CNS Infections- Enteroviruses/Non-polio Enteroviruses

Question 1

Non-polio enteroviruses have little cross neutralization between serogroups
-There are many (>70) serotypes:
(list

Answer 1

1. ECHO virus (enteric cytopathic human orphan virus – many [31] serotypes).
2. Coxsackie viruses (A and B - many [30] serotypes).
3. Enteroviruses 68→71.
4. Human Parechoviruses: HpeV-1→3
   - Picornavirus too

Question 2

Non Polio Enterovirus is one of the most common and important viral pathogens in humans (5-10M symptomatic cases/y in US) and causes a __________

Answer 2

nonspecific febrile illness with or without rash

Question 3

Responsible for ½ of all febrile illness in _______ during the _________. It’s a major reason why blood culture and&/or spinal taps are done on _________.

Answer 3

infants and young children

summer and early fall months

infants and young children in the US

Question 4

Among infections of the CNS, they are common and important known causes of morbidity in both children and adults. Most common known cause of ____________.

Answer 4

aseptic meningitis (80 → 90% of all cases) in countries which immunize against mumps.

Question 5

Transmission of Non Polio Enterovirus

Answer 5

1. fecal-oral route (water is most common vehicle)- mainly among small children and adults changing the diapers of an infected infant.
2. inhalation of aerosols via the RT
3. direct contact with respiratory secretions (e.g., saliva, sputum, or nasal mucus).
4. hand→eye, rarely,
5. in utero; true for some strains of ECHOvirus and Coxsackie viruses

Question 6

Reservoir

Answer 6

1. Humans are sole host

2. Environment and humans can be reservoir

Question 7

Both incidence and severity vary inversely with _______

Answer 7

patient age

• Highest attack rate is in children under 1 year old
• Severe disease is more common in adults
• Males and females are equally infected, but males more commonly manifest with disease

Question 8

Seasonality

Answer 8

In the temperate climates, peak incidence is during the summer and fall months, but sporadic cases occur year round, with the prevalent serotype(s) varying annually

Question 9

Patients at greatest risk for enteroviral encephalitis and/or sequelae from CNS enteroviral disease include:

Answer 9

1. neonates

2. the immunocompromised (humoral or CMI)

Question 10

Neonatal sepsis is usually caused by an infection with ________.
May be acquired by any route but usually by _________. POE to CNS is via a _______. Predisposing factors to getting this are being _____, _______, and having maternal infection 2 weeks before delivery.

Answer 10

ECHOvirus

vertical transmission

viremia

male, premature

Question 11

The incubation period is 3 → 7 days, S/S include:

Answer 11

In children and adults, the abrupt onset of a nonspecific illness:

• fever
• headache
• malaise/fatigue
• vomiting, diarrhea.
• maculopapular rash

Question 12

This febrile, nonspecific disease (described by s/s) sometimes develops into the classic common syndromes:

Answer 12

1. fever + rash (mostly maculopapular, can be petechial, vesicular),
2. Hand Food & Mouth Disease
3. herpangina (often from coxsackie)
4. pleurodynia (pain w/ breathing)
5. pharyngitis
6. conjunctivitis

Question 13

Febrile, nonspecific disease may also sometimes develop into other SEVERE diseases:

Answer 13

Severe diseases:

1. aseptic meningitis
2. neonatal viremia + meningitis or encephalitis
3. encephalitis
4. myocarditis
5. hepatitis

Question 14

Aseptic meningitis is an undifferentiated febrile illness sometimes progresses to acute onset aseptic meningitis in:

Answer 14

1. young child (fever, irritability)
2. older child (fever, headache, nuchal rigidity)
3. adult (fever, nuchal rigidity; and a headache so severe that narcotics are required to manage the pain)

Question 15

Undifferentiated febrile illness sometimes progress to encephalitis, which is generally a ______________

Answer 15

diffuse, but increasing recognition of focal encephalitis due to these agents

Question 16

Encephalitis is much _______ than aseptic meningitis, but with a much higher ________.

Answer 16

less common

mortality rate

Question 17

_________ causes regional & world-wide epidemics of undifferentiated febrile illness that sometimes progress to encephalitis.

Answer 17

Enterovirus 71

Question 18

Enterovirus 71 produces 3 different encephalitis syndromes based on geographic location:

Answer 18

1. a transient or persistent acute flaccid paralysis (AFP) + encephalitis which mimics polio (US, Europe, South America)
2. HFMD cases, leading to meningoencephalitis but few case fatalities (China, Japan).
3. HFMD cases, leading to encephalitis with brain-stem involvement + pulmonary edema, hemorrhage. Deaths due to pulmonary edema and cardiac dysfunction caused by brain-stem infection, NOT heart-lung infection (Taiwan-1998; Malaysia-1999).

Question 19

Neonatal sepsis is a ____, not a _____, which may lead to encephalitis/disseminated disease

Answer 19

viremia

bacteremia

Question 20

Predisposing factors for neonatal sepsis

Answer 20

male, prematurity, maternal infection in 2 weeks before delivery

Question 21

Neonatal sepsis may lead to encephalomyocarditis, which is caused by

Answer 21

group B coxsackieviruses

Question 22

Neonatal sepsis may lead to hemorrhage-hepatitis syndrome, which is caused by

Answer 22

echovirus 11

Question 23

During neonatal sepsis, infection is systemic with corresponding signs and symptoms which occur within the first 2 weeks of life:

Answer 23

1. fever/chills/temp instability
2. rash
3. anorexia/poor feeding
4. jaundice (liver)
5. GIT distress (vomiting)
6. RT distress
7. Cardiac distress (tachycardia)
8. neurologic findings
9. bulging anterior fontanelle (indicates pressure on the brain)

Question 24

Death is due to hepatic failure from ________, myocarditis from __________, or hemorrhagic infarcts of major organs

Answer 24

ECHOvirus

Coxsackie virus

Question 25

With CSF specimen, use PCR for ________, Tissue culture is _________, and make sure ______ predominate early, then a shift to lymphocytosis.

Answer 25

enteroviral agents

gold standard, rarely done

PMNs

Question 26

Treatment is

Answer 26

1. symptomatic, supportive
   OR with
2. Pleconaril (which binds to capsid→blocking viral uncoating) on compassionate use/release basis.