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.
Enteroviral infections cover a wide range of illnesses that are caused by 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 mostly been eradicated. Other enteroviruses are the Coxsackie A and B viruses (CVA and CVB) and the echoviruses (ECHO: enteric cytopathic human orphan).
Enteroviruses have been classified into five groups based on their molecular properties.
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.
Enteroviral infections are widespread 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:
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 enteroviruses implant and replicate in the alimentary tract.
If the infection remains localised there are usually no symptoms. However, if the virus passes into the lymphatic system, generalised un-wellness may develop. If the virus spreads into the bloodstream more severe symptoms are experienced.
Many enteroviruses cause diseases with associated cutaneous or mucous membrane reactions.
Hand, foot and mouth disease
Boston exanthem disease
Other cutaneous features are sometimes seen in enterovirus infections and include:
Fewer than 1% of enteroviral infections result in symptomatic severe illness. Occasionally, enteroviruses can cause heart and nervous system complications such as myocarditis, aseptic meningitis, meningoencephalitis and paralysis.
The diagnosis of enteroviral infections is primarily based on clinical findings.
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 an effective treatment in some severe enteroviral infections. Pleconaril is not available in New Zealand (December 2016).
Most enteroviral infections heal spontaneously within 7–10 days. Cutaneous lesions heal without scarring.
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