Enteroviral infections

Author: Vanessa Ngan, Staff Writer, 2008. Updated by Dr Jannet Gomez, Postgraduate Student in Clinical Dermatology, Queen Mary University, London, United Kingdom; Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, December 2016.

What are enteroviral infections?

Enteroviral infections cover a wide range of illnesses that are caused by a group of viruses called enteroviruses (EVs). They are members of the picornaviridae family which are small, icosahedral, single-stranded, positive-sense RNA viruses.

The most well known of the enteroviruses is the poliovirus (PV) but this has largely been eradicated. Other enteroviruses are the coxsackie A and B viruses (CVA and CVB) and the echoviruses (ECHO: enteric cytopathic human orphan).

How are enteroviruses classified?

Enteroviruses have been classified into 5 groups based on their molecular properties.

1. Poliovirus

2. Human EV A (HEV-A)

3. Human EV B (HEV-B)

4. Human EV C (HEV-C)

5. Human EV D (HEV-D)

Enteroviruses are the cause of many illnesses including the common cold. Some of the coxsackieviruses, echoviruses and EV71 cause exanthems (skin rash or skin eruption as a symptom of a more general disease) or enanthems (rash on the mucous membranes). Cutaneous manifestations may be severe and atypical in some cases.

Who gets enteroviral infections?

Enteroviral infections are very common and it is estimated that more than one billion people worldwide are affected annually. In the United States 30,000 to 50,000 hospitalisations each year are due to enteroviral infections. People at risk include:

How are enteroviral infections spread? 

Enteroviral infections are highly contagious. Enteroviruses spread from person-to-person via:

The incubation period for enteroviruses is usually 2–5 days. Once someone is infected the enterovirus implant and replicate in the alimentary tract.

If the infection remains local there is usually no symptoms. However, if the virus passes into the lymphatic system, generalised symptoms of un-wellness may develop. If the virus spreads into the bloodstream then more severe symptoms are experienced.

Cutaneous features of enteroviral infections 

Many enteroviruses cause diseases that have associated skin or mucous membrane reactions. 

Herpangina

Hand-foot-and-mouth

Boston exanthem disease

Eruptive pseudoangiomatosis

Below is a list of other cutaneous features that have been associated with the following enteroviruses.

What are the complications of enteroviral infections?

Less than 1% of enteroviral infections result in serious symptomatic illness. Occasionally, enteroviruses can cause severe heart and nervous system complications such as myocarditis, aseptic meningitis, meningoencephalitis and paralysis. 

How are enteroviral infections diagnosed?

Diagnosis is primarily based on the clinical findings.

Enteroviral PCR assays are helpful in confirming the pathogens.

Serologic testing and culture of virus are done in rare cases.

What is the treatment of enteroviral infections?

Treatment is limited to supportive therapy.

Intravenous immunoglobulin has been used for the treatment of enterovirus  infection in symptomatic infants.

The antiviral drug pleconaril has shown to be effective treatment in some severe enteroviral infections. This is not available in New Zealand (December 2016).

What is the outcome of enteroviral infections?

Most enteroviral infections heal spontaneously within 7–10 days. Cutaneous lesions heal without scarring.

Related information

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