exposure to polioviruses (i.e. a completely naïve population with no immunologically cross-reactive species). This represents a completely different situation than what actually exists, because historical endemic transmission and widespread use of polio vaccines currently imply very high levels of individual and population immunity. We ignore any cross-protection that may exist from prior exposure of some individuals in the population to any related enteroviruses. Since three independent stable serotypes of wild polioviruses (WPVs) exist (WPV1, WPV2, and WPV3) with different properties [48], we model each independently to show the different behaviors with respect to transmission dynamics and expected disease burden. We refer to these generally as novel WPV (nWPV) and specifically as nWPV1, nWPV2, and nWPV3 to indicate properties like the existing WPV serotypes.
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