Enteroviruses, are picornaviruses (pico, or small, RNA viruses) and include coxsackieviruses A1 to A21, A24, and B1 to 6, echoviruses (enteric cytopathic human orphan viruses) 1 to 7, 9, 11 to 21, 24 to 27, and 29 to 33, enteroviruses 68 to 71, 73 to 91, and 100 to 101, and polioviruses types 1 to 3.
Enteroviruses are shed in respiratory secretions and stool and sometimes are present in the blood and cerebrospinal fluid of infected patients. Infection is usually transmitted by direct contact with respiratory secretions or stool but can be transmitted by contaminated environmental sources (eg, water). Enteroviral diseases or epidemics in the US are more common in summer and fall.
Infection transmitted by a mother during delivery can cause severe disseminated neonatal infection, which may include hepatitis or hepatic necrosis, meningoencephalitis, myocarditis, or a combination of these, and can lead to sepsis or death. Intact humoral immunity and B-cell function are required for control of enteroviral disease.
Diagnosis is made by clinical evaluation and sometimes culture or reverse transcriptase–polymerase chain reaction (RT-PCR). Laboratory diagnosis is usually unnecessary but can often be made by culturing the virus, detecting viral RNA using RT-PCR, less commonly, demonstrating seroconversion.
Treatment of enteroviral disease is supportive. Patients with agammaglobulinemia are treated with IV immune globulins with variable success.
The oral antiviral drug pleconaril, which has shown activity against a number of picornaviruses, is being investigated for treatment of severe neonatal enteroviral disease.